Vertical Mammaplasty Research Articles

Combination of the vertical and periareolar mammaplasty.

Vertical mammaplasty has been perfected and popularized by Madeline Lejour; this technique is one of the most versatile methods of mammaplasty today. The vertical scar from the nipple areola to the submammary line is often much longer and distorted than the conventional mammaplastys. The length of the vertical scar can be reduced by 2-3 cm by combining the skin pattern of the periareolar and vertical mammaplasty. The aesthetic result can be improved by shortening the vertical scar.

Vertical mammaplasty for breast reduction and mastopexy

Madeleine Lejour, MD Brussels, Belgium Vertical mammaplasty is a technique that involves adjustable markings, an upper pedicle for the nipple-areola complex, and a central breast reduction with lower skin undermining. The shape of the breast is created by suturing the gland and does not rely on the skin. No scar is produced in the submammary fold. Liposuction is added whenever feasible (in 55% of the cases). This technique, derived from the technique of Lassus,1 can be applied to small and large breasts. 2–4 It benefits from three innovative principles: Results have been very gratifying with regard to not only the reduced scarring but also the durable improved shape obtained. Complications have been uncommon and only one case in a series of 220 patients required a revision with the patient under general anesthesia. The main drawback of this technique is that the result is not obtained immediately. This is often more difficult for the surgeon who is just starting to use the technique than for the patient. In many breast reductions, late results show breasts that are too broad, too flat, and too low. This means that, besides volume reduction, the other deformities of large breasts either have not been adequately corrected or have recurred. If the surgeon understands that the results obtained by the surgery will progressively deteriorate, the deformities can be overcorrected as part of the technique. Thus, contrary to traditional plastic surgery principles, a perfect result is not achieved on the operating table. This requires a mental effort and some courage by the surgeon, …

Vertical mammaplasty for breast hypertrophy and ptosis

Vertical mammaplasty is a technique that uses adjustable markings, an upper pedicle for the areola, and a central breast reduction with lower skin undermining. The shape of the breast is created by suturing the gland and does not rely on the skin. No scar is produced in the submammary fold. Liposuction is added whenever feasible (in 55% of the cases). This technique, which can be applied to small and large breasts, benefits from three innovative principles: (1) wide lower skin undermining to promote skin retraction and reduce the amount of scarring, (2) overcorrection of the deformities to produce better late results, and (3) liposuction to facilitate molding of the breast and to remove unnecessary tissue, which is prone to absorb when the patient loses weight. A personal series of 220 cases is analyzed. Results have been very gratifying, not only as concerns the reduced scarring, but also for the durable beautiful shape obtained. Complications have been uncommon, and only one case required a revision under general anesthesia. The main drawback of this technique is that the result is not obtained immediately, but this is more a problem for the surgeon who starts to use the technique than for the patients.

A 30-year experience with vertical mammaplasty.

In 1964, I started using vertical mammaplasty without a submammary scar for all breast reductions. This technique was based on the following principles: a central wedge resection, an upper pedicle for the areola, no undermining, and a vertical scar to finish off. Because of the drawings, there was a pitfall: In large breasts, the inferior portion of the vertical scar was showing below the submammary fold. This is why, in 1977, I modified the technique with the addition of a short horizontal scar to eliminate this drawback. At the time, I was respecting the dogma that the length of a vertical scar should not exceed 5.5 cm. Taking a look again at my patients after a few months, I was surprised to find that the horizontal scar had moved upward. This led me to verify that the distance between the inferior border of the areola and the inframammary fold was variable with the size of the breast. I was then convinced that it was possible to finish every mammaplasty with a vertical scar. Thus I modified the procedure again to make the vertical scar stay above the inframammary fold in almost all patients. In a personal series of 710 patients (1350 breasts) operated on from 1964 to 1994, mastopexy was performed in 439 breasts and breast reduction was performed in 911 breasts. There were few complications. This long experience with vertical mammaplasty indicates that it is a safe procedure giving long-lasting results.

Combination of the Vertical and Periareolar Mammaplasty

Combination of the Vertical and Periareolar Mammaplasty

Incidence of calcifications in the breast after surgical reduction and liposuction.

Liposuction of the breast in combination with vertical mammaplasty was applied to 250 breasts among 386 reductions of large breasts performed in 2 years (1989 to 1991). To evaluate the possible damage to the breast caused by this combined procedure, especially in terms of the occurrence of the postoperative development of calcifications, a comparative study of preoperative and postoperative mammograms was undertaken in 60 randomly selected cases (120 breasts), 34 with and 26 without liposuction. Altogether, 13 calcifications (11 percent) were discovered during the 6- to 30-month follow-up, representing the lowest rate reported in the literature. Deep intraparenchymal calcifications were more frequent after liposuction; most (5 of 7) were macrocalcifications. None could be confused with malignant calcifications because they were more scattered, more regular, and less numerous. Attempts to evaluate the fat content of breasts via preoperative mammography failed to prove this examination a useful way to predict the viability of breast liposuction.

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.

BOOK REVIEWS

Book reviewed in this article: Questions You Should Ask Your Surgeon. By G. Maddern Complications In Orthopaedic Surgery, Vol. 1 & 2. Edited by C. H. Epps Jnr Vertical Mammaplasty and Liposuction. By M. Lejour Death to Dust—What Happens to Dead Bodies? By K. V. Iserson Maxlllofacial Injuries—A Synopsis of Basic Principles, Diagnosis and Management. By G. Dimitroulis and B. S. Avery

Vertical mammaplasty and liposuction

Vertical mammaplasty and liposuction

Vertical Mammaplasty and Liposuction

Vertical Mammaplasty and Liposuction

Vertical mammaplasty and liposuction of the breast.

Since 1989, I have used vertical mammaplasty without a submammary scar for all breast reductions. This technique uses adjustable markings, an upper pedicle for the areola, and a central breast reduction with limited skin undermining. The shape of the breast is created by suturing the gland and does not rely on the skin. A personal series of 100 consecutive patients (192 breasts) operated on from 1990 through 1992 is reviewed. Mastopexy was performed in 39 breasts. Among the 153 breasts that required reduction, liposuction was attempted as a complementary procedure before the surgical reduction in the 120 fattest breasts. Between 100 and 1000 cc of fat (mean 300 cc) could be suctioned in 86 breasts. This figure represents 50 percent of the large breasts in patients under 50 years of age and 100 percent of the breasts in patients older than 50 years. In these cases, liposuction made modeling of the gland easier and produced breasts with more useful and stable components. When liposuction was performed, surgical resection was adjusted to obtain the desired breast volume. The amount excised ranged from 120 to 1600 gm per breast (mean 480 gm). There were few complications, none of which required early reoperation. These complications were related to the weight of the breasts and not to the patient's obesity or to the liposuction procedure. In 10 percent of the patients, mostly those with very large and ptotic breasts, some skin redundancy was excised at the lower extremity of the scar after several months to improve the final result. This series proves that vertical mammaplasty can be used in all cases of breast reduction, producing consistently good, stable results with limited scars. The adjunctive use of liposuction in fatty breasts can be considered safe and efficient.

Vertical Mammaplasty Without Inframammary Scar and With Breast Liposuction

Vertical Mammaplasty Without Inframammary Scar and With Breast Liposuction

Vertical mammaplasty

Vertical mammaplasty

Vertical mammaplasty.

The vertical mammaplasty technique has undeniable advantages over combined techniques. It involves only the inferior pole of the breast, thus avoiding horizontal scars, which are the ones that most frequently hypertrophy. The main disadvantage of the technique is the inferior compensation, leaving visible scars in the thorax. We have modified this technique, making the compensation at the level of the areola. With this procedure, the vertical scar does not go below the submammary fold and is easily concealed.

New refinements in vertical mammaplasty

A few years ago 1 published a technique of breast reduction, resulting in a vertical scar. Actually, a two or three centimeters scar appearing beyond the brassiere line is no more accepted by the patients; so 1 modified the technique. The new one ends in a vertical line and a very short horizontal one which gives in the opinion of the author the minimum scarring in this kind of operation.