Macromastia reduction is where reconstructive principles collide with aesthetic outcomes—and the inverted-T (Wise) pattern stays dominant because it’s predictable. In this episode, we walk through the anatomic “non-negotiables” for NAC perfusion + sensation, then translate that into practical pedicle selection (inferior, superomedial, central mound, and vertical bipedicle) for the real cases: large breasts, ptosis, and gigantomastia.

What you’ll learn:

• Triple-source vascular logic (medial perforators/internal mammary, lateral thoracic, intercostals) and why collateralization matters in big moves. 1

• NAC sensation: protecting the lateral cutaneous branch of the 4th intercostal nerve and how pedicle choice influences risk. 1

• When inverted-T is the safer “teaching pattern” (large volume + skin excess) vs when vertical strategies make sense. 1,2

• Inferior vs superomedial: complication profiles and what changes in large-volume reductions. 3

• Free nipple grafting: true indications, functional tradeoffs, and evolving alternatives (extended/elongated pedicles). 4,5

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #Residency #BreastReduction #ReductionMammaplasty #WisePattern #InvertedT #NippleAreolaComplex #AestheticSurgery

Citations (AMA) — in text shown as #
References (numbered):

1. Study Guide – Breast Reduction: The Inverted-T Technique and Pedicle Variations.

2. Serra MP, et al. Breast reduction with a superomedial pedicle and a vertical scar… PMID: 20179472.

3. Ogunleye AA, et al. Complications After Reduction Mammaplasty… PMID: 28328638.

4. Talwar AA, et al. Outcomes of Extended Pedicle Technique vs Free Nipple Graft… PMID: 36161307.

5. Bonomi F, et al. Is free nipple grafting necessary… PMID: 38183875.