Background
Gigantomastia is a debilitating condition that has been shown to affect quality of life for patients. Management of this condition has predominantly been through reduction mammoplasty followed by free nipple graft. This study shares our experience with the use of a superior medial pedicle for massive gigantomastia without the use of a free nipple graft.

Objective
To determine the outcomes of patients with massive gigantomastia managed using a superior medial pedicle technique.

Design
This was a prospective longitudinal study.

Setting
Kenyatta National Hospital and other selected hospitals in Nairobi, Kenya.

Subjects / Participants
Patients who underwent reduction mammoplasty between January 2015 and December 2025 using the superior medial pedicle technique. Gigantomastia was defined as resection weights of more than 1500 grams per breast. Outcomes measured included sternal nipple distance, resected weights, viability of the nipples, and post operative complications.

Results
A total of 68 patients (131 reduction surgeries) were followed during the study. The mean age of the patients was 37.5 years, with a range from 14 to 54 years.

The mean sternal nipple distance was 36.5 cm with a range from 34 to 56 cm. This was reduced to a mean of 24.5 cm with a range from 21 to 27 cm after surgery.

The average weight excised per breast was 1990 g on the right and 1970 g on the left, with a range from 1500 to 4250 grams.

One patient who developed post surgical sepsis experienced total nipple loss, while another had partial nipple necrosis.

Conclusion
The superior medial pedicle is a reliable technique for patients requiring massive breast reduction. This approach has a high likelihood of preserving the nipple, which contributes significantly to improving the patient’s quality of life.