Breast Reduction, Mastopexy, Augmentation-Mastopexy, and Fat Grafting — Pedicles, Planning, and Complications

This episode reviews the core principles of breast reduction, mastopexy, augmentation-mastopexy, and breast fat grafting, focusing on anatomy, patient selection, operative planning, and complication prevention.Topics include breast blood supply from the internal mammary perforators, nipple sensation through the lateral cutaneous branch of T4, smoking cessation, cotinine testing, breastfeeding counseling, and the functional indications for reduction mammoplasty, including neck pain, shoulder grooving, and intertrigo.Reduction and mastopexy strategies are reviewed through inferior pedicle, superomedial pedicle, vertical reduction, Wise-pattern reduction, free nipple grafting, and Regnault ptosis classification, with emphasis on bottoming out, stargazer deformity, pseudoptosis, and the principle that durable breast shape requires reshaping the parenchyma, not relying on skin alone.Augmentation-mastopexy is discussed as a high-risk operation with competing forces between implant volume and skin tightening. The episode also reviews tailor tacking, staged versus single-stage planning, fat grafting principles, radiology concerns, imbibition, and the “spaghetti, not meatballs” technique for fat survival. Additional complications include T-junction breakdown, nipple sensory changes, symmastia, bottoming out, asymmetry, and patient expectation management.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsbreast reduction, reduction mammoplasty, mastopexy, augmentation mastopexy, breast fat grafting, internal mammary perforators, T4 nipple sensation, inferior pedicle, superomedial pedicle, vertical breast reduction, Wise pattern reduction, free nipple graft, Regnault ptosis classification, pseudoptosis, bottoming out, stargazer deformity, T-junction breakdown, symmastia, tailor tacking, spaghetti not meatballs fat grafting, breast surgery complications