Vertical Scar Breast Reduction Research Articles

Vertical Scar Breast Reduction: Does Gathering the Incision Matter?

The vertical scar bilateral breast reduction is a highly effective technique to reduce breast volume and create long-lasting aesthetic improvements. A cited disadvantage is the inability to adequately shorten the vertical scar, leading to chest wall scars or inframammary puckers. Gathering or cinching sutures have been described as a strategy to confront this issue. This article aims to determine if suture gathering is an effective methods to (1) reduce the incision length, (2) shorten the areola-to-inframammary fold (IMF) distance, and (3) reduce the pucker revision rate. All patients undergoing vertical breast reduction performed by the senior author (E.H.F.) from 2001 to 2007 were included. The patient population was divided into "gather" and "no gather" groups depending on how the vertical incision was closed. There were 203 patients in the "no gather" group and 193 in the "gather" group. Age, body mass index, and resection weight were statistically but not clinically different. The percent reduction in vertical incision length was significantly greater in the "gather" group (34.2 ± 9.9% vs. 12.2 ± 5.9%). Both groups showed a gradual lengthening of areola-to-IMF distance postoperatively. Suture gathering had no impact on the pucker revision rate but increased healing complications. Gathering sutures significantly reduce the incision length in the operating room but do not change the areola-to-IMF distance or pucker revision rate. Gathering negatively influences skin vascularity and wound healing. It is acceptable and necessary to have a longer areola-to-IMF distance in a vertical reduction to accommodate increased projection.

Tuberous breast deformity: A modified technique for single-stage correction.

Introduction:Tuberous breast deformity is one of the most challenging congenital breast anomalies. Severe forms present as hypoplasia of lower medial and lateral quadrants and breast base constriction. We present a modified technique based on redistribution of breast tissue for single-stage aesthetic correction of this deformity.Material, Methods and Surgical Technique:The technique is based on Lejour's method of single vertical scar breast reduction. The breast tissue is divided into three superiorly based pedicles. However, instead of joining the three pedicles, they are spread to redistribute tissue to quadrants which are deficient. This technique is combined with implant insertion if the breast volume is deficient or mastopexy if there is significant ptosis. The level of nipples is matched to achieve symmetry and areolar reduction done where indicated. We have used this for six patients with Type I/II/III (von Heimburg, 2000) tuberous breast deformity.Results and Discussion:The aesthetic results have been very good in terms of shape, volume, symmetry and patient satisfaction. A historical summary of the development of techniques for correction of tuberous breast is presented along with description of our method and its results.

Secondary Augmentation Mastopexy to Correct Malpositioned Nipple Areola Complex (NAC) and Baker's Grade III Capsular Contracture 15 Years Later

We report a case of a 51 year old woman who underwent a no vertical scar breast reduction with augmentation mastopexy 15 years ago and presented with breast distortion, gross asymmetry with medialized nipples and Baker’s Grade III capsular contracture. This report details the surgical steps undertaken to correct the deformity and the postoperative results. Secondary augmentation mastopexy presents a unique challenge due to the limited amount of tissue to work with and decreased blood supply to the flaps.

Superior Pedicle Reduction Mammoplasty Supported with Inferior Pedicle Chest Wall-Based Flap: Refinements to the Technique.

Breast reduction techniques strive to obtain a final aesthetic breast shape. The most difficult issues to address after breast surgery are providing consistent upper pole fullness and preventing recurrent ptosis. Our surgical approach is a superior pedicle vertical scar breast reduction with an inferior pedicle chest wall-based flap to enhance the projection of the breast. We describe our refinements to the previously described similar techniques to provide upper pole fullness with long-lasting breast shape and prevent the bottoming out deformity. Twenty-five patients underwent reduction mammoplasty and/or mastopexy (15 mastopexy, 10 reduction mammoplasty) using modified superior pedicle reduction mammoplasty supported with inferior pedicle chest wall-based flaps between 2009 and 2013. Medical records and follow-up outcomes were retrospectively analyzed. Scar widening was acceptable even for larger reduction cases. The aesthetic results of both reduction and mastopexy cases were satisfying. Upper pole fullness was maintained in the long-term follow-up. Significant bottoming out was not observed. No skin excess was noted at the inferior fold region in any of the cases. In our modified technique, tissue is excised in a beveled fashion under the superior pedicle and pillars, particularly from the lateral; hence, the chest wall flap does not cause tissue excess at the upper infra-areolar site of the vertical scar. Flexibility in choosing the location from which to remove the breast tissue provides a custom-made approach to shape each breast. The long-term results of our technique demonstrate minimal breast descent and sufficient upper pole fullness.

Pseudoangiomatous stromal hyperplasia: case report in a young patient and review of the literature

Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast pathology, ranging from focal microscopic findings to clinical and mammographically evident masses, characterized by abnormal proliferation of the mammary stroma. Hormonal factors contribute probably to this pathology, since the average age of patients has been reported to be 40 years and can occur in postmenopausal patients who are on hormone replacement therapy. Notwithstanding, the etiology remains unclear and controversial. Usually, it is characterized by solitary, mobile, and slow-growing nodules. Notwithstanding, it may also occur as nodules or diffuse masses with rapid growth, simulating a malignant tumor. The recommended treatment is a wide excision of the lesion, with adequate free margins of resection, avoiding local recurrences. Herein, authors present a rare case of PASH in a 14-year-old patient, that produced severe breast deformity and assymetry. After complete excision, the breast was reconstructed by applying concepts of vertical scar breast reduction to restore breast symmetry. Level of Evidence: Level V, therapeutic study.

Modified vertical reduction mammaplasty: ten years of experience

Background Over the years, vertical scar breast reduction has gained more and more importance. This is due to the fact that this technique is associated with smaller scars and absence of scars in the inframammary fold. However, this technique also has some disadvantages, such as the pleating of the vertical scar during the first 6–12 months and final shape of the breast is achieved only after a year. It also cannot be applied to very large mammary hypertrophies. Herein, we present some modifications to the vertical scar breast reduction that allow long lasting results and reduced complications.

Response to "Limitations of the Horizontal (No Vertical Scar) Breast Reduction"

We thank Dr Swanson for his detailed analysis of our article.1 In recent years, aesthetic surgeons have been heavily biased toward the vertical scar breast reduction technique. Horizontal breast reduction has generally been excluded from the literature. None of the articles referenced in Dr Swanson's letter include horizontal reduction, thus rendering most of the comments inapplicable. Our study was, to our knowledge, the first comparing the horizontal scar pattern with the other 2 common types of scar patterns. Our primary objective was to determine …

A Matched Cohort Study of Superomedial Pedicle Vertical Scar Breast Reduction (100 Breasts) and Traditional Inferior Pedicle Wise-Pattern Reduction (100 Breasts)

The superomedial pedicle vertical scar breast reduction is gaining popularity for its round, projecting breast and shorter incision when compared with the traditional Wise-pattern reduction using an inferior pedicle. However, there is a paucity of large-volume institutional outcomes studies identifying how this technique fares against more traditional methods of reduction. A retrospective review of a prospectively maintained database of bilateral breast reductions over a 3-year period was performed. One hundred superomedial breast reductions (50 patients) were matched to 100 inferior pedicle breast reductions (50 patients). Matching was implemented based on age (±3 years) and size of reduction (±200 g). Patient demographics, size of reduction, nipple-areola complex sensitivity, minor and major postoperative complications, and symptomatic relief were assessed. Statistical analysis was performed with SAS Version 9.2. Two hundred twelve patients underwent 424 bilateral breast reductions between January of 2009 and June of 2012 at a single institution. Mean volume of tissue reduced was 815 g per breast (range, 200 to 2068 g) and 840 g per breast (range, 250 to 2014 g), respectively. All patients achieved symptomatic relief. No statistical difference in major or minor complications was seen between the two cohorts. No statistical difference in major or minor complications was seen between the two cohorts. No significant difference in complications was seen between small- and large-volume reductions. Superomedial pedicle vertical scar breast reduction is a novel, alternative mammaplasty technique with excellent functional and aesthetic outcomes which can be used for a wide range of macromastia without a significant difference in complication rates when compared with traditional Wise pattern inferior pedicle reduction mammaplasty. Therapeutic, III.

Learning From Our International Colleagues

With growing contribution to plastic surgery by our international colleagues, one may be wondering about what US plastic surgeons have learned from them. The purpose of this study was to evaluate a single surgeon's experience to identify any specific areas of plastic surgery that one has learned substantially from our international colleagues. All plastic surgical procedures performed by a single US plastic surgeon at an academic medical center with an active plastic surgery residency training program during the past 10 years were reviewed. More frequently performed procedures by the author were identified. In each identified procedure, critical references used by the author were examined to find out whether these references were from domestic or international sources. More frequently performed procedures by the author were (1) free anterolateral thigh perforator flap and free-style free flap, (2) deep inferior epigastric perforator flap breast reconstruction, (3) implant-based breast reconstruction, (4) oncoplastic breast reduction or mastopexy for breast reconstruction, (5) vertical scar breast reduction, and (6) fat grafting for correction of contour deformity after breast reconstruction. Much more innovative procedures that the author had learned after his residency were published primarily by our international colleagues. The author has learned substantially from our international colleagues because many new procedures may be either first described by them or they have more extensive clinical experience. It is important to fully appreciate the significance of international scientific exchange in plastic surgery and its impact on a US plastic surgeon's clinical practice.

3-D analysis of breast morphology changes after inverted T-scar and vertical-scar reduction mammaplasty over 12 months

One major objective of all types of breast reduction procedures is to achieve a long-lasting, stable and aesthetically pleasing three-dimensional (3-D) breast shape, but current surgical outcome evaluation is limited. This study compares the extent of soft-tissue oedema and breast tissue migration related to 3-D breast morphology changes after inverted T-scar and vertical-scar breast reduction over 12 months. 3-D breast surface scans of patients undergoing inverted T-scar (n=52 breasts) and vertical-scar (n=44 breasts) reduction mammaplasty were obtained preoperatively and 2-3 days, 1 week, 1 month, 3 months, 6 months, 9 months and 12 months postoperatively. 3-D images were analysed at each time point comparing distances, 3-D breast contour deviations (%), breast surface (cm2) and volume (cc) measurements including volumetric distribution between the upper portion (UP) and the lower portion (LP) of the breast (%). Total postoperative breast volume decreased by 11.7% (T-scar) and by 7.8% (vertical-scar) during the first 3 months (both p<0.001) without relevant changes in the following months, indicating that soft-tissue oedema is resolved after 3 months. The T-scar (vertical-scar) group showed a preoperative UP to LP volumetric distribution of 43:57% (45:55%) versus 86:14% (91:9%) immediately after surgery. Breast tissue significantly redistributes (both p=0.001) from the UP to the LP during the first postoperative year by 16.5% (T-scar) and 21% (vertical-scar), resulting in a final UP to LP ratio of 70:30% for both techniques, without further breast contour deviations (both p>0.05) after 6 months (T-scar) and 9 months (vertical-scar). Breast morphological changes after reduction mammaplasty are completed after a period of 3-6 months in the T-scar group and 6-9 months in the vertical-scar group.

A Retrospective Photometric Study of 82 Published Reports of Mastopexy and Breast Reduction

A Retrospective Photometric Study of 82 Published Reports of Mastopexy and Breast Reduction

Y-Scar Vertical Mammaplasty for Treatment of Mild Macromastia with Pseudoptosis

Y-scar vertical mammaplasty is a technical modification of vertical scar breast reduction, which avoids superior areolar scarring. It has been previously shown to be particularly useful in young patients with mild macromastia and minimal or no ptosis. This case report presents a new indication for which to apply this technical approach. A 58-year-old patient presented with mild macromastia of mainly the inferior pole and pseudoptosis. Since there was no need to transpose the nipple, a Y-scar vertical mammaplasty was performed, removing tissue from the lower pole and preserving upper-pole fullness. Furthermore, superior areolar scarring was avoided. In conclusion, Y-scar vertical mammaplasty may find its use in other less commonly seen patient profiles such as this presented case of an older patient with slightly enlarged breasts and pseudoptosis.

Breast Reduction With a Superomedial Pedicle and a Vertical Scar (Hall-Findlay's Technique)

Vertical scar breast reduction has not achieved widespread acceptance and many still view it as a technique with certain limitations. We present the results of a vertical scar pattern breast reduction with superomedial pedicle (Hall-Findlay's technique) in a series of 210 breast reductions. A superomedial pedicle was used with no pectoralis fascial suspension sutures, no or minimal use of liposuction or skin undermining. Glanduloplasty sutures were used to shape the breast parenchyma and the vertical incision closed with less gathering. Reductions of up to 1100 g per side were successfully achieved. Satisfactory healing was observed in 96.7% patients. All patients had a satisfactory final breast shape. 11 dog ears (5.2%) of which 9 had a revision (4.2%), 1 puckering on the inframammary fold on one side (0.47%), which did not require a revision, 7 wound problems in the vertical component of the scar (3.3%), which spontaneously healed in 4 weeks, and 2 re-reduction for further reducing the weight of the breasts (0.95%). The total rate of complications was 10% while the revision rate was 5.2%. We validate Hall-Findlay's technique with our independent results. The technique combines the safety of the superomedial pedicle with advantages of a vertical scar in a quick but safe manner ensuring adequate resection and sound healing with less scars and faster recovery for the patient.

A method to select patients for vertical scar or inverted-T pattern breast reduction

A method to select patients for vertical scar or inverted-T pattern breast reduction

Breast Sculpturing: Overcoming the Limits of Traditional Approaches in Breast Reduction

A technique based on original refinements of the vertical breast reduction was developed in our department. The aim of the technique was the safe and aggressive sculpture of an attractive breast mound with minimal scarring and long-lasting results that is easy to perform and suitable for teaching purposes in a surgical training unit. Fifty consecutive patients who were to undergo bilateral breast reduction were prospectively enrolled in the study. Accurate standard anthropometric measurements and photographs were taken preoperatively and postoperatively at 2, 6, 12, 24, and 36 months. A selective breast liposuction plus a superior pedicle breast reduction with a vertical scar skin pattern was performed in all cases. Nipple lifting ranged from 5 to 14 cm; reduction of the distance between the inframammary fold and the nipple ranged from 0.5 to 7 cm; breast base width reduction ranged from 0 to 7 cm. This technique further contributes to vertical mammaplasty refinements, enhancing the key role of selective liposuction prior to surgical dissection of the breast. The basic principle is to convert a large breast into a middle-sized one, making vertical scar breast reduction the most appropriate technique for all cases. A thorough and selective liposuction of the breast mound reduces the breast cone base width safely and with virtually no limitations, thus breaking a taboo of traditional breast reduction techniques.

Inverted-T Versus Vertical Scar Breast Reduction: One Surgeon's 5-Year Experience With Consecutive Patients

Breast reduction is one of the most commonly performed plastic surgery procedures. Many approaches to breast reduction have been described, including inverted-T and vertical scar techniques and various types of dermoglandular pedicle for the nipple. This study compares the outcomes of patients undergoing vertical scar medial pedicle versus inferior pedicle inverted-T scar breast reduction by a single surgeon. Ninety-five consecutive patients who had undergone inverted-T scar breast reduction between January 2002 and July 2005 were compared with 96 consecutive patients undergoing vertical scar breast reduction between September 2005 and August 2007. Patient age, body mass index (BMI), resection weight, complications, and surgical revision rates were compared. Mean age, BMI, and resection weight were comparable in both groups. The rates of major complications of both groups were equal (24%). There was a higher hematoma rate in the vertical series (8 vs 3; P < .05). The inverted-T series was complicated by more wound dehiscence (37 vs 11; P < .05), surgical site infections (16 vs 8; P < .05), and involved a longer operative time (102 minutes vs 83 minutes; P < .05). There was a higher scar revision rate in the inverted-T series (11 vs 32; P < .05). Vertical scar breast reduction is associated with a major complication profile similar to that for inverted-T scar breast reduction with a shorter operative time and fewer scar revisions. There were fewer minor complications with the vertical series, and it is safe and easy to adopt by the surgeon.

A method to select patients for vertical scar or inverted-T pattern breast reduction

Vertical scar breast reduction (VSBR) is an increasingly popular technique but can carry a high complication and revision rate. We evaluate our complication rate when selecting patients for VSBR or inverted-T breast reductions (ITBR). We looked at 133 consecutive primary bilateral breast reductions performed by a single consultant from 1998 to 2003 (23 incomplete records). VSBR (82 breasts) and ITBR (120 breasts) were performed, with glandular or superomedial pedicle transposition of the nipple-areola complex (NAC), or free nipple grafts (FNG) (18 breasts). The pattern of skin excision chosen was determined by the degree of skin shrinking required to achieve the correct vertical height of the new breast. If the measurement from the inframammary fold to the lower border of the new areola position was < 18 cm the patient underwent VSBR. We assessed complication and revision rates in each group. The complication rate (haematoma, infection, delayed healing, nipple/fat necrosis) in VSBR was 11%, in ITBR 23% (P<0.05). Revision rate was 2.4% in the VSBR and 3.3% in ITBR group. The VSBR had no problem scars, while the ITBR produced problem scars in 16% of operated breasts (P<0.001). We feel it is possible to reduce skin to 40-50% of its original length. Attempting a greater degree of shrinkage produces a high rate of revision surgery. We suggest a method of selection of technique by a reproducible measurement of the vertical skin reduction to produce a low complication rate and low revision rate.

The Asplund-Davies vertical scar breast reduction technique preserves the sub-areolar skin thickness in the long term: a matched comparative study with the inverted T technique

The inverted T technique, a popular method of breast reduction, relies on stretching the skin over glandular breast tissue to create the breast shape. The Asplund-Davies vertical scar method of breast reduction by contrast uses glanduloplasty to create the desired breast shape, achieving tension-free skin closure. Indeed the skin at the end of the vertical scar technique is wrinkled. It is known from tissue expansion literature that when skin is placed under tension the dermis becomes thinner. In this pilot cross-sectional study we compared breast skin thickness between two matched groups of patients undergoing breast reduction either with the inverted T or the vertical scar techniques, to determine whether the method of breast reduction impacts on breast skin thickness in the long term. With a high frequency ultrasound machine the breast skin thickness of 24 breasts, 12 in each group, was measured by an independent consultant radiologist. Patients were matched in terms of age, time since operation, Fitzpatrick skin type, preoperative cup size and the amount of tissue resected. The breast skin in the inverted T group was significantly thinner than the vertical scar group (P<0.001). The inverted T group also had thinner skin in comparison to its control point (P<0.05). The vertical scar group had comparable skin thickness compared to its control point (P>0.05). This pilot study suggests that tension-free closure of skin with the vertical scar technique maintains breast skin thickness. Maintenance of breast skin thickness in this group may in turn contribute to the long term preservation of breast shape and form.

Internal Pedicle Shaping to Improve Aesthetic Results in Reduction Mammaplasty

Reduction mammaplasty has been performed utilizing various techniques to achieve reduction in breast volume and to enhance aesthetic shape. The conventional inverted T-scar method is the most widely used technique in breast reduction given its predictability and versatility [1]. Nonetheless, newer surgical techniques have been developed in order to optimize outcome while minimizing associated complications. Pedicle types include inferior, central, superior, lateral, and bipedicle, all of which maintain the blood supply and innervation to the nipple-areola complex [2]–[6]. Cosmetically acceptable placement of scars, although debated, has also been emphasized through additional technical modifications including short scar periareolar inferior pedicle reduction mammaplasty (SPAIR), vertical mammaplasty without inframammary scar, or no vertical scar breast reduction [7]–[10].

The No Vertical Scar Breast Reduction: A Minor Variation That Allows You to Remove Vertical Scar Portion of the Inferior Pedicle Wise Pattern T Scar

The No Vertical Scar Breast Reduction: A Minor Variation That Allows You to Remove Vertical Scar Portion of the Inferior Pedicle Wise Pattern T Scar