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The vertical reduction mammoplasty is part of a growing trend to use shorter incisions in surgical techniques that to reduce, lift, or to correct asymmetry in the breasts.
The inverted T has been the standard procedure for the last 40 years. This procedure produces a periareolar scar with a vertical and a horizontal component, with the horizontal scar being primarily in the inframammary fold. The horizontal scar can extend quite far laterally and can even meet the opposite side in the midline.
Advantages of this procedure include its relative safety to the nipple and other breast tissue. The procedure can be performed with few complications, and is fairly easy to learn. The disadvantages primarily have been with regard to a long, sometimes quite visible scar. The scar has a tendency to be become either hypertrophic or keloid and has been a major source of patient dissatisfaction with the inverted T procedure.
Vertical Reduction Mammoplasty
The most widely used new technique for breast reduction called vertical reduction mammoplasty, which leaves a ‘lollipop’ shaped incision. The incision is made around the areola and includes a vertical incision that extends to the inframammary fold. Skin is removed around the areola and in the vertical segment, but there is no horizontal scar in the fold. The vertical reduction mammoplasty technique relies on the inherent ability of the skin to shrink down and reshape itself after the glands have been reduced or lifted.
The ideal candidates for the vertical technique are those without striae and with firm glandular tissue as opposed to fat. The patients need to be advised that it takes a little longer for the final breast shape to evolve and occasional revisions are necessary if there’s excess skin at the bottom of the vertical lift, but these are oftentimes able to be done in the office under local anesthesia. The revision rate should be less than ten percent.
Older patients who do not have a considerable number of striae of the skin can still be treated with the vertical technique. As surgeons have gained more experience with the vertical technique it’s being used for larger and larger reduction mammoplasty. Contraindications for using this short scar technique include patients with excessive ptosis and patients with very thin striated skin.
Plastic surgeons in the United States have been slower to adapt the shorter scar techniques, which in large part have been developed in Europe and Brazil. Part of that is due to the fact that surgeons in America have been very comfortable using the inverted T for so many years and perhaps the fact that American surgeons have a higher percentage of Caucasian patients who tend to form better scars.
In general, patients will accept scars if they have good breast shape, but what surgeons have found they can produce a similar or even better shape with the vertical technique for shorter scars. There are some clear advantages to try and reduce scars in aesthetic breast surgery and there is a major movement at the present time towards those techniques in selected patients.
Other Short Scar Procedures
Another procedure that produces minimal scaring is liposuction of the breast, with or without the use of ultrasound. This procedure produces a single quarter inch-incision scar. That would be for the patient who has good breast shape but just may want a relatively minor reduction in volume. The best candidates for this procedure are those with good skin that hasn’t been stretched out and patients with high fat content in their breasts.
The next shortest incision would be the periareolar incision. This procedure works well for small to moderate breast lifts, and generally reductions less than about 300 or 400 grams. Excess skin can be removed as well as the breast gland in the case of a reduction. In the case of a lift, the underlying glands would be reshaped, and all these techniques are designed to preserve sensation in the nipples.
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Dr. Grotting
