Introduction: Reduction mammoplasty for bilateral asymmetric hypertrophy remains challenging due to variability in tissue distribution and difficulty in achieving predictable symmetry. This study proposes a numerical planning method that simplifies preoperative markings, minimises subjectivity and enhances reproducibility using fixed reference measurements. Methods: Patients with bilateral asymmetric macromastia and varying degrees of ptosis were planned for reduction using a superomedial pedicle–based technique. The upper breast border (UBB) was identified as the key primary landmark, from which the new nipple–areola complex (NAC) medial and lateral pillars were defined numerically at fixed measured points, eliminating the ambiguity during marking and making the process more objective and easily reproducible. Results: The numerical method provided consistent, symmetric and aesthetically balanced reductions. Defining the UBB simplified localisation of the NAC, improved prediction of skin excision patterns and maintained scar centrality. The approach decreased operative subjectivity and enhanced predictability of the final breast contour and upper pole fullness. Symmetry was achieved more reliably across various breast sizes, asymmetric as well as symmetric. Conclusion: Numerical planning in reduction mammoplasty introduces a system that standardises preoperative markings, optimises parenchymal resection and facilitates aesthetically pleasing symmetry in bilateral asymmetric hypertrophy. The use of UBB as a key landmark redefines surgical planning, emphasising preservation of form and predictable volume reduction. Longterm comparative studies are warranted to validate the stability and efficacy of this simplified, measurement-based approach.
Bhadani et al. (2026) studied this question.