Introduction: Breast reduction is one of the most prevalent plastic surgery procedures in Syria and the world, bottoming out on the other hand is one of the most happened disadvantages after breast reduction with inferior pedicle technique. Different techniques were used to prevent this deformity after inferior pedicle. In this study we tried to prevent bottoming out by using two crossed dermal flaps suspending the inferior pedicle to the periosteum of the 2nd rib. Methods and materials: 32 patients had breast reduction surgery using inferior pedicle technique at Almowassat University Hospital in Damascus. We divide them into 2 groups, 16 patients each. First group we used crossed dermal flaps with the inferior pedicle and the second group was without these flaps, the dermal flaps had a base on the side of the inferior pedicle base, crossed anterior to it in the middle point between the lower edge of the areola and the IMF and then sutured to the periosteum of the 2nd rib on each side. Results: Preoperatively, the average distance between the inframammary fold and areola was 14.5 cm (range, 11 - 18 cm) in the first group without dermal flaps and 14 cm in the second group with dermal flaps. The average amount of breast parenchymal resection was 790 g (range, 140 - 1600 g). The average distance between the inframammary fold and the lower border of the areola was 8.5 cm (range, 7.5 - 9 cm) on the postoperative first-year measurements in the group with flaps and 10.2 cm (8.6 - 11.4 cm) in the other group. Conclusion: Inferior pedicle suspension using crossed dermal flaps has a real role in preventing bottoming out, without using any allogenic or alloplastic materials, making it one of the considered ways in preventing bottoming after breast reduction.
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