Alan Matarasso, MD Foad Nahai, MD Stanley A. Klatsky, MD G. Patrick Maxwell, MD Dr. Matarasso: The need for secondary breast reduction is an uncommon but vexing problem. Indications for secondary breast reduction may include poor shape from previous surgery, unsightly scars, breast asymmetry, increase in breast volume, need for mastopexy, need to increase breast volume and, occasionally, need for reduction of one breast after having cancer in the opposite side. Our first patient is a 63-year-old woman who had a reduction mammaplasty 12 years ago with an inferior pedicle technique (Figure 1). She gained considerable weight over 10 years and complains that her breasts have become larger. Dr. Klatsky, what would be your treatment approach? Figure 1 This 63-year-old woman had an inferior pedicle reduction mammaplasty 12 years ago. She has gained considerable weight over the past 10 years and complains that her breasts have become larger. Dr. Klatsky: Her nipples seem symmetrical and in good position. At the same time, on the lateral view, it looks as though she may have some pseudoptosis. You indicate she has had an overall weight gain, and she does show lateral fullness of the breasts. Since the nipple-areola position is good, I would consider treating her with lipoplasty to reduce volume, accompanied by a mastopexy to provide better shape. In terms of repeating an inferior pedicle technique, since we know that is what she had, I can feel fairly secure about the perfusion. To determine the operative course, I would first perform the lipoplasty and then intraoperatively perform a “tailor-tack” mastopexy, rather than committing to a pattern for the skin resection. I would like to keep the infraareolar to inframammary distance no greater than 7 cm and, ideally, with her volume, 4.5 to 6 cm from the infraareolar margin. Dr. Matarasso: Dr. Maxwell, would …