ANATOMY

More recent techniques have shifted this focus to concentrate on shaping the breast content (parenchyma) and allowing the skin envelope to re-drape. This “philosophy” of moving away from skin tightening and towards effecting change through manipulation of deeper tissues is also found in modern facelift techniques.

Advantages: It is easy to perform, easy to teach and easy to learn. It involves the application of a “fixed” skin pattern design which results in an “anchor” type of scar on the breast (around the areola, a vertical scar to the breast fold, and a long scar underneath the breast, in the fold, from side to side). It can be used for small reductions, lifts, as well as very large reductions, and the results are generally good.

Disadvantages: The major disadvantage is the extent of the scarring, the quality of which can be good or bad, depending on the patient’s skin type, and wound healing ability. In addition, the breasts are occasionally slightly under projected, and tend to “bottom out” with time – this may well be due to the fact that the breast content is not specifically addressed in this surgery, but rather, the shape of the content is determined by the skin pattern design which removes excess skin in both the vertical and horizontal planes.

This vertical breast reduction has undergone several refinements over the years, and is only more recently gaining wider acceptance. I was fortunate enough to attend a course in San Diego in 2003 given by Dr Elisabeth Hall-Findlay who has refined the technique, and whose method I tend to follow when doing this surgery.

Advantages: Interestingly, the main reason for pursuing this operation (i.e. the shorter scar) is not the major benefit of the surgery. Although the scar is shorter (and the operating time somewhat less) the main advantage appears to be the improved breast projection gained from shaping the parenchyma (content) by using sutures in the breast substance to maintain this projection over time. Conceptually, this is a “breast content shaping” operation, rather than a “skin shaping” operation. In addition, the breast base is narrowed somewhat, and the breast fold is lifted.

Disadvantages: The operation is more difficult to teach, to learn and to perform, as no “fixed pattern” is used – hence some degree of experience is needed. That said, this operation does have a slightly higher minor revision rate (small scar revisions etc) than the Wise pattern , even in the best hands. Another disadvantage is that this technique is not suitable, in my opinion, (and hands!) for larger reductions (over about 500g per side), where I still tend to favour the Wise pattern. Lastly, patients need to be made aware that the breasts will often take a minimum of 3 months to look more natural – they usually have a slightly odd shape early post- op, and the skin of the lower pole is often pleated (much like a curtain pushed together on a rail) initially.

Despite these “trade-offs”, the improved projection, lesser scarring, and probable better long term stability of results, make this an attractive option in well selected patients.