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Breast Reduction Techniques: Pedicles, Incisions and How Much to Remove?

Pedicles?! What in the heck are those?

When it comes to breast reduction surgery, you’ll find some strange terms cropping up that you’ve probably never heard of before. The “pedicle” is one of them. Rather than just nodding and smiling should the strange terms come up either in your online research, or in a chat with a surgeon, you should arm yourself with information!

While it’s true that you should leave your breast reduction technique “to the experts”, how do you know who is an expert and who isn’t? Learning about the current and traditional techniques can help you to understand what will be happening with your body, as well as determine who is an expert – by what techniques they use and what techniques they are familiar with.

Breast reduction surgery has been around since the early 1900s, and the surgical techniques involved have come a long way since then. Would you trust a surgeon from the 1920s with your breasts?! We didn’t think so!

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Understanding your breast reduction procedure in advance can help to set your mind at ease that you will be getting the best possible result from your surgery. Knowing the key facts about pedicles, incision points, and the amount of tissue you want removed will ensure you understand the procedure.

If you know all these facts, you can then chat with your potential surgeon at ease about what is going to happen to your body. Not only that, it can help you weed out any surgeons that aren’t practicing the best techniques available to them!

They say that knowledge is power, so inform yourself about your surgery before you dive in at the deep end. Clear understanding can help to ensure that you have a great result from your surgery, and reduce the risk of needing revision cosmetic surgery breast reduction.

Key terms in this post:

For the ease of understanding, here are a few key terms contained in this article and what they mean.

Areola complex: The nipple and surrounding areola

Breast pedicle: An areola complex cut from the breast but attached by a cord of tissue to a part of the breast

Incision: A surgical cut

Free nipple technique / nipple grafting: An areola complex that is cut completely free from any breast tissues

What is a pedicle?

A pedicle is a part of tissue that is still connected to the blood supply, nerves, and, in the case of breasts, ducts. A breast pedicle is the areola complex (that’s the nipple as well as the surrounding areola) attached to tissues that supply it with blood, nerves, and milk ducts. In an intact breast, blood, nerves, and milk ducts surround the areola complex to supply it with all these.

With a breast reduction, we will usually need to reposition the areola complex, moving it to a more aesthetically pleasing place on the body. So, we will need to cut around the areola complex, perhaps entirely (but perhaps not, too), and reposition it higher up the breast. But we will want to make sure that the nipple still functions like it should, so we leave it connected to other internal tissues in a certain spot, which will provide the areola complex blood supply, nerves, and ducts. This type of surgical technique is also known as flap surgery.

For nipples, a pedicle can be either from above the areola (superior pedicle), to one side of the areola (medial pedicle from close to the centre or lateral pedicle from the outside of the breast), below the areola (inferior pedicle), or directly underneath the areola complex (central pedicle).

The vast majority of breast reduction cosmetic surgery performed today uses the pedicle technique. The alternative is the free nipple technique, or nipple grafting, which removes the nipple completely from the body before reattaching it.

Why don’t we use the free nipple technique?

The free nipple technique is only used in extenuating circumstances for large breast reduction surgery, such as when a pedicle would exceed 40cm, or when more than 1kg of breast tissue needs to be removed from each breast.

The reason that this technique is not often used except in certain cases is because those who undergo breast reduction using nipple grafting will lose sensation in their nipple and will not be able to breast feed afterwards. This is because nerves and milk ducts are severed when the nipple is removed. Women who undergo this particular procedure technique will need to accept these facts before undergoing surgery.

This article from Medscape goes into further depth about the free nipple technique, if you’re interested in reading up.

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How do we know which pedicle to use – how is breast reduction surgery performed?

The inferior pedicle (where the areola complex is still attached to lower tissues)

A technique popular since the mid 1970s, the inferior pedicle technique, it is used by surgeons due to the relative ease of performing the operation, and the reliability of the nipples retaining sensitivity post op. Complications of this technique include the “bottoming out” of the breast following surgery. What is bottoming out?

The superior pedicle (where the areola complex is attached to higher tissues)

Used because it gives upper breast fullness, and good breast projection, the superior pedicle technique has also been around since the 1970s. It is generally used for women who do not have very large breasts (i.e. less than 1kg of tissue to be removed from each breast). This technique has higher rates of sensation loss than the inferior pedicle technique.

The medial pedicle (where the areola complex is still attached to inner breast tissues)

The medial pedicle technique is an alternative technique used in very large breasts that can avoid the use of the free nipple technique. Big busted ladies can retain nipple sensation, etc. when the medial pedicle technique is used.

The lateral pedicle (where the areola complex is still attached to outer tissues)

The lateral pedicle technique is a less common technique which may be used when most of the tissue to be removed lies in the underside and middle of the breast. This kind of pedicle is also used sometimes in a breast lift, as opposed to a breast reduction.

The superomedial/superolateral pedicle technique

A pedicle is made that points either down and outward, or down and inward. This is a slight variation on the superior pedicle technique.

Horizontal bi-pedicle technique (where the areola complex is attached to both the outer and inner tissues)

Used widely in the 1960s, the horizontal bi-pedicle technique is a safe and reliable procedure. The areola complex remains attached to the body from both sides of the breast during the operation. The surgery, however, may result in strange nipple placement, and a loss of sensation in the nipples.

Vertical bi-pedicle technique (where the areola complex is attached to both the outer and inner tissues)

Connected at both the top and bottom of the breast, the vertical bi-pedicle is another reliable technique that produces a good aesthetic outcome. Less commonly used these days, complications of the surgery can result in a “broad” breast if not performed correctly, and a loss of sensation in the nipples.

Central pedicle technique (where the areola complex is attached to the tissue directly underneath it)

The central pedicle technique is not a very common technique that is practiced, however it can have good results. Breast tissue is removed around the central breast mound while shaping the breast. Usually sensation remains and the technique for surgery for breast reduction can be used both for smaller or larger breast reductions.

Pedicle techniques, if performed correctly, should allow you to breastfeed following your surgery. When thinking about which technique is best for you, you surgeon will look at what’s most important for you – whether it’s fullness up top, removing bulk, or which size you’re ultimately aiming for.

How do we know which incisions to make – which is the best breast reduction surgery procedure?

Inverted T (Wise) inferior pedicle

A keyhole shape is cut above the areola complex, with the bottom of the areola complex lining up with bottom of the keyhole. Incisions then extend left and right horizontally along the centre of the breast, and curve around the base of the breast, excising everything in between –  looking like a T shape. This is only available with the inferior pedicle and is quite aggressive, but will only leave a scar around the areola (hidden when healed), vertically down the centre of the breast to the base, and along the curvature of the base (hidden when healed).

Circumvertical inferior pedicle aka the short scar periareolar inferior pedicle reduction (SPAIR)

An incision is made similar to a stretched circle, which surrounds the areola complex and goes down to the bottom of the breast. The top of the stretched circle is cut outside of the areola complex, which is then moved further up the breast. This technique is practiced with the inferior pedicle technique and results in – you guessed it – a shorter scar than traditional inferior pedicle incision techniques. There will be a hidden scar around the areola, and a vertical scar line extending down the breast.

This same cut can also be applied with the superior pedicle technique.


A cut is simply made larger than the outline of the areola and that is all. The scar lines will be hidden at the outline of the areola. This is only a technique used in minimal breast reductions usually.

L shaped

The L-shaped incision is very similar to the inverted T incision, except the cut only extends towards your side at the base of the breast, and not towards the centre of the body.

J shaped aka peri-areolar inferior pedicle reduction

Similar to the circumvertical inferior pedicle incision, the J shaped incision is a short scar technique that circles outside of the areola, but then has an inverted triangular end extending down and towards the side, towards the bottom of the breast. The incision results in a J-shaped scar.

Chiari, Regnault, and more…

There are many other incisions that have been followed over the years by different segments of the plastic surgery community. If you have a technique not mentioned (such as the Chiari, Regnault, or something else) then feel free to bring it up to discuss with your surgeon.

Most incisions for breast reduction surgery will result in a scar around the areola and a vertical line extending down to the bottom of the breast. This may or may not be accompanied by a scar along the bottom of the breast line. Techniques that do not involve the vertical scar (which many women worry about) will generally not bring the best result, especially for those with quite large breasts.

When researching your breast reduction surgery, you want to obtain the best results. And what’s more important? A great shaped breast? Or a scar that will fade? Surgeons will generally recommend a vertical scar technique as it will bring about the best outcomes.

So what’s best for me?

Hopefully you’ve got some ideas from this article about what might be best for you. Now that you’ve got a fair idea of what’s involved in the different breast reduction techniques, it’s time to make an appointment with a cosmetic surgery NSW.

Each woman is different, so each woman’s breasts require a slightly different approach. Dr. Beldholm employs a number of different techniques for his breast reduction clients that may or may not require liposuction alongside the breast tissue removal.

In your initial appointment in our cosmetic surgery Newcastle, he can assess your current breast size and your desired result to determine which techniques he thinks would be best for your body, or whether a breast reduction and lift is recommended. Keep in mind the knowledge that you learned here and you’ll be able to ask the curly questions with ease! We also provide 3D imaging which can show you how your breasts will look following your breast reduction surgery.

If you’re ready to book in for your first appointment on the road to less annoying breasts, then call us on (02) 4934 5700 to arrange a time to see Dr. Beldholm – cosmetic surgeon Newcastle –  for your breast reduction surgery options. His professional manner and expertise in breast reductions and techniques is sure to have you feeling happy about your decision.



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