Vertical reduction mammaplasty represents a fundamental shift in breast reduction philosophy. Instead of relying on skin tension to maintain shape, the vertical approach prioritizes internal parenchymal architecture to create durable projection, narrower bases, and reduced scarring.

In this episode of Plastics in Practice, we break down the core principles of Hall-Findlay’s vertical reduction mammaplasty, focusing on how breast shape is determined by tension-free pillar closure—not a “skin brassiere.” We review anatomical foundations, marking strategies, pedicle selection, and operative techniques that consistently produce superior aesthetic outcomes.

Key topics include:

• Why nipple position should be based on the upper breast border, not the suprasternal notch

• The rationale behind the “snowman” skin resection

• Medial vs superomedial pedicles and their impact on vascular reliability and sensation

• Management of postoperative puckering and expectations for skin adaptation

• Common pitfalls, including under-resection and premature revision

This episode is designed for plastic surgery residents and early attendings looking to understand why the vertical technique works—not just how to perform it.

• Final breast shape comes from parenchymal pillars, not skin tension

• Vertical techniques improve projection and base width compared to inverted-T

• Medial pedicles demonstrate the highest sensation recovery (~85%)

• Inferior puckering is expected and usually resolves without intervention

• Predetermined resection weights help avoid under-reduction

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

#PlasticSurgery #BreastReduction #VerticalMammaplasty #PRS #Residency #HallFindlay #SurgicalEducation

1. Hall-Findlay EJ. Vertical breast reduction. Plast Reconstr Surg. PMID: 12711950.

2. Hall-Findlay EJ. Pedicles in vertical breast reduction. Clin Plast Surg. PMID: 15576215.