Central breast pedicle and "free-hand" technique for alteration of volume and skin envelope of the breast.

We have found the central pedicle, free-hand technique applicable across the spectrum of surgical endeavors that seek to alter breast volume and revise the skin envelope for aesthetic and functional improvement. The rate of occurrence of significant complications has been low. The primary advantages of this approach are that (1) excellent pedicle vascularity has virtually eliminated the need for free nipple-areolar grafting in major reductions and correction of severe ptosis, and (2) in addition to its application in a wide variety of standard breast pathology, the technique allows individualization of volume change and skin brassiere alteration, which has significantly improved aesthetic results in more difficult cases such as the severe asymmetries presented.