A change in surgical technique is daunting for most surgeons, who spend much of their surgical career refining well-established and learnt surgical techniques.1 The now popular Hall-Findlay breast reduction technique is reported to be a quicker procedure that improves breast projection, upper-pole fullness, bottoming-out issues, blood loss, and recovery times.2 The senior author (D.H.S.) made the switch from inferior pedicle Wise pattern breast reduction to a modified Hall-Findlay technique based on expert testimony, and subsequently audited his objective and subjective outcomes.3 This comparative study demonstrated similar complication rate profiles between the two techniques,3 but the subjective questionnaire sent to those patients revealed a potential difference in subjective outcomes, specifically nipple sensation.
A postoperative quality-of-life survey, based on that of Hermans et al.,4 was sent to patients. The reader should note that this questionnaire is not validated. Patients were asked to self-assess satisfaction with current breast size, shape, scarring, wound healing, and nipple sensation since surgery, along with other subjective outcomes.
A total of 270 questionnaires were sent to patients in early March of 2010. The closing date for return of the questionnaires was the end of May of 2010, and 40 percent of patients (n = 108) responded to the questionnaire. A comparison of nonresponder and responder demographics found that the only significant difference was that the responders' age was slightly higher than that of the nonresponders (49 years versus 45 years; p = 0.04). The spread of the responses was typically clustered at higher values (positive outcomes). The major difference found was that 55 percent in the modified Hall-Findlay group reported reduced nipple sensation, compared with 23 percent of respondents who had an inferior pedicle Wise pattern technique breast reduction. Using multiple logistic regression analysis, we found that patients who had reduced nipple sensation after surgery were 3.85 times as likely to have undergone a breast reduction using a modified Hall-Findlay technique (95 percent confidence interval, 1.60 to 9.26; p = 0.003). The results showed that although more patients reported decreased nipple sensation in the modified Hall-Findlay group, both techniques were associated with high patient satisfaction, with 98 percent in the inferior pedicle Wise pattern group and 92 percent in the modified Hall-Findlay group reporting they were happy to undergo the procedure again and would recommend the surgery to their friends or family.
It is clear from the paucity of information regarding the comparison of these two breast reduction procedures that the surgical community needs more comparative data before conclusions can be drawn. We, along with the rest of the plastic surgery community, await with anticipation the final report of McMaster University's NCT00149344 randomized controlled trial comparing two breast reduction techniques (recruitment ended in 2011), which is expected to provide the community with data-driven evidence to support a particular surgical technique for breast reduction surgery. For now, we ask other surgeons performing these types of interventions to “keep an eye out” for losses of nipple sensation in patients having received a breast reduction using the Hall-Findlay breast reduction technique.
Nicolas R. Smoll, M.B.B.S.
Bhaveen Marne, M.B.B.S.
Hein Maung, M.B.B.S.
Michael W. Findlay, M.B.B.S., Ph.D.
David J. Hunter-Smith, M.B.B.S.(Hons.), M.P.H.
Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia
The authors have no financial interest to declare in relation to the content of this article.
The authors thank Laetitia Smoll for reviewing this article.
1. Ahmad J, Lista F. Vertical scar reduction mammaplasty: The fate of nipple-areola complex position and inferior pole length. Plast Reconstr Surg. 2008;121:1084–1091.
2. Hall-Findlay E. Pedicles in vertical breast reduction and mastopexy. Clin Plast Surg. 2002;29:379–391.
3. Hunter-Smith DJ, Smoll NR, Marne B, Maung H, Findlay MW. Comparing breast-reduction techniques: Time-to-event analysis and recommendations. Aesthetic Plast Surg. 2012;36:600–606. E-published ahead of print January 19, 2012.
4. Hermans BJ, Boeckx WD, De Lorenzi F, van der Hulst RR. Quality of life after breast reduction. Ann Plast Surg. 2005;55:227–231.
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