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.

Unilateral vertical scar breast reduction with glandular transposition of the nipple-areola in breast asymmetry.

BACKGROUND: A unilateral breast reduction procedure to mimic the contralateral breast poses a challenge to the plastic surgeon. All aspects of breast aesthetics are essential surgical considerations. The authors have used a vertical scar technique with glandular transposition of the nipple-areola complex. METHODS: In this series of patients, the larger of the asymmetrical breasts was reduced using a modified vertical scar breast reduction technique to simulate the shape and size of the smaller breast. Thirty-four patients are presented. Preoperative marking of the patient was modified to simulate the smaller breast, including measurements from the sternal notch to the nipple, to the midline of the submammary fold, the base of the breast, and the diameter of the nipple-areola complex. The mean resection weight was 282 g (range, 76 to 860 g) and the mean follow-up period was 15 months. A glanduloplasty was performed to simulate the shape of the contralateral breast. RESULTS: Thirty-one of the 34 patients reported that, overall, they were satisfied (91 percent) with the final shape of the breasts, symmetry, and the nature of the scars. Three patients were not entirely satisfied. Two of these requested further resection and one requested a minor scar revision because of persistent wrinkles in the submammary fold. CONCLUSIONS: Adequate long-term breast symmetry was achieved as confirmed by a high patient satisfaction rate. Unilateral vertical scar breast reduction with glandular transposition of the nipple-areola has been a valuable method in selected cases of breast asymmetry.