Vertical Scar Reduction Research Articles

Vertical Scar Reduction Mammaplasty Using the Superomedial-Based Pedicle Technique in Gigantomastia.

Breast reduction surgery has witnessed significant advancements in recent years; however, it continues to pose challenges for both surgeons and patients when dealing with cases involving excessive breast volume and severe breast ptosis. This study aimed to assess the aesthetic outcomes and the impact on the quality of life, as measured by the BREAST-Q questionnaire, in patients with gigantomastia and severe breast ptosis who underwent reduction mammaplasty using the superomedial-based pedicle technique. We present a retrospective series comprising 84 patients who underwent reduction mammoplasty utilizing the superomedial pedicle technique. The surgical resections exceeded 1 kg per breast, with a mean resection weight of 1506.58 g (right breast) and 1500.32 g (left breast). The preoperative mean suprasternal notch to nipple distance measured 40.50 cm (right breast) and 40.38 cm (left breast). Postoperatively, the patients were followed up for a minimum of 6 months. Both preoperative and postoperative BREAST-Q surveys were administered to the participants, and scores were analyzed using descriptive statistics. Complications were observed in 3 patients (3.57%), characterized by partial loss of the areola, which resolved spontaneously over time. Additionally, 2 cases of hematoma and 2 instances of minor delayed wound healing were reported. All patients expressed satisfaction with their aesthetic outcomes, as they achieved a natural breast shape and minimal scarring, along with symptomatic relief. The superomedial pedicle reduction mammaplasty technique has demonstrated its ability to produce satisfactory aesthetic outcomes and long-term benefits in patients with excessively large breasts. Careful patient selection and postoperative management are vital for achieving optimal results. Further investigations involving larger sample sizes and longer follow-up periods are warranted to validate our findings. IV.

3D Analysis of Breast Morphological Changes after Vertical-Scar Reduction Mammoplasty: A Prospective Study.

In addition to symptom relief, the crucial objective of reduction mammoplasty is to achieve a stable and esthetically pleasing postoperative breast shape. However, the morphological changes in breasts following reduction mammoplasty have not been comprehensively understood. In this study, we applied three-dimensional (3D) scanning technology for long-term follow-up monitoring of breast morphological changes to discern their changing trends. Our goal was to provide a reliable basis for assessing postoperative effects and determining follow-up time points. This prospective study included patients undergoing vertical-scar reduction mammoplasty. We utilized a combination of linear measurements and 3D scanning to measure various parameters, including breast volume, breast volume distribution, nipple position, and scar length at various time points: pre-surgery, immediately post-surgery, 3-month postoperative, 6-month postoperative, and 1-year postoperative. A total of 115 patients were enrolled in this study. Throughout the initial 3 months of postoperative follow-up, there was a gradual reduction in breast volume, which tended to stabilize from 3 to 12months. The nipple position showed a gradual shift both laterally, inferiorly, and posteriorly. The volume of the lower and lateral part of the breast increased gradually. Notably, at 1year after surgery, the scar length was approximately 6.3% shorter compared to the immediate postoperative measurement. Our 3D analysis unveiled comprehensive changes in breast morphology: The overall breast volume shifted laterally and inferiorly, the nipple position moved laterally, inferiorly, and posteriorly, and there was a significant reduction in scar length. Concurrently, breast volume exhibited a gradual decrease and stabilization after 3months, establishing it as a suitable follow-up point for assessing postoperative results. Additionally, surgical plans can be formulated based on the overall trend of changes in breast volume and distribution, combined with methods such as three-dimensional scanning, to enhance surgical outcomes and patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to authors www.springer.com/00266 .

Comparative Study between No Vertical Scar Reduction Mammoplasty and Subcutaneous Mastectomy with Free Nipple and Areola Grafting in Management of Post Bariatric Marked Breast Ptosis

Comparative Study between No Vertical Scar Reduction Mammoplasty and Subcutaneous Mastectomy with Free Nipple and Areola Grafting in Management of Post Bariatric Marked Breast Ptosis

Comparative Study between No Vertical Scar Reduction Mammoplasty and Subcutaneous Mastectomy with Free Nipple and Areola Grafting in Management of Post Bariatric Marked breast ptosis

Comparative Study between No Vertical Scar Reduction Mammoplasty and Subcutaneous Mastectomy with Free Nipple and Areola Grafting in Management of Post Bariatric Marked breast ptosis

The Passot Technique Revisited: No Vertical Scar Reduction Mammoplasty in Unmarried Females: A Case Series.

BACKGROUNDMacromastia in adolescent girls is a distressing condition. There is an increase in the number of patients opting for reduction mammoplasty in the late teens. The semicircular horizontal method of breast reduction, first described by Passot in 1925 has the advantage of being able to do larger reduction, particularly suitable for pendulous breasts and having a hidden scar in the inframammary fold.METHODSEleven patients of adolescent macromastia were included in this study. It was conducted over a period of 4 years (2013-17) at two teaching institutions in Kolkata and Rishikesh, India. The mean age of the patients was 19.2 years. The Passot technique of reduction mammoplasty was performed in each case and the volume of resected breast tissue recorded by weighing the specimen. The aesthetic outcome was assessed by Lowery scale (volume, contour, placement of the breast mound and inframammary fold). Patient satisfaction was assessed after 6 months of follow up on a scale of 1 to 10, where 1-4 was poor, 5-6 fair, 7-8 good and 9-10 excellent. RESULTSMean total reduction per breast was 856 gm. Patients reported a mean decrease of cup size by 1.5. The aesthetic outcome was excellent in 6 patients and good in 5 patients. Patient satisfaction was excellent in 9 patients and good in 2 patients.CONCLUSIONPassot technique is a safe and effective technique of reduction mammoplasty and is especially useful in adolescent macromastia where the absence of visible scar on the breasts is very satisfying for the patients.

The Passot Technique Revisited: No Vertical Scar Reduction Mammoplasty in Unmarried Females: A Case Series

The Passot Technique Revisited: No Vertical Scar Reduction Mammoplasty in Unmarried Females: A Case Series

Vertical Scar Versus Inverted-T Scar Reduction Mammaplasty: A Meta-Analysis and Systematic Review.

Women with macromastia experienced constitutional and psychosocial symptoms which could be improved by vertical scar or Inverted-T scar reduction mammaplasty. The authors conducted the first systematic review and meta-analysis in an attempt to declare the differences of the vertical scar versus the Inverted-T scar reduction technique by comparing the postoperative complications and aesthetic effects. PubMed, EMBASE, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases for clinical studies were searched through June 30, 2019. Cumulative analysis was conducted using the Review Manager Version 5.3 software. The summary odds ratio (OR) was estimated using random effect models at 95% confidence intervals (CIs), statistical heterogeneity was tested using the Chi-square test and risk of bias was assessed using the Cochrane Handbook 5.1.0 and the Newcastle-Ottawa scale (NOS). Two randomized controlled trials (RCT) and nine observational comparative studies were included. The vertical scar method was significantly lower than the Inverted-T scar method in overall incidence of complications (OR: 2.06; 95%CI, 1.15 to 3.70; P: 0.002) and wound dehiscence (OR: 4.62; 95%CI, 2.33 to 9.16; P<0.00001). No significant differences in seroma, hematoma, nipple necrosis, fat necrosis and reoperation were noted. Both two breast reduction techniques are equally safe, while the vertical scar approach resulted in a statistically lower rate of overall complications and wound dehiscence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Principles of Breast Re-Reduction: A Reappraisal.

This article examines outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Patient demographics, surgical technique, and outcomes were analyzed. Ninety patients underwent breast re-reduction surgery. The average interval between primary and secondary surgery was 14 years (range, 0 to 42 years). The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 percent)]. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 percent)]. The nipple-areola complex was repositioned in 60 percent of patients (n = 54). The mean volume of tissue resected was 250 g (range, 22 to 758 g) from the right breast and 244 g (range, 15 to 705 g) from the left breast. Liposuction was also used adjunctively in all cases (average, 455 cc; range, 50 to 1750 cc). Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 percent). Breast re-reduction can be performed safely and predictably, even when the previous technique is not known. Four key principles were developed: (1) the nipple-areola complex can be elevated by deepithelialization rather than recreating or developing a new pedicle; (2) breast tissue is removed where it is in excess, usually inferiorly and laterally; (3) the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and (4) skin should not be excised horizontally below the inframammary fold. Therapeutic, IV.

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.

Vertical Scar Reduction Mammaplasty

Vertical Scar Reduction Mammaplasty

Vertical Scar Reduction Mammaplasty.

Since 1989, the authors have performed vertical scar reduction mammaplasty on over 3000 patients. In 2006, the authors described their technique. Since then, the authors have made several modifications that they believe have improved both the reliability of the procedure and the outcomes that they are able to achieve. Key modifications are described in this article and the accompanying video.

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.

PCN118 - Cost–Effectiveness Analysis Parallel to a Randomized Controlled Trial Comparing Vertical Scar Reduction (VSR) and Inverted T-Shaped Reduction (ITR) Mammoplasty

PCN118 - Cost–Effectiveness Analysis Parallel to a Randomized Controlled Trial Comparing Vertical Scar Reduction (VSR) and Inverted T-Shaped Reduction (ITR) Mammoplasty

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.

Randomized Controlled Trial Comparing Health-Related Quality of Life in Patients Undergoing Vertical Scar versus Inverted T–Shaped Reduction Mammaplasty

There is controversy regarding the superiority of the vertical scar reduction technique versus the inverted T-shaped reduction technique for breast reduction surgery. Two hundred fifty-five patients were randomized to either the vertical scar reduction or inverted T-shaped reduction technique immediately before surgery over a 5-year period. Patients completed the Health Utilities Index Mark 3, Short Form-36, Breast-Related Symptoms Questionnaire, and Multidimensional Body-Self Relations Questionnaire at 1 week preoperatively and 1, 6, and 12 months postoperatively. Data were treated according to intention-to-treat principles. The primary outcome was the difference in the change in Health Utilities Index Mark 3 score from baseline to 12 months postoperatively between the two techniques. Patients undergoing either technique gained a statistically significant and clinically important improvement from baseline to 1 year postoperatively in the Health Utilities Index Mark 3 (vertical scar reduction, 0.81, 0.16 to 0.87, 0.19; inverted T-shaped reduction, 0.79, 0.20 to 0.89, 0.15) and the Breast-Related Symptoms Questionnaire (vertical scar reduction, 50.26, 12.98 to 95.59, 9.36; inverted T-shaped reduction, 50.06, 12.50 to 94.09, 9.86). No difference in mean change in scores from baseline to 12 months postoperatively was seen in any of the quality of life questionnaires between the techniques. There was a clinically important improvement between baseline and 1 year postoperatively in both groups in the Health Utilities Index Mark 3 and the Breast-Related Symptoms Questionnaire. The authors conclude that the techniques are similar when quality of life is the outcome of interest. Therapeutic, I.