Papers of the Northeastern Society of Plastic Surgeons: PDF OnlyObtaining Projection in the Amputation Free Nipple/Areolar Graft Breast Reduction Without a Vertical Scar: Using Breast Parenchyma to Create a New MoundManstein, Mark Eric MD; Manstein, Carl H. MD; Manstein, George MDAuthor Information From the Albert Einstein Medical Center, Philadelphia, and the Holy Redeemer Hospital and Medical Center, Meadowbrook, PA Annals of Plastic Surgery: April 1997 - Volume 38 - Issue 4 - p 421-425 Buy Abstract Multiple techniques for breast reduction in the giant breast have been used. The amputation technique with the free nipple/areolar graft has been the mainstay for severe macromastia since 1921. Traditional methods for amputation of the inferior pole of the breast have created fairly flat breast mounds. Projection of the mound was enhanced by an inferior pleat with a resulting vertical scar. A new technique employing a superiorly based dermal fat flap folded back behind the residual breast to improve projection and roundness has been developed. It has not only eliminated the vertical scar but improved the shape of the mound. It has also given patients who were not previously good candidates for reduction with other techniques an option for surgery despite the presence of old scars or the need for lumpectomy in the lower third of the breast. A clinical series is presented. © Williams & Wilkins 1997. All Rights Reserved.