Tripedicle Breast Reduction Technique: Superomedial, Central and Inferior. A Modified McKissock Technique

Aesthetic breast surgery is a frequently performed procedure. Since the 6th century, numerous methods for manipulating breast tissue have been documented. Both arterial supply and breast pedicles are well-studied, with particular emphasis on ensuring adequate blood flow to the nipple-areolar complex (NAC), the primary focus of pedicle irrigation. However, the creation of a dermoglandular pedicle with three distinct sources of blood supply has yet to be described in the literature. We present a breast reduction technique using a triple pedicle approach combined with an inverted T incision, as performed by the authors. This study includes outcomes from 227 consecutive patients treated between 2013 and 2024, with each patient followed for a 12-month period. A total of 227 patients (454 breasts) were included, with a median age of 34 years (range: 25.5-42). Among them, 81.06% (184) were classified as overweight or obese, while 18.94% (43) had a normal weight. The median weight of resected tissue was 648 grams (range: 482-817.5) for the right breast and 640 grams (range: 480-817) for the left. The overall complication rate was 2.64% (12 cases). The most frequent complication was bottoming out, followed by areolar epidermolysis, which occurred in 1.32% (6 cases). Areolar necrosis and hematoma were rare, each observed in only one patient (0.22%). The triple pedicle technique is a safe and effective breast reduction surgery option, especially for patients with large-volume breasts. This approach offers reliable blood supply to the nipple-areolar complex (NAC) and yields aesthetically pleasing results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 ..AQ.