Guidelines for reduction mammaplasty.

Symptoms of breast hypertrophy are discussed. Both physical and psychological indications for corrective procedures are related to patients' expectations. Shape is discussed in terms of the patient's preference, her activities, and her geographic and historic background. Two main techniques are described--the Arié-Pitanguy-Ribeiro technique with a dermis-fat flap, which is recommended for extremely ptotic breasts, and the oblique technique, which is preferred for rounder hypertrophic breasts. In small ptoses the original Arié vertical wedge excision technique is still indicated. All patients are treated by the Schwarzmann maneuver with preservation of the periareolar nerves and vessel network, and areola transposition at the end of the operation. No drains are used.