INNOVATIVE TECHNIQUES BREAST Meridian Pedicle-Based Breast Shaping in Reduction Mammaplasty: A Technical Modification Ilker Yazici • Unsal Demir • Sevin Fariz • Altughan Cahit Vural • Esen Ibrahim Karakaya • Tarik Cavusoglu • Ibrahim Vargel Received: 12 September 2012 / Accepted: 20 December 2012 / Published online: 5 February 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013 Abstract Background We present a technical modification of ver- tical reduction mammaplasty which provides a reliable pedicle that can be used in large and highly ptotic breasts with confidence when compared to vertical mammaplasty techniques without sacrificing conical breast shape and projection, in contrast to Wise pattern reduction techniques. Methods Thirty-two patients under general anesthesia were operated on using this modification between 2008 and 2012. The surgical technique is as follows: after general anesthesia induction and local anesthetic infiltration, skin incisions are made according to preoperative drawings. The breast meridian is prepared by superior and inferior plica- tion of the vertical pedicle, including two dermal and one central attachment to the chest wall. Lateral and medial tissue resections are performed, thus preparing medial and lateral pillars after skin undermining. The pillars are sutured to the meridian to reconstruct a projectile conical breast shape. Inverted-T scar (87.5 %, n = 28) and vertical scar (12.5 %, n = 4) were used for closure. Results All patients were satisfied with the outcome regarding breast projection, shape, and size at 12 (n = 30) and 24 months (n = 15) after surgery except for 12 cases that needed reoperations: 2 cases for bottoming out and lower pole deformity, 2 cases needed more reduction by liposuction or re-excision, and 8 scar revisions. Conclusion Early and late results (up to 2 years) regarding breast shape and projection were found to be satisfactory while providing a reliable pedicle with less postoperative drainage. Level of Evidence V 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. Keywords Breast meridian Á Vertical mammaplasty Á Breast reduction Introduction Reduction mammaplasty is a common procedure that addresses both the aesthetic refinements and the postural ‘‘skeletal’’ consequences of macromastia. Many breast reduction techniques have been published to date and can be classified into two major groups: inverted-T techniques and vertical scar techniques. It is widely accepted that vertical scar techniques provide better breast shape quali- ties, including conical breast shape with satisfactory upper, lower medial, and lateral fullness and better projection. The vertical mammaplasty technique was first reported by Dartigues and popularized by Lassus [1]. Revolutionary modifications by LeJour [2] and Hall-Findlay [3] provided some attractive results, thus making the technique more appealing to more plastic surgeons around the world, ‘‘especially in the US where inverted-T techniques were predominant’’ [4]. Among many authors, we also believe that the principal philosophy of vertical scar techniques is I. Yazici Á U. Demir Á S. Fariz Á A. C. Vural Á E. I. Karakaya Á T. Cavusoglu Á I. Vargel Department of Plastic Reconstructive and Aesthetic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey I. Yazici (&) Kırıkkale U ¨ niversitesi Tıp Faku¨ltesi, Plastik Rekonstru¨ktif ve Estetik Cerrahi Anabilim Dalı, 71100 Kirikkale, Turkey e-mail: ilkeryazici@gmail.com 123 Aesth Plast Surg (2013) 37:372–379 DOI 10.1007/s00266-013-0064-x