Abstract:In spite of more recent techniques for breast reduction, the inferior pedicle technique has proven to be enduring being a still a very popular option in the plastic surgeons armamentarium despite certain shortcomings. This utility is especially so for the treatment of large breasts with a long sternal notch to nipple distance. The modifications we describe in this article, overcome some of the main drawbacks of the standard inferior pedicle technique, and is particularly effective when used with appropriately selected patients. This is achieved principally by the making of a strong, durable and internalized "dermal cage" that remains fixed to the chest wall in the upper part, as well as on both sides, to support the majority of the remaining breast tissue. This serves several purposes, including the narrowing of the breast, thereby giving good projection and reduction of the N-IMF length of the inferior pedicle.Through suspension and fixation of the inferior pedicle to the chest wall, one can obtain mitigation of the effects of gravity on the inferior pedicle. The benefits include reduced tension on the T junction, thereby reducing the incidence of wound dehiscence in the immediate post-operative phase; whilst reduction of tension on the NAC reduces "bottoming" out over the longer-term. This process has been the main short coming of the inferior pedicle technique to date.The technique was used for 26 patients over a 7 year period with a mean long term follow up of 41 months. The results demonstrate the short and long time effectiveness of our own particular combination of modifications to previously described techniques and modifications of the inferior pedicle breast reduction.EBM level: V 2

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