Excessive breast development causes excessive breast size, resulting in breast hypertrophy or gigantomastia, which causes mental and physical pain to women. It also causes neck, shoulder and back pain, and skin diseases such as eczema in the inframammary fold area, causing both physical and psychological burdens to women and affecting their self-confidence. In order to repair the changes in the shape and function of women’s breasts caused by large sagging breasts, plastic surgeons have performed various forms of breast reduction and reconstruction surgery. The basic principle of breast reduction surgery is to reduce the volume of the breast, and after surgery, the breast shape is good, and both sides of the breast are symmetrical, the scar is not obvious and the nipple and areola sensation is normal. There is a significant loss of sensation in some patients. Although the modified Mckissock method reduces some of the postoperative scars, in clinical practice, blister formation in the areola area of the nipple is often encountered to varying degrees, and the breast ducts are often cut, thus affecting lactation function. Although the postoperative scar is small, only the areola ring-shaped scar, but the breast shape is not good, the postoperative breast protrusion is not enough, and is only suitable for mild to moderate breast enlargement, and the most popular procedure in Europe and North America is Lejour’s linear incision mammaplasty. The linear incision mammaplasty, also known as vertical incision mammaplasty, was first used in 1925 by Dartigues for breast suspension and then again by Lassus in 1970, but it was not popularized because the incision extended beyond the inframammary fold to the lower chest wall. In 1990, Lejour, a professor of plastic surgery at the Faculty of Medicine of the University of Brussels, Belgium, modified the method and began to promote it. The design of this method is simple and standardized, with good postoperative breast shape, small scar, and better blood supply to the nipple and areola, in line with the basic principles of breast reduction. This method relies on the upper tip of the breast to nourish the nipple and areola, and achieves breast reshaping by reducing the breast tissue in the lower and central part of the breast, and reduces the incisional scar by extensive skin freeing in the lower part of the breast. Straight-line method mammaplasty is suitable for female patients with moderate to severe breast overgrowth and breast ptosis. Since 1999, we have performed nearly 1,000 cases of mammaplasty using this method with satisfactory results and have accumulated some experience. The results are satisfactory, and we have accumulated some experience. The following is an introduction. Linear mammaplasty is performed by removing the overgrown breast tissue through a linear incision at the lower pole of the breast to correct the sagging breast shape and create a hemispherical breast-like entity. In addition, the nipple and areola are displaced and reshaped upward while removing the hypertrophic, lax breast skin and subcutaneous tissue. Prior to surgery we first design the patient’s breasts according to their condition. A preoperative camera is routinely taken to preserve information for preoperative and postoperative comparisons (Figure 1). The patient is placed in an upright position, and the anterior midline, breast-milk distance, and midclavicular line are marked (Figure 2). The breast is gently pushed inward and extended upward along the midclavicular line of the inframammary fold to mark the lateral line of the proposed skin removal (Figure 3), and the breast is gently pushed outward to mark the medial line of the skin removal (Figure 4). The original inframammary fold is arced 5-10 cm above the midline of both clavicles to extend the new inframammary fold upward 5-10 cm (Figure 5). The position of the new nipple (Figure 6) can be shifted down by 1~2cm according to the height of the normal person, and the distance between the new breast and the breast is usually 18~20cm (Figure 7), so that the distance between the new nipple and the new breast is controlled at 8~12cm by shifting the new nipple down and elevating the new inframammary fold as much as possible, which is conducive to shortening the postoperative vertical scar and obtaining a better breast shape. The circumference of the new areola is designed in an arc 2 cm above the new nipple, with a length of 14-16 cm (Figures 8 and 9). General anesthesia or epidural anesthesia is usually chosen for the surgery. A tourniquet is placed on the base of the breast to facilitate separation and reduce bleeding (Figure 11). The skin is incised according to the design, and the epidermis is removed within the drawn line to preserve the dermis to ensure blood supply to the nipple and areola (Figures 12 and 13). The lower breast is dissected from the breast surface to the inframammary fold (Figure 15), and the new inframammary fold is dissected with as little subcutaneous fat as possible, leaving only the subdermal vascular network intact, so that the new inframammary fold does not appear bloated after surgery (Figure 16). After the separation of the breast surface is completed, the pectoralis major muscle is completely freed from the surface to the base of the breast (Figures 17 and 18). If there is concomitant breast hypertrophy, the lower part of the breast and the basal breast tissue are mainly removed (Figures 19, 20, 21). The excised breast tissue is weighed as a reference for the amount of contralateral excised tissue. Internal breast fixation must be secure, with the breast tissue fixed at the level of the 2nd rib with 7 gauge wire (Figure 22) and the nipple and areola flap displaced upward while narrowing the basal breast diameter (Figure 23). The breast tissue is self-shaping before skin suturing (Figure 24), instead of relying on skin tissue to shape the breast, so that the skin is sutured without tension to minimize postoperative scarring. Negative pressure drains are routinely placed, and the new areolar incision is closed with purse-string sutures to avoid gradual postoperative areolar enlargement (Figure 25). No-sew tape was applied to the incision (Figure 26), and the area was dressed with pressure and the negative pressure drain was removed when the 24-hour drainage was less than 10 ml. An elastic shaping bra was worn for 2 months starting 5-7 days after surgery. In the thousands of cases we have performed, no nipple or areola blood flow disorders were found. In the early postoperative period, the breast shape was slightly irregular and a more obvious incision scar could be seen (Figures 27 and 28). However, the shape of the breast was satisfactory after 3-6 months, and most of the linear incisions and circumareolar scars were not obvious (Figures 29, 30, 31, 32). For the very few patients with a more obvious circumareolar incision scar, better results were achieved within 6 months after surgery either by re-excision of the circumareolar incision scar or by local injection of Coninextrone.