Vertical scar reduction mammoplasty in massive macromastia: A prospective case series

Background: Vertical scar superomedial pedicle breast reduction offers a shorter scar and improved breast projection, yet its safety and outcomes in cases of severe macromastia remain under discussion. Methods: A prospective case series was conducted from October 2022 to January 2025, including fifteen female patients (30 breasts) with suprasternal notch-to-nipple distance ≥30 cm or resection weight ≥750 g per breast. All underwent vertical scar reduction mammaplasty using a superomedial pedicle technique and were followed for 12 months. Results: The mean patient age was 33.7 ± 8 years, and the mean BMI was 28.3 ± 3.9 kg/m². Average resected tissue was 812.4 g (right) and 794.5 g (left). Common presenting symptoms were neck/back/shoulder pain (100%), shoulder grooving (93.3%), and social embarrassment (93.3%). Early complications were minimal, including wound dehiscence in two cases (13.3%), partial nipple-areolar necrosis in two cases (13.3%), and infection in one case (6.7%). No hematomas or seromas were observed. Late outcomes showed favorable results in breast shape (93.3%), volume (80%), scars (80%), and areola appearance (86.7%), with fair symmetry in 53.3% of cases. Patient satisfaction was high, with 80% rating the results as "very good" or "excellent." Only 20% of patients required secondary revision. No statistically significant association was found between complications and smoking, obesity, or resection weight. Conclusion: Vertical scar superomedial pedicle breast reduction is a safe and effective technique for patients with severe macromastia. It provides excellent aesthetic outcomes, minimal complications, and high patient satisfaction, even in high-BMI populations. These findings support its role as a reliable first-line surgical option in the management of extensive breast hypertrophy.