Short Scar Technique Research Articles

The Crossed Dermal Flaps Technique for Breast Reduction

More than100 techniques and variations of breast reduction have been published. In most, the principal differences involve the method of transpositioning the nipple-areola complex and the pattern of skin resection. Skin resection inevitably causes scarring, which has given rise to an ongoing debate over long scar techniques and short scar techniques. The debate would be mute if only the extent of the scar was evaluated: ideally, the shorter the better. However, this limitation of scar extension conditions other elements to be evaluated in the results. On the other hand, there is a great variety of clinical cases in which not only the volume must be considered, but also the degree of ptosis, the quality of the skin, the age, and, most importantly, the wishes of the patients. The objective of the crossed dermal flaps procedure was to obtain optimum volume, position, and shape of the breast; well-located good-quality scars as short as possible; and early satisfactory and long-lasting results. Between June 1986 and June 2003 136 women underwent this procedure, performed under controlled hypotension (median arterial blood pressure, 60 mmHg). The technique is based on Wise-type skin marking associated with glandular resection in the lower and lateral poles, and transpositioning of the nipple-areola complex with a superior medial dermoglandular pedicle. Two rectangular areas under each cutaneous vertex are delimited, which will correspond with the future dermal flaps. These flaps are crossed, then fixed to the musculoaponeurotic chest wall, and the rest of the wound is sutured by planes in a conventional manner. Two patients (1.4%) experienced minimum cutaneous epidermolysis without dehiscence at the union of the vertical and horizontal sutures, which later healed by second intention without interference with the aesthetic result. Three cases (2%) showed partial and superficial necrosis of one of the areolae, but healed during the following 3 weeks without secondary surgery. In three patients (2%), hematomas developed, which were drained in the dressing room with no complications. One patient experienced thickening of the scar. No infections were observed. The authors believe the cross dermal flaps technique is safe and applicable to an extensive variety of cases. It is easy to execute and to teach, and therefore, those who are beginning to use inverted T techniques such as that described, can, from the beginning, diminish the incidence of short- and long-term complications such as dehiscence that lead to scarring at the convergence of the flaps and bottoming out of the inferior pole, with the horizontal scar displaced upward and an increase in the distance between the later and the nipple areola complex.

“Marriage” abdominoplasty: A short scar technique

Short scar abdominoplasty—that is, a marriage of aggressive superwet lipoplasty, rectus abdominis muscle plication, and excision of lower abdominal skin and excess adipose tissue—can be used as an alternative to conventional abdominoplasty in properly selected patients. According to the authors, this technique offers the advantages of less invasive surgery, decreased pain, and faster return to work. ( Aesthetic Surg J 2002;22:294-301.)

Vertical reduction

Reduction of the breast with the vertical technique not only eliminates the inframammary scar but also improvesbreast shape. Elimination of the inframammary scar is a great advantage, especially in those women prone to keloids and hypertrophic scars. Although the ideal candiate for this technique is a nonsmoker, with moderately large breasts and elastic skin, an experienced surgeon may apply this technique to all breast types, regardless of size or skin elasticity. The inconvenience of the unusual early appearance of the breast is far outweighed in terms of final breast shape and scar reduction. Patient satisfaction has been extremely high and complication rates are comparable to those of other techniques. It is my firm belief that short scar techniques, especially the vertical scar technique, will eventually replace those techniques relying on the classical inverted T-incision.

Early experience with Lejour vertical scar reduction mammaplasty technique

The study contains 163 patients who underwent a reduction mammaplasty at the Karolinska Hospital during 1991–1992. Seventy patients were operated on using the Lejour short scar technique (superovertical pedicle) and 93 using the Strombeck method (medial pedicle). The aim of this study was to compare the results of these two different methods with regard to scar formation, position and sensation in the nipple areola complex, postoperative complications, healing conditions, shape and volume symmetry of the breasts and patient satisfaction. An objective method [20] was used for assessment of postoperative breast asymmetry. Advantages and disadvantages of both methods are presented. The incidence of early complications was low in both groups, compared with the data presented in the literature, but Strombeck's method was found to be superior in some respects because of fewer early postoperative complications, shorter healing period and better breast symmetry postoperatively.