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Breast Surgery


Authors: Mia Demant, MD, Magnus Balslev Avnstorp, MD, and Mia Steffensen, MD


Breast reduction surgery, or reduction mammaplasty, plays a vital role in alleviating physical discomfort and enhancing the quality of life for patients with overly large breasts. Plastic surgeons have a range of techniques at their disposal to tailor breast reduction procedures to individual patient needs – without compromising blood supply to the skin, nipple, and breast parenchyma.

Each reduction technique has its unique combination of skin incision, pedicle planning, and resection pattern. In Denmark, the most common pedicle used is the superomedial, and the most commonly used techniques are:

The Wise Pattern or inverted T-technique: also called Orlando’s technique (1).

Also known as the anchor technique, this approach uses three incisions: around the areola, vertically down to the inframammary fold, and along the fold itself. The resulting shape resembles an inverted “T” or an anchor. The inverted-T technique is suitable for patients with significant ptosis and excess breast tissue. It offers maximal tissue removal and thorough reshaping capabilities.

Figure 1 | The inverted T scar after an Orlando breast reduction.

The vertical scar technique: also called the “Keyhole”-technique or Hall-Findlay’s technique (2).

The vertical technique involves two incisions: a circular one around the areola and a vertical one extending down to the inframammary fold, creating a lollipop shape. This method minimizes scarring compared to the traditional inverted-T technique while allowing for significant tissue removal and reshaping. The vertical technique is ideal for patients with moderate to severe breast ptosis.

Figure 2 | The vertical scar after a Hall-Findlay breast reduction.

Pedicle Techniques: These techniques involve preserving a pedicle of tissue, usually based on the superior or medial aspect of the breast, to maintain blood supply to the nipple-areolar complex. Pedicle techniques are commonly used to prevent loss of nipple sensation and necrosis in cases of severe reduction.

  • a. Superior Pedicle: The nipple-areolar complex remains attached to the upper breast tissue, allowing for its repositioning while preserving blood supply.
  • b. Medial Pedicle: The nipple-areolar complex is moved medially and upward, based on tissue from the inner breast area.

Liposuction-Assisted Breast Reduction: Liposuction is used to remove excess adipose tissue from the breast, allowing for modest volume reduction and reshaping. This technique is suitable for patients with more fatty tissue and less glandular hypertrophy.


To relieve the patient’s physical and psychological difficulties related to her breast size and weight.

Indications for surgery

In Denmark the indications for being a candidate for breast reduction at a public hospital are as following:

  • Skin irritations, macerations, intertrigo, and fungal infections under the breasts
  • Heavy, pendulous breast (The reduced amount of breast tissue should be at least 400-500 g on each side)
  • Neck- and back pain related to the weight of the breasts
  • Indentations on the shoulders from bra straps
  • Limitations on physical activity due to breast size and weight
  • Abnormal ptosis due to age
  • Psychological affection due to unwanted attention to the large breasts


  • Smoking
  • BMI > 25
  • Age < 18 years (lower age can sometimes be accepted if the patient’s difficulties are of  significant size)

Pre-operative assessment

  • All women ≥ 35 years of age must have normal mammography within the last 6 months
  • Any palpable breast lumps must be examined by mammography and ultrasound before surgery
  • The skin incision pattern and pedicle (most commonly superiomedial pedicle) is chosen pre-operatively

Risks of reduction surgery

  • Necrosis of the NAC
  • The ability to breastfeed may be affected
  • Decreased skin sensitivity of the NAC and breast
  • Hematoma
  • Infection

Choosing the appropriate pedicle

The blood supply relies on the chosen pedicle; a superior, medial, inferior, or lateral pedicle for blood vessels and nerves is chosen. The pedicle is de-epithelialized for the preservation of the subdermal blood supply to improve circulation for the NAC. As mentioned, in Denmark surgeons often rely on the superiormedial pedicle. The benefits and drawbacks of various pedicles are presented in Table 1.

Benefits and drawbacks of different pedicle techniques

Lateral pedicleLarge volume resection possible
Breast feeding ability
Limitation of lateral debulking
Inferior aesthetic outcome
No dual bloodsupply
Inferior pedicleIncreased NAC sensibility
Large volume resection possible
High risk of bottoming out
No dual blood supply
Superior pedicleLeaves upper-pole fullness
Maintains breast projection
Impairment of NAC sensibility
Limited to small resection
No dual blood supply
Medial pedicleIncreased NAC sensibility
Larger volume resection possible
Less risk of bottoming out
No dual blood supply
Superomedial pedicleIncreased NAC sensibility
Large volume resection possible
Less risk of bottoming out (an appearance of the bottom of the breast tissue bulging downward)
No dual blood supply
Central pedicleIncreased NAC sensibility
Large volume resection possible
Breast feeding ability
Less risk of bottoming out
No dual blood supply


Illustrators: Christian Paaskesen, med.stud., Emma Tubæk Nielsen, med.stud.


  1. Brown RH, Siy R, Khan K, Izaddoost S. The Superomedial Pedicle Wise-Pattern Breast Reduction: Reproducible, Reliable, and Resilient. Semin Plast Surg. 2015 May;29(2):94–101.
  2. Hall-Findlay EJ. Pedicles in vertical breast reduction and mastopexy. Clin Plast Surg. 2002 Jul;29(3):379–91.

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