Obtaining projection in the amputation free nipple/areolar graft breast reduction without a vertical scar: using...

Multiple techniques for breast reduction in the giant breast have been used. The amputation technique with the free nipple/areolar graft has been the mainstay for severe macromastia since 1921. Traditional methods for amputation of the inferior pole of the breast have created fairly flat breast mounds. Projection of the mound was enhanced by an inferior pleat with a resulting vertical scar. A new technique employing a superiorly based dermal fat flap folded back behind the residual breast to improve projection and roundness has been developed. It has not only eliminated the vertical scar but improved the shape of the mound. It has also given patients who were not previously good candidates for reduction with other techniques an option for surgery despite the presence of old scars or the need for lumpectomy in the lower third of the breast. A clinical series is presented.