Egypt, J. Plast. Reconstr. Surg., Vol. 33, No. 2, July: 167-171, 2009 The Quadruple Pedicled Reduction Mammoplasty AMGAD A. HENDY, M.D.; AHMED M. HEGAZY, M.D.; WALID A. MOSTAFA, M.D.; ATEF A. ALLAM, M.D. and EHAB F. ZAYED, M.D. The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Tanta University. ABSTRACT Nipple-areola complex (NAC) safety, scar reduction and long term aesthetically pleasing results are the components of ideal reduction mammoplasty surgery. We present a technique which maximize nerve and blood supply to nipple-areola complex, besides being versatile, easy, rapid and with pleasing cosmetic outcome. The technique ensures blood supply from superiomedial, superiolateral, superior and posterior regions to nipple (quadruple blood supply). INTRODUCTION Through years reduction mammoplasty become a topic for heated debate due to different parameters involved in the procedure. The debate involves the survival of the nipple-areola complex, the scar length, scar quality, breast projection and long term preservation of the results especially avoiding pseudoptosis (bottoming) [1,2]. Mc Cully and Hudson [3] stated that superior pedicled R.M have lower incidence of bottoming and increases upper pole projection and allows reduction where it is most demanded i.e., the lower quadrant of the breast. Bottoming is the vertical sagging of parenchy- ma of the breast leading to increased nipple- inframammary fold distance and leaving (NAC) at a higher position. This accumulation of breast parenchyma leads to empty upper pole of the breast where aesthetically fullness should be. However, the superior pedicle techniques are accused of being less safe for (NAC) survival especially with large reductions (supra sternal notch- NAC distance more than 42cm) due to kinking of the blood supply. 167 Scars are the final challenge in reduction mam- moplasty [4] . It is the most common cause for litigation in R.M surgery [5]. We adopted a technique which besides its sim- plicity and rapidity it is safe for NAC sensation and blood supply as well as future lactation even with large reduction. It is versatile and can be used in both inverted T pattern and vertical skin closures. PATIENTS AND METHODS During a period of one year and three monthes, 30 patients with mild to severe degree of macro- mastia were operated upon using the quadruple pedicled reduction mammoplasty technique. They were followed up for a period ranged from 3 to 6 months. Their ages ranged from 18-55 years. All of them were surgically fit, lactation free for at least one year before operation. Four patients were smokers and preoperative mammography was done to all patients above 35 years. Surgical technique: (Plates 1&2) Skin incisions were designed in the classic Wise pattern technique in 20 patients while in 10 patients they were done in the same way as Hall-Findlay technique. The areola was designed to have a diameter of 5-6cm [6]. The following was done in cases of inverted T pattern reductions: • De epithelization was done from within the mark- ings of the new NAC site till reaching a horizontal line extending from 3 & 9 o'clock position to the lateral lines of skin incisions. Also, a circle of areolar skin was de epithelized leaving a ring of