Narrow inferior-central septum–based pedicle: A safe technique to improve aesthetic outcomes in breast reduction

background: Inferior-central pedicle has some aesthetic drawbacks, including hypertrophic scar along the inframammary fold (IMF), squaring of the breast contours, and propensity to develop long-term ‘bottoming-out.’ this study aimed to verify if the narrow inferior-central (NIC) septum–based pedicle can allow the surgeon to improve aesthetic outcomes compared with the traditional inferior-central pedicle approach. methods: forty breasts underwent NIC-based breast reduction (group A), and 37 underwent traditional inferior-central pedicles (group B). the NIC pedicle was drawn with a width of 3.5–4.5 cm. the recorded measurements were sternal notch to nipple distance (S-N) and nipple to IMF distance (N-IMF) at the time of preoperative markings and follow-up 1, 6, and 18 months after the procedure. results: the two groups were homogeneous regarding demographics, operative data, and preoperative S-N and N-IMF distances. both groups showed no total or partial nipple-areola necrosis. at the 18-month follow-up, S-N (p < 0.00001) and N-IMF (p = 0.00039) distances were statistically different between the two groups, in favour of NIC group a. changes in N-IMF distances between the 1- and 18-month visits were statistically different among groups (p < 0.0001), with a length variation of + 17.51% and + 28.46%, respectively. patient satisfaction rate regarding “breast shape” (p = 0.021), “lower pole appearance” (p = 0.00017), and “scar” (p = 0.047) were higher in group a. conclusion: NIC-based pedicle proved to be a safe procedure and allowed us to overcome limitations that typically characterise the inferior pedicle, i.e., ‘bottoming-out’ deformity, hypertrophic scar of the lower pole, and squaring of the breast contours. level of evidence: II.