Objective To discuss the reduction mammaplasty procedures by reserving the T4 nerve and blood vessels and by repairing the ligament for macromastia patients. Meths Eighteen cases of macromastia were enrolled in this study. The supeior and inferior polar portions on the median line of the breast were dissected to form a central pedicle. Outside deep and fleet branches of the ligament were repaired and the lateral deep and fleet branches of the 4th intercostal nerve reserved in the pedicle. The pedicle was revolved and fixed, the fundus of breast was reduced and the tensile force of the ligament was enhanced. The operation of two-flap rotated flaps reduced the breast volume from inside to the outside. The corium where T4 intercostal nerve distributed skin was reserved to protect the fleet branches of the nerve, and then rotated and fixed to act as a fibrous septum. Results After the operation, the blood vessel and feeling of nipple-areola complex were all satisfactory and the profile of breast was tall and straight. Follow-up from 3 months to 2 years (7 months in average) showed that the scar was unconspicuous, the appearance of the breast was not evidently changed and the patients were satisfactory. Conclusion It is a simple and well-designed procedure of reduction mammaplasty for macromastia with repaired ligment and reserved 4th intercostal nerve. The breast profile is tall and straight after the operation.