Background and Aims Reduction mammaplasty (breast reduction surgery) is effective method for the treatment of breast hypertrophy and macromastia. There are a variety of surgical options for breast reduction, and the principal criteria for surgical success are the preservation of blood supply and sensation of the nipple-areola complex (NAC) as well as satisfactory postoperative breast appearance. The authors' team previously developed an axial three-pedicle breast reduction technique based on an inverted T-incision, and satisfactory results were obtained in breast cancer patients with concomitant breast hyperytophy and/or moderate to severe breast ptosis. This study was performed further evaluate the application efficacy of this method in patients with moderate to severe physiological breast hypertrophy or macromastia.Methods The clinical data of patients with moderate to severe breast hypertrophy or macromastia who underwent inverted-T incision and axial three-pedicle breast reduction between January 2017 and March 2021 in the Department of Breast Surgery, West China Hospital of Sichuan University, Fourth People's Hospital of Sichuan University and Longquan Branch of West China, Sichuan University were collected. The incidence of postoperative complications (NAC necrosis, T-incision dehiscence, cellulitis, hemorrhage, skin flap necrosis, and fat liquefaction) was recorded. The treatment outcomes were determined by self-assessment of the breast satisfaction, physical well-being, psychosocial well-being and sexual well-being of the patients in the BREAST-Q reduction/mastopexy module before and after breast reduction.Results A total of 28 patients (53 breasts) were included. Of the patients, the average age was (33.7±6.8) years old, and the average BMI was (25.8±3.2) kg/m². The breast cup size was E in 2 cases, FF in 2 cases, G in 4 cases, GG in 7 cases and H in 13 cases before operation. The average tissue resection weight for the left and right breast was 993.5 g and 1 017.7 g, and the elevation distance for the left and right nipple was (14.4±3.7) cm and (14.5±3.4) cm, respectively. After the operation, the breast cup size was B in 10 cases, C in 15 cases, and D in 3 cases. The overall incidence of postoperative complications was 7.5%. T-shaped junction wound dehiscence occurred in one case, and breast cellulitis and fat liquefaction occurred in one case each. The NAC was preserved in all patients, and only 1 patient (1.9%) developed hypopigmentation of the NAC. The median follow-up time was 24 (1-36) months. The preoperative breast satisfaction score was 15.5±8.2. The postoperative breast satisfaction scores at 1, 3, 6 months, and 1, 2 and 3 years after operation were 32.2±4.8, 42.6±7.5, 52.7±8.0, 52.7±8.5, 56.9±8.0 and 60.8±5.1, respectively, which were all significantly higher than the preoperative score (all P<0.05). The postoperative scores of psychosocial well-being and physiological function at each time point were significantly higher than those before operation (all P<0.05). Except for the first month after operation, the scores of sexual and physiological well-being at the remaining time points were significantly higher than those before operation (all P<0.05).Conclusion For patients with moderate to severe breast hypertrophy or macromastia, the inverted T-incision and axial three-pedicle breast reduction is an ideal procedure, with simultaneous advantages of good cosmetic effect and relatively less complications.