Autologous Free Dermal Graft Support in Superior Pedicle Vertical Scar Reduction Mammaplasty

The goal of this observational study is to learn whether using an autologous free dermal graft during breast reduction surgery helps maintain lower breast pole shape over time in women undergoing primary bilateral reduction mammaplasty. The main question it aims to answer is: Does autologous free dermal graft support reduce lower pole lengthening between 1 month and 6 months after surgery? Researchers will compare two groups of participants. One group will undergo superior pedicle vertical scar reduction mammaplasty with autologous free dermal graft support as part of routine surgical care. The other group will undergo the same basic breast reduction technique without autologous free dermal graft support. Participants will: * Have their planned breast reduction surgery as part of routine care * Attend postoperative follow-up visits at 1, 3, and 6 months * Have standard breast measurements and medical photographs taken during follow-up * Complete a breast satisfaction questionnaire at 6 months

Inclusion Criteria: * Female participants aged 18 to 65 years * Planned primary bilateral reduction mammaplasty * Planned use of the superior pedicle vertical scar technique * Willingness to attend at least 6 months of postoperative follow-up * Ability to provide written informed consent * Consent for standardized medical photography and clinical breast measurements Exclusion Criteria: * Previous breast surgery * Oncoplastic breast reduction * Unilateral reduction mammaplasty * Use of a pedicle technique other than the superior pedicle * Use of a scar pattern other than the vertical scar pattern * Presence of a systemic condition expected to significantly impair wound healing * Active smoking within the last 6 weeks before surgery * Incomplete 6-month follow-up data for the primary outcome analysis