Breast reduction/mastopexy with short inverted T scar

Abstract

Poor scars, breast size error, odd shape, and unequal breasts are the commonest causes of postoperative dissatisfaction. Women request this operation for functional reasons and are willing to accept complications, but would obviously like the best cosmetic outcome possible. There is a point at which reduced scar burden is not worth a trade for compromised breast shape and nipple areola complex (NAC) aesthetics. Breast reduction is a common and continually evolving procedure. There are many surgical procedures for reduction mammaplasty [1]. Each presents particular advantages in terms of indications, vascular preservation, technique design, ease of realization, minimum scarring, maintenance of innervation, long-term results, etc. Despite the aesthetic complications of poor scars, asymmetry of breast shape, and the NAC, this operation shows a high degree of long-term satisfaction of the patients [2, 3]. Because of the rich mammary vascularization and the importance of preserving the vascular integrity of the NAC [4], the great majority of breast reduction techniques have based their design on preserving the vascularization of this complex. It is also important to preserve the innervation of the NAC [5, 6], and the integrity and the continuity of the galactophorous ducts [7, 8]. Strömbeck [9] set a golden standard with his mammaplasty technique in 1960. A few years later, for small reductions and for mastopexies, Pitanguy [10] showed how to minimize the submammary scar and how to improve the shape of the reduced breast and the position of the NAC. Very large breasts were better managed by the technique of McKissock [11] in 1972. This replaced the widely performed Strombeck [9] technique. Soon thereaft er, in 1977, an inferior pedicle technique was proposed by Robbins [12]. This technique became popular and it is still used for relieving breast hypertrophy and ptosis. The author uses Robbins technique, with several technical variations that eliminate the main drawback of the original procedure: the long submammary scar. The modification includes a precise preoperative breast assessment using TTM chart [13], a precise planning and marking prior to surgery, and also several combined maneuvers based on the breast fascial and ligamentous anatomy. The primary indication of the procedure is mammary hyperplasia and/or ptosis of moderate to severe degree. © 2009 Springer-Verlag Berlin Heidelberg.