No-Vertical-Scar Reduction Mammaplasty in Asian Patients: A Comparison of Superior Versus Inferior Pedicle Techniques

Currently popular reduction mammaplasty techniques, namely the inverted-T and vertical scar patterns, frequently lead to conspicuous scarring in Asian patients, given their racial predisposition toward hypertrophic scars and hyperpigmentation. The no-vertical-scar approach thus offers a compelling alternative. By preserving the skin bridge between the areola and the inframammary fold, this procedure can significantly improve the aesthetic contour of the lower breast pole. However, guidance on optimal pedicle selection for this specific technique remains scarce in the literature. This study introduces the surgical details of a superior pedicle no-vertical-scar breast reduction for the first time. Moreover, we compared the practical outcomes of superior and inferior pedicle designs, intending to help facilitate its broader clinical application.

A retrospective cohort study was conducted on 76 Asian women undergoing bilateral no-vertical-scar reduction mammaplasty between January 2017 and December 2022. Patients were stratified into two cohorts: superior pedicle (n = 29) and inferior pedicle (n = 47). The procedure involved glandular resection and reshaping without a vertical skin incision. Outcomes were evaluated based on advantages, disadvantages, complications, and patient satisfaction of the two surgical approaches using the BREAST-Q Reduction/Mastopexy module over a mean follow-up of 14.5 months.

Both cohorts demonstrated statistically significant postoperative improvements in all BREAST-Q domains, including satisfaction with breasts and psychosocial well-being, compared to preoperative baselines (P < 0.0001). Complications were minor and infrequent, with no significant difference between groups (p > 0.05). The superior pedicle technique facilitated effective remodeling of the inframammary fold (IMF) in ptotic breasts. Conversely, the inferior pedicle technique, supported by a dual blood supply (deep and subdermal), allowed for larger volume resections suitable for severe hypertrophy with a reliable safety profile.

No-vertical-scar breast reduction is especially suitable for Asian patients with moderate to severe breast hypertrophy and severe loose breasts. The superior pedicle method can remodel the inframammary fold, and the inferior pedicle method is more suitable for hypertrophic breasts.

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