the bipedicle (full thickness vertical dermal flap) breast reduction, or mckissock reduction mammaplasty, has long been a standard to which other operative methods of breast reduction have been compared. Paul kendrick mckissock, a california plastic surgeon, published his procedure in the march 1972 issue of plastic and reconstructive surgery. A retrospective review was performed over a 2-y period of bipedicle-conjoined abdominal perforator flaps in 28 patients. For each reconstruction, the pedicle of one flap was anastomosed to the anterograde internal mammary artery vessels and the pedicle of the second flap to a side branch of the primary flap or the retrograde internal mammary vessels. Bipedicle-conjoined abdominal perforator flaps represent a novel technique in select patients seeking breast reconstruction. The added complexity was safe and reliable in this series of patients. The upper half of the bipedicle flap was freed from the pectoral fascia after a central wedge of breast tissue was excised. The lateral and medial breast flaps were thinned and feathered. Evaluation and comparison of aesthetic results and patient satisfaction with bilateral breast reduction using the inferior pedicle and mckissocks vertical bipedicle dermal flap techniques. The refinements and finishing touches for breast reconstruction with expanders and implants may be far different than those for a transverse rectus abdominis myocutaneous (tram) flap for immediate reconstruction or a delayed latissimus flap in an irradiated mastectomy defect. reduction mammaplasty and mastopexy are commonly performed aesthetic procedures. One such procedure, the vertical scar technique, has gained popularity in recent years, and various types of pedicles have been designed and associated with it. The vertical scar with the bipedicle technique is one such combination that ensures nipple safety and minimizes scarring, with a good aesthetic result. 1055b-0040-176817 51 transverse rectus abdominis musculocutaneous flapsglyn e. Jones summary this chapter describes the unipedicle transverse rectus abdominis musculocutaneous flap and its use in breast reconstruction. The indications for and technique of performing the flap are discussed in detail, outlining important technical tips, which may help with overall success. Inferior pedicle technique in breast reduction basic concepts navin k. This means that the blood supply to the muscle doesnt need to be cut. The technique of a pedicled flap was introduced in the early seventies in breast reconstruction surgery. The pedicled tram flap (transverse rectus abdominis muscle) has been used for breast reconstruction since the early 1980s.