Vertical Breast Reduction with Limited Horizontal Scar: A Broad-Based Superior Areolar Pedicle Approach Ensuring Neurovascular Safety and Emphasizing Shape Stability.

INTRODUCTION: Breast reduction surgery aims to alleviate physical symptoms and improve breast esthetics. Vertical techniques have evolved to reduce scarring and complications. This study describes a modified vertical breast reduction technique utilizing a broad-based superior areolar pedicle to enhance neurovascular safety and long-term contour. METHODOLOGY: A multicenter retrospective review included 194 patients who underwent implant-free vertical breast reduction between 2020 and 2024. Exclusion criteria were prior implant surgery or <6 months of follow-up. Demographics, resected tissue volume, surgical time, nipple-areola complex (NAC) elevation, and complications were analyzed. Patients were stratified by risk factors including BMI >30 kg/m2, resection >1000 g, smoking, diabetes, and prior irradiation. Statistical significance was set at p<0.05. RESULTS: The mean patient age was 42.2 years, and BMI was 25.4 kg/m2. The average total breast tissue resected was 570.7 g. Combined procedures were performed in 27.8% of cases. Complications occurred in 4.1% of patients, primarily minor issues such as unesthetic scars and wound dehiscence. No cases of areolar necrosis or infection were observed. Risk factor stratification and NAC elevation >8 cm did not significantly impact complication rates. CONCLUSION: The proposed technique is safe, effective, and versatile for both moderate and large-volume reductions. It offers a low complication rate, preserves NAC vascularity and sensation, and enables intraoperative customization. This approach is a reliable alternative to traditional patterns, providing shorter scars and stable, long-term esthetic outcomes. 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 .