Horizontal breast reduction – Technical refinements and patient selection

Introduction: Breast reduction techniques differ according to skin incision and pedicle. Lower pole scarring is reduced through vertical or horizontal scars only. Vertical techniques are popular, but the scar may be less aesthetic and take time to settle, parenchymal excision is limited, and dog-ears may occur. Horizontal techniques were highlighted to the senior author in her Australian fellowship. When presented with a 19 year old with gigantomastia, grade 3 ptosis, Fitzpatrick type 6 skin and sternal notch to nipple distance of 50cm, rather than a Wise pattern with free nipple grafts, horizontal reduction was performed on an inferior pedicle. Following this success, other select patients have benefitted from the technique.