There are more than ten types of breast reduction surgery so far, but all of them have more or less different defects. The vertical double-tip method has been used in our department for large breast size, which leaves an obvious inverted “T” scar in the lower part of the breast, which is unacceptable to many patients. Since October 2005, our department has adopted a modified upper-tip breast reduction procedure and treated more than 40 patients, which is easy to use and leaves only vertical scars on the lower part of the breast. The position of the nipple is marked on the axis from the midclavicular point to the nipple, and the new nipple is located on this axis at a distance of 19-22 cm from the midclavicular point, which is usually the point of projection of the breast surface at the intersection of the mid-breast axis and the inframammary crease line. The point of intersection between the upper end and the axis from the midclavicular point to the nipple is point “A”, and the lower “4” and “8” points of the areola are points “B” and “C”. Point “C”. The diameter of the new areola is 5 cm, the original nipple is the center, and the diameter of the preserved areola is about 3-4 cm. 2. Make a flap from points B and C to the underside of the areola, with the lower edge of the flap around the original preserved areola, which is the extent of the skin removal. 3. Mark the original inframammary fold line, the intersection of which with the axis from the midclavicular point to the nipple is point G. Mark point F 2-3 cm upward, which will be the midpoint of the new inframammary fold line. 4. Make an arc line B-F and C-F, and design the size of the arc according to the amount of tissue removed; medial line B-F, mark point E 9cm from point B; lateral line C-F, mark point D 7cm from point C. 5, from point D oblique downward drawing H-D line, point H is the line and the original breast fold line intersection. h-D line will be the new breast fold line. Surgical operation: 1. The patient is placed in a semi-recumbent position, and the hands are inserted diagonally behind the back. 2.The nipple areola flap tip is de-epithelialized. 3, Excision of the tissue in the area between C-B-F, including fat and glandular tissue, up to the surface of the pectoralis fascia. The glandular tissue is preserved under the tip of the de-epithelialized nipple-areola flap. 4. Separate the bottom surface of the breast tissue flap toward the clavicle to form a tunnel of about 4 cm, and then fix the glandular tissue under the tip of the flap with sutures to the pectoralis major fascia, at a position about the second rib; if the upper part of the breast is desired to be full after surgery, the suspended tissue will be higher and more. 5. The nipple areola flap is folded and the areola is sutured to the new areola position; then the glandular tissue under the incision is sutured; 6. At this point in the surgery, if the BF and CF are sutured directly, it is the Lejour method of vertical scarring; the change in this method is to suture the two points of D-E. After the D-E suture, it will produce excess tissue in the lower outer part of the breast, cut the skin along the D-H line, trim away the excess The D-H line becomes the horizontal branch of the “L” shaped scar by cutting the skin along the D-H line, trimming away the excess skin and subcutaneous tissue, and suturing the skin in layers. (See Figure 3-6.) 7. In addition to subcutaneous sutures, absorbable sutures were used for intradermal sutures, and extracutaneous sutures were added in case of poor skin alignment. Surgical results 1. All patients were satisfied with the surgical results, which solved the burden that had been bothering them for many years; they were also satisfied with the smaller and more concealed scars; 2. The surgical method is simple and easy to master, and the operation is more flexible, with a wide range of indications; 3. Only one case had delayed healing of the incision at the corner of the “L”-shaped scar due to greater skin tension; 5. One patient had mild bilateral breast asymmetry. Discussion In 1924 Dartigues [1] introduced vertical incision atrial suspension surgery, after which the method has not received much attention. Modern vertical-incision breast reduction was first applied by Lassuss [2][3] in 1964 and was improved and extended by Lejour [4][5] in 1990, using the famous mosquito-dome design with intraoperative fat aspiration. Lejour, however, had some limitations with the vertical incisional mastopexy: it was not suitable for cases with oversized breasts, the amount of tissue removed was limited, and the breast was then positioned high after surgery, with excessive fullness in the upper part of the breast and significant skin folds in the lower part of the breast. The classical breast reduction represented by the inverted “T” surgery can effectively remove the huge breast tissue, improve the breast shape, and relieve the patient’s symptoms and discomfort, but leave obvious surgical scars, and over time, the lower pole of the breast gradually expands and forms a prominent deformity of the lower part of the breast (buttom-out). From the late 1990s, German plastic surgeon Norbert Pallua [6] improved Lejour’s vertical incision for breast reduction by basing his procedure on the upper tip, where the breast tissue below the tip can be removed and readily adjusted according to breast enlargement. He transferred the skin folds of the lower part of the breast from the Lejour method to the lateral side by rotation, creating an “L” shaped scar. He designed this procedure to avoid the exposure of the medial breast scar when Western women wear bikinis. His approach incorporates the advantages of the Lejour method and overcomes the disadvantages of his approach and the inverted “T” scar of the conventional approach. complications also occurred early in the use of the method. Ninety-one percent of their patients were very satisfied with the procedure, and only some of the giant breasts with too much tissue removed (>800g) showed decreased or even loss of nipple sensation. Our department has been using the Pallua procedure since October 2005 and the number of our cases is gradually increasing and the surgical operation is in the process of maturing. Since Chinese women have smaller breasts than Western women, the amount of breast tissue removed is relatively small, so the loss of nipple sensation is not obvious in our cases, and there is no skin necrosis or poor healing of the nipple areola. Since the lower medial edge of the incision (B-E) is longer than the upper medial edge (C-D), the sutures create a crease in the B-F line. Our experience is to use a 4-0 microchopper suture for continuous intradermal sutures, evenly spreading the excess skin in the B-E line and adding extra-dermal sutures at the corners of the “L” shaped scar. In some cases, slight folds in the incision skin are visible for a short period of time after surgery, but with prolonged consultation, these folds disappear and the breast shape becomes more rounded. In one of our cases, there was a mild bilateral breast asymmetry because the patient was not in the semi-recumbent position and there was no intraoperative observation of the breast morphology; the breast morphology varied greatly in the recumbent and standing positions, and our experience was that the patient was operated in the semi-recumbent position as close to the sitting position as possible so that there would be no deviation in the breast morphology. Case 1 (one week after surgery): Case 2, female 23 years old.