Learning Objectives: After studying this article, the participant should be able to: 1. Understand the technical nuances and outcome implications of the various options available in inverted-T scar breast reduction operative design. 2. Discuss the advantages, disadvantages, technical problems, best indications, and relative popularity today of vertical-scar reduction mammaplasty methods. 3. Describe the design concepts behind new techniques that seek to combine the best features of traditional inverted-T scar and vertical-scar mammaplasty methods. 4. Formulate a strategy for selection of the best reduction technique based on patient physical characteristics.
Current trends in the development of breast reduction surgery include a few minor refinements in classic inverted-T scar methods but, more, the increased use of vertical-scar reduction mammaplasty. The benefits of the latter, which include reduced scar burden and improved long-term projection, are attractive, although the technique itself has proved to be somewhat intuitive and more difficult to master. These shortcomings can be minimized and the technique safely learned by initially applying it to patients with minor degrees of macromastia and ptosis. New modifications and alternative approaches have been introduced recently to address the problematic areas of the vertical-scar technique.
A survey of members of the American Society of Plastic and Reconstructive Surgeons was undertaken at the 1998 annual meeting to review the current role of various techniques in breast reduction. The results revealed a slow acceptance of vertical-scar methods and the dominance of the inferior/central pedicle inverted-T scar method for a wide variety of macromastia types. Other issues were reviewed; they revealed the minimal role of both blood transfusion and liposuction and that more than half of breast reductions are still performed on an inpatient basis.
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From Emory University; the Albert Einstein College of Medicine at Montefiore Medical Center; Northwestern University Medical School; and the Department of Surgery at Michigan State University.
Received for publication February 9, 1999.
Presented at the Annual Meeting of the American Society of Plastic and Reconstructive Surgeons, Boston, Massachusetts, October 3 through 7, 1998.