Central glandular reduction mammaplasty Full and rounded breasts are an important symbol of female beauty and a symbol of femininity. The standard of beauty for oriental women is a hemispherical breast with a volume of 250-300ml, beyond this range is breast enlargement, and enlarged breasts are accompanied by breast sagging. Breast sagging is a common breast deformity among women, especially in women after childbirth and breastfeeding. The overall sagging of the breast caused by the relaxation of the breast support tissues not only affects the beauty of the curves of the body, but also makes the lower crease of the breast prone to eczema, erosion and other skin diseases, causing physiological and psychological pain to the patient, so surgery is often required. There are many types of reduction mammaplasty, whether it is the horizontal double-tip method, Mckissock’s vertical double-tip method, Robbins’ modified single-tip method, or Lejour’s L-shaped reduction mammaplasty, all of which have more severe scarring and are particularly unsuitable for Oriental women. Therefore, over the years, there has been a continuous search for a gelatinous technique that can minimize postoperative scarring, preserve the sensory function of the nipple and areola, and create a beautiful hemispherical breast shape. Since the adoption of the double-ring breast suspension by Himderer, after continuous improvement, the double-ring breast reduction provides a new concept and a new method for breast reduction, and is currently the more perfect procedure. From the point of view of nipple areola blood supply, the double ring method is based on the central glandular tip to ensure the blood supply to the nipple areola. We used the central glandular tip method to perform mammaplasty and achieved satisfactory results. 1.Surgical method 1.1 Pre-operative design The patient is placed in a standing position, and the anterior midline, midclavicular line, anterior axillary line, the level of the second rib plane, and the inframammary fold are marked. The location of the new nipple areola after breast reduction surgery can be determined according to the following methods: ① 1 cm outside the midclavicular line and the junction of the fourth intercostal space; ② the line between the two nipples, the nipple and the sternocervical vein tangent line in an equilateral triangle, and the distance between the two nipples is 18-22 cm; ③ the junction between the horizontal line of the midpoint of the upper arm and 1 cm outside the midclavicular line. The incision line is then designed: Inner ring incision line: In the natural state of the nipple areola, a circle is drawn with the nipple as the center and a radius of 2 cm, which is the size of the new areola; Outer ring incision line: The position, shape and size of the outer ring are determined according to the following four points. Upper point (A): 2cm above the newly determined nipple position; medial point (B): (newly determined distance between the two nipples/2)-2cm; lower point (C): 5-7cm from the inframammary fold; lateral point (D): in the anterior axillary line (Figure 1). According to these four points, a circle is drawn around the nipple areola, which can be reduced inward by 1 to 3 cm depending on the height of the breast. the outer ring does not have to be round or centered on the nipple, but can be oval or irregular in shape to ensure equal tension around the outer ring. 1.2 Surgical operation ① Formation of the dermal cap The epidermal layer is incised along the incision line of the inner ring and the incision line of the outer ring, and the epidermis between the two rings is cut away to form a dermal cap around the nipple areola; the diameter of the dermal cap should not be too small, preferably above 10 cm, so that it can better wrap the gland and facilitate breast shaping. The flap should be separated along the surface of the breast toward the base of the breast, paying attention to maintaining the thickness and flatness of the flap, which should not be too thick near the outer ring and should remove excess fat so that the areola edge is flat after suturing. When separating the flap, it must reach the base, medially to the edge of the sternum, up to the second rib or intercostal space, laterally to the lateral chest wall, and inferiorly to the inframammary fold, and pay attention to ligating the mammary branch of the thoracic acromion artery near the base, and try to avoid damaging the penetrating branch of the internal thoracic artery and the mammary branch of the lateral thoracic artery. Depending on the amount of the breast to be removed, the upper and lower poles of the breast are wedge-shaped or the peripheral breast is removed, while the breast tissue at the base of the nipple areola is preserved and the upper and lower pole incisions are not penetrated. When removing the breast tissue, pay attention to the blood flow of the nipple areola. ④Breast contouring The upper pole edge is sutured and fixed to the second rib, with one stitch above its inner and one stitch above its outer edge, and the lower pole breast edge is intermittently sutured. The edges of the dermal cap are slightly separated and then sutured and fixed to the chest wall, with care taken to adjust the position and orientation of the nipple when suturing so that the nipple is in a normal position and facing slightly outward and downward, and to compare both sides for symmetry. ⑤ Suturing The intra-dermal purse-string suture is made with a straight needle through nylon thread and gradually and evenly tightened towards the areola, approximately 4 cm in diameter. the areola edge is slightly separated subcutaneously and the skin is intermittently sutured with 5-0 Proline. A negative pressure drainage tube was placed subcutaneously and drained from the axilla. A tape is fixed and shaped (Figure 2-5). The anatomical basis of the central glandular tip method The in-depth study of breast anatomy and the proposed deep nipple-areolar artery are the basis for this procedure. The deep nipple areola artery is located in the center of the breast and is an important source of deep blood supply to the nipple areola, and its origin, course and distribution are relatively constant. In addition, as the volume of the breast increases, the diameter of the deep breast artery increases accordingly, and the survival of the nipple areola can be ensured by the deep breast blood supply alone. In this procedure, the deep nipple areola artery is used as the feeding vessel for the nipple areola, and the medial, lateral, and basal parts of the breast are used as the tissue tips, and the nipple areola is part of this tissue flap, which are the two conditions that ensure no nipple areola necrosis in this procedure [12-16]. 3, Indications This procedure can be used for mild, moderate and severe breast enlargement. In mild cases, the outer ring is small, the folds are not obvious after suturing, and the areola margins are well shaped, but the caps are also small, so the caps cannot be used for shaping; in moderate cases, the caps are large enough for good shaping, the outer ring is moderate in size, the sutures are flat, and the results are ideal; in severe cases, as long as the blood supply to the nipple areola is ensured during excision of the gland, the gland is fixed with good shaping of the caps, and good purse-string suturing, the results can also be achieved. The same ideal results can be achieved. The central glandular tip method of breast reduction can ensure the blood supply to the nipple areola, and the double ring incision around the areola can avoid obvious scarring on the surface of the breast skin, so that the incision scar of breast reduction can be reduced to a minimum, and at the same time there is a reliable suspension and shaping effect, which can achieve good results for mild, medium and severe breast enlargement, and is the ideal procedure for patients with sagging breasts and breast enlargement.