Purpose: Traditional breast reduction surgery is represented by the inverted “T” shape surgery, which leaves a significant surgical scar after surgery. The vertical incision breast reduction surgery reduces the surgical scar and improves the shape of the breast, but there is a risk of nipple areola necrosis in patients with severe ptosis, so in order to reduce this risk, we improved the nipple areola displacement and adopted the upper wide tip vertical incision breast reduction surgery. METHODS: Using a Lejour vault-top surgical design, the skin and glands below the breast were excised, and the dermal glandular tissue above the nipple areola was lifted broad-tipped to its normal position for breast contouring, leaving only a vertical scar after surgery. Results: There were 46 cases of breast reduction with a vertical wide incision above, 4 of which were unilateral breast reduction with satisfactory surgical results and good breast shape. 14 breast incisions were partially dehiscent, 3 of which were healed by wound debridement and suturing, and the rest of the breasts healed after dressing change, and no nipple areola necrosis occurred. Conclusion: The upper broad-tip vertical incision for breast reduction is effective and reduces the risk of nipple areola necrosis, and is worthy of promotion. With the improvement of living standards, the incidence of obesity is increasing, and the incidence of large breasts is on the rise. Overly large breasts cause a lot of inconvenience in daily life. Traditionally, breast reduction is represented by the inverted “T” surgery, which is not easily accepted by young women because of the obvious surgical scar left after surgery and the protruding deformity of the lower pole of the breast as time goes by. lassuss [1], lejour [2-3] and others used the upper tip The vertical incision breast reduction method has achieved good surgical results, but there is a possibility of necrosis of the nipple areola in the severely sagging giant breast. For this reason, some scholars have explored the safe displacement of the nipple areola while reducing the breast scar by vertical incision, Hammond [4] used the inferior tip, Findley [5] used the medial superior tip, and Lassus [1] used the lateral tip. since March 2006 we have used the vertical incision breast reduction with the superior wide tip to improve the safety of the operation and achieve good results . A literature search has not yet been reported at home or abroad. 1. Surgical design The patient is placed in a standing position, and the midline of the chest, the inframammary fold and the clasping line are marked. The breast is held up with the left hand, and the projection of the inframammary fold on the clavicle line is used as the position of the new nipple. For large breasts with severe ptosis, the position of the new nipple is shifted down by 2 cm, and the new areola incision line is marked with a 14-cm arc, similar to the “dome of the fornix”. Draw a vertical line below the center of the inframammary fold, push the breast inward and mark the extension of the vertical line on the breast; push the breast outward and mark the extension of the agreed vertical line on the breast, connect the two extensions to the two ends of the “dome” opening, and fix a point 2-5 cm above the intersection of the breast lock line and the inframamammary fold, through which A curve is used to connect the two extensions at this point (Figure 1). The more severe the breast enlargement, the greater the distance between this fixed point and the inframammary fold. (1) The patient is placed in a semi-recumbent position, and the incision site is anesthetized by infiltration of lidocaine with a little epinephrine 0.25%. (2) The epidermis is removed from the nipple-areola flap tip area (Figure 2). (3) A portion of the glandular tissue is excised, and the excision of the gland includes the nipple and part of the breast tissue under the areola. A glandular dermal tip is formed, with 1 cm-3 cm thick glandular tissue retained at the tip. (5) The bottom surface of the breast tissue flap is slightly separated and the gland is sutured to reshape the breast gland (Figure 3). (6) The subcutaneous and skin is sutured from the lower end. A negative pressure drainage tube was placed under the gland. Postoperatively, the upper part of the breast showed excessive fullness at that time, and the incision suture was wrinkled and not flat enough, which gradually improved with time and the shape tended to be beautiful. 3, clinical data Using a retrospective case analysis method, 46 patients, aged 14 to 62 years old, average 34 years old, including 17 unmarried and 29 married, were treated with upper wide tipped vertical incision for breast reduction since March 2006. The evaluation of surgical results included improvement of patients’ subjective symptoms, patient satisfaction, morphological evaluation of the operator, comparison of preoperative and postoperative photographs, measurement of relevant data, and occurrence of complications. The patients’ satisfaction was divided into: very satisfied, satisfied, average, and unsatisfied; the morphological evaluation of the operators was divided into: excellent, good, moderate, and poor. Those with symmetrical bilateral breasts, moderate size, no deformity in shape, normal texture, symmetrical inframammary folds, small scar, and normal nipple areola position and sensation were considered excellent. Those with symmetrical breasts and inframammary folds on both sides, with size, scar without obvious hyperplasia, and normal nipple areola position and sensation are considered good. Slightly asymmetric breast and inframammary folds on both sides, no significant difference in size, slightly wide scar without hyperplasia, normal nipple areola position and sensation are considered good and medium. Those with more obvious asymmetry between the two breasts and inframammary folds, wide and hyperplastic scar, nipple areola deviating from normal position and sensory impairment are considered poor.