Lower Pole Elongation

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