Eliminating the vertical scar in breast reduction

Abstract

Reduction mammaplasty is one of the most commonly performed breast operations in the United States. In 2006, over 104,000 breast reductions were reported by the American Society of Plastic Surgeons, ranking it among the top five reconstructive procedures performed in the US, and representing a 162% increase from 1992 [1]. Breast reduction, in general, is associated with high patient satisfaction and significant improvements in health-related quality of life [2, 3]. Many techniques of breast reduction exist, with skin incisions including the inverted-T method, vertical-scar technique, vertical mammaplasty with short horizontal scar, periareolar technique, short-scar periareolar technique, L-short-scar mammaplasty, reduction with free nipple graft ing, and liposuction alone. Each of these skin incisions has also been adapted to include a variety of pedicles such as the inferior, lateral, superomedial, central, vertical bipedicle, and horizontal. In addition, countless variations and combinations of these have been developed. The most popular technique currently is one of the various forms of inverted-T scar methods, such as the Wise-pattern reduction [4, 5]. All methods of breast reduction share several key principles: removal of excess and redundant parenchyma, removal of excess skin, preservation of the nipple- areola complex (NAC) vascularity, and reshaping of the breast [4]. Ideally, production of the "perfect" breast size and shape are achieved with minimal scarring, normal nipple vascularity and sensation, good projection, a stable inframammary fold (IMF), preservation of the ability to lactate [6], and structural stability over time. Furthermore, a method should be relatively easy to perform, reproducible by other surgeons, easy to teach, expeditious, and free from complications. However, as evidenced by the number of operations available, no one procedure has been able to reliably provide all of the above; there is no technique which is ideal "for all seasons." While no one individual technique of breast reduction fulfills all criteria for the "perfect" operation, the key to the best result lies in correct patient selection for a particular procedure. Breast reduction without a vertical scar is no exception. © 2009 Springer-Verlag Berlin Heidelberg.