Since 1989, I have used vertical mammaplasty without a submammary scar for all breast reductions. This technique uses adjustable markings, an upper pedicle for the areola, and a central breast reduction with limited skin undermining. The shape of the breast is created by suturing the gland and does not rely on the skin.
A personal series of 100 consecutive patients (192 breasts) operated on from 1990 through 1992 is reviewed. Mastopexy was performed in 39 breasts. Among the 153 breasts that required reduction, liposuction was attempted as a complementary procedure before the surgical reduction in the 120 fattest breasts. Between 100 and 1000 cc of fat (mean 300 cc) could be suctioned in 86 breasts. This figure represents 50 percent of the large breasts in patients under 50 years of age and 100 percent of the breasts in patients older than 50 years. In these cases, liposuction made modeling of the gland easier and produced breasts with more useful and stable components. When liposuction was performed, surgical resection was adjusted to obtain the desired breast volume. The amount excised ranged from 120 to 1600 gm per breast (mean 480 gm). There were few complications, none of which required early reoperation. These complications were related to the weight of the breasts and not to the patient's obesity or to the liposuction procedure. In 10 percent of the patients, mostly those with very large and ptotic breasts, some skin redundancy was excised at the lower extremity of the scar after several months to improve the final result.
This series proves that vertical mammaplasty can be used in all cases of breast reduction, producing consistently good, stable results with limited scars. The adjunctive use of liposuction in fatty breasts can be considered safe and efficient.