Although multiple pedicle and skin excision techniques exist for gigantomastic breast reduction, no consensus exists as to which method is most effective in providing an aesthetically pleasing breast, especially in the long-term period. This study aimed to compare the aesthetic and surgical outcomes between inferior pedicle and superomedial pedicle reductions, which both use Wise pattern skin excision in gigantomastic patients.A prospective study was planned, and the number of patients was determined before the beginning of the study. Fifty inferior pedicle breast reductions (25 patients) were matched to 50 superomedial pedicle breast reductions (25 patients) after a 1-year postoperative period. Matching was done based on age, body mass index, size of reduction, minor and major postoperative complications, symptomatic relief, long-term measurements of the nipple-areola complex position, and inferior pole length elongation at 1 year postoperatively.There was no significant difference in complications between the inferior and superomedial pedicle groups. The mean resection weight was 1320 (right) and 1355 g (left) in the inferior pedicle group and 1380 (right) and 1310 g (left) in the superomedial pedicle group (P < 0.05). The mean elongation of the nipple-areola complex to inframamarian fold distance was 1.97 (right) and 2.19 cm (left) in the inferior pedicle group and 2.15 (right) and 2.26 cm (left) in the superomedial pedicle group (P < 0.05). At 1 year postoperatively, the mean suprasternal notch to nipple distance was 22.10 (right) and 22.33 cm (left) in the inferior pedicle group and 22.90 (right) and 22.14 cm (left) in the superomedial pedicle group (P < 0.05). All patients achieved symptomatic relief.This study shows that the inferior pedicle is not superior to the superomedial pedicle technique with Wise patern skin excision in gigantomastic patients. Although both pedicle techniques generate acceptable aesthetic outcomes, bottoming-out has occurred in each of the groups with time. To prevent this deformity, some pedicle modifications may be required.