Eliminating the vertical scar in breast reduction–Boston modification of the Robertson technique

Abstract

Surgeons often advise patients with large ptotic breasts to undergo a Wise pattern reduction (WPR) mammaplasty using an inferior pedicle technique with consideration of a free-nipple graft. We describe the Boston modification of the Robertson technique (BMRT), which allows for the elimination of the vertical scar using a low horizontal scar mammaplasty with a broad central-inferior pedicle. We retrospectively reviewed the surgical characteristics of 239 patients who underwent mammaplasty using the BMRT technique (n = 145) and compared these with patients undergoing WPR (n = 94). Patients were eligible for BMRT if they had a minimum of 5 cm between the lower aspect of the new areola and superior aspect of the old areola. The BMRT patients were more obese than the WPR patients (BMI 32.4 +/- 6 kg/m(2) vs 28.0 +/- 5 kg/m(2)) and also were more ptotic. The average distance from the suprasternal notch to the nipple was (36.5 +/- 5 cm vs 30.1 +/- 3 cm). For bilateral reductions, the average combined weight removed was 1240 g for BMRT, and 700 g for WPR. The BMRT unilateral reductions also had more tissue removed than unilateral WPRs (980 g vs 465 g). Rates of hematoma formation, minor wound dehiscence, and scar hypertrophy were greater in bilateral WPRs compared to bilateral BMRT mammaplasties. The BMRT is a safe and reliable method of reduction mammaplasty when there is macromastia and significant ptosis. This technique avoids the vertical scar and hides the transverse scar in the shadow of the inferior breast.