eMedicine Specialties > Plastic Surgery > Breast

Breast Reduction, Lejour: Treatment

Author: Antonio Espinosa-de-los-Monteros, MD, Staff Physician, Department of Surgery, Division of Plastic Surgery, University of Alabama, Birmingham
Coauthor(s): Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Contributor Information and Disclosures

Updated: Sep 30, 2009

Treatment

Medical Therapy

Some of the symptoms related to macromastia may show some improvement with analgesics, but definitive treatment of macromastia is entirely surgical.

Surgical Therapy

The Lejour technique involves a vertical reduction based on a superior pedicle and includes breast liposuction and wide lower skin undermining.

Preoperative Details

Before the surgery, pictures are taken in different views. The sternal notch – to-nipple distances and the nipple-to – inframammary fold distances are recorded and documented properly. Patients are instructed on the purposes of the procedure, the goals that may be achieved, the expected final size and shape of the breasts, the expected final appearance of the scars, changes in nipple sensations, changes in the ability to breastfeed, and possible complications. Patients are instructed on what to expect during their recovery period and on proper wound care.

While the patient is standing, the technique begins by marking the patient with the mosque dome pattern of skin incision and the area that represents the superior dermoglandular pedicle. Markings are placed in the breast midline, the inframammary fold, and the vertical axis of the breast beneath the inframammary fold. The upper edge of the future areola is marked slightly below the level of the inframammary fold, and a semi-circumference no larger than 16 cm is marked. By displacing the breast medially and laterally in relation to its vertical axis, the peripheral limbs are marked, joining together no less than 5 cm above the inframammary fold. The future areolar circumference is marked around the nipple. A minimum of 10 cm of superior pedicle width is marked at the upper border of the future areola and continued in a conical shape down around the marked circumference.

Preoperative markings that demonstrate superior p...

Preoperative markings that demonstrate superior periareolar pedicle and inferior skin/parenchymal resection margins.

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Preoperative markings that demonstrate superior p...

Preoperative markings that demonstrate superior periareolar pedicle and inferior skin/parenchymal resection margins.


Intraoperative Details

After markings are done, patients are placed symmetrically on the operating room table with arms abducted and secured to allow intraoperative placement in a semisitting position. Draping is also performed symmetrically to provide an accurate assessment of postoperative breast symmetry. A dose of prophylactic antibiotic is administered. The breasts are injected with lidocaine and epinephrine, the pedicle epidermis that surrounds the areola is excised, and fat from the breast tissue is suctioned. Next, the medial, lower, and lateral segments of the breast are resected, with undermining of the skin below the lower curved marking. Resected tissue is sent for histopathology inspection, since subclinical foci of cancer can be found in 0.1-0.9% of the specimens.10,11,12

Demonstration of partial inset of superior pedicl...

Demonstration of partial inset of superior pedicle and development of breast mound from medial and lateral pillars.

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Demonstration of partial inset of superior pedicl...

Demonstration of partial inset of superior pedicle and development of breast mound from medial and lateral pillars.


Next, the nipple-areola complex is inset, the parenchymatous pillars are approximated, and the skin is closed. The original technique does not result in horizontal scars, but some newer modifications include the use of small horizontal scars along the inframammary fold in order to avoid redundant skin, particularly in larger breasts.13

Immediate postoperative appearance, demonstrating...

Immediate postoperative appearance, demonstrating exaggerated upper pole fullness, downward pointing nipple, and bunched skin on the lower pole of the breast.

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Immediate postoperative appearance, demonstrating...

Immediate postoperative appearance, demonstrating exaggerated upper pole fullness, downward pointing nipple, and bunched skin on the lower pole of the breast.


Current evidence suggests that drains can be avoided, since the incidence of collections and wound healing events are the same with or without their use.14

Postoperative Details

Dressings may vary with surgeon preference and include adhesive strips of tape, liquid skin adhesive, gauzes, pads, tape, and supporting brassieres. Patients are told to ambulate and resume light diet the same day of the surgery. They can shower the day after the surgery but should avoid strenuous physical activity and should wear a sports brassiere. This can be maintained for 3 months.

Follow-up

Regular visits are scheduled to ensure an adequate outcome and provide early identification and proper care of possible complications. The wrinkles at the bottom of the vertical scar usually fade away in 1-6 months, although some surgical revision of this area might be required.

Complications

In the original report from Lejour, 153 reduction mammaplasties were performed in 79 patients, with an average liposuction of 300 mL per breast and an average resection of 480 grams per breast with very satisfactory results.7 Postoperative complications in the form of seroma, wound dehiscence, hematoma, and partial areolar necrosis were seen in 10% of breasts. Lejour later updated her experience on 324 reductions performed in 167 patients, with this complication seen in 7% of breasts.8

Several studies on the use of this technique have been published since. In general, postoperative complications are seen more commonly in patients with large resections, obesity, history of tobacco use, and young age.15,16 Some evidence suggests that wound dehiscence, epidermolysis, fat necrosis, and infection are less common in patients who undergo the Lejour technique than in those who undergo the Wise pattern and inferior pedicle techniques. However, some asymmetry, particularly along the bottom edge, tends to be more common in patients who undergo the Lejour technique; revision rates can be up to 10%. Liposuctioning of the breast has not been shown to increase the rate of local complications. Decreased sensitivity is seen in 10% of patients, while total loss of sensitivity occurs in 1%.9

More on Breast Reduction, Lejour

Overview: Breast Reduction, Lejour
Workup: Breast Reduction, Lejour
Treatment: Breast Reduction, Lejour
Follow-up: Breast Reduction, Lejour
Multimedia: Breast Reduction, Lejour
References
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References

  1. Wise RJ. A preliminary report on a method of planning the mammaplasty. Plast Reconstr Surg. May 1956;17(5):367-75. [Medline].

  2. McKissock PK. Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg. Mar 1972;49(3):245-52. [Medline].

  3. Lassus C. A technique for breast reduction. Int Surg. Jan 1970;53(1):69-72. [Medline].

  4. Lassus C. An "all-season" mammoplasty. Aesthetic Plast Surg. 1986;10(1):9-15. [Medline].

  5. Lassus C. Breast reduction: evolution of a technique--a single vertical scar. Aesthetic Plast Surg. 1987;11(2):107-12. [Medline].

  6. Weiner DL, Aiache AE, Silver L, Tittiranonda T. A single dermal pedicle for nipple transposition in subcutaneous mastectomy, reduction mammaplasty, or mastopexy. Plast Reconstr Surg. Feb 1973;51(2):115-20. [Medline].

  7. Lejour M. Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg. Jul 1994;94(1):100-14. [Medline].

  8. Lejour M. Vertical mammaplasty: early complications after 250 personal consecutive cases. Plast Reconstr Surg. Sep 1999;104(3):764-70. [Medline].

  9. Hofmann AK, Wuestner-Hofmann MC, Bassetto F, Scarpa C, Mazzoleni F. Breast reduction: modified "Lejour technique" in 500 large breasts. Plast Reconstr Surg. Oct 2007;120(5):1095-104; discussion 1105-7. [Medline].

  10. Kakagia D, Fragia K, Grekou A, Tsoutsos D. Reduction mammaplasty specimens and occult breast carcinomas. Eur J Surg Oncol. Feb 2005;31(1):19-21. [Medline].

  11. Pitanguy I, Torres E, Salgado F, Pires Viana GA. Breast pathology and reduction mammaplasty. Plast Reconstr Surg. Mar 2005;115(3):729-34; discussion 735. [Medline].

  12. de Groot RM, Kingma-Vegter F, Bakker XR. [Occult breast cancer discovered following breast reduction.]. Ned Tijdschr Geneeskd. 2009;153:[Medline].

  13. Azzam C, De Mey A. Vertical scar mammaplasty in gigantomastia: retrospective study of 115 patients treated using the modified lejour technique. Aesthetic Plast Surg. May-Jun 2007;31(3):294-8. [Medline].

  14. Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trail. Br J Plast Surg. Apr 2005;58(3):286-9. [Medline].

  15. Cunningham BL, Gear AJ, Kerrigan CL, Collins ED. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg. May 2005;115(6):1597-604. [Medline].

  16. Schumacher HH. Breast reduction and smoking. Ann Plast Surg. Feb 2005;54(2):117-9. [Medline].

  17. O'Blenes CA, Delbridge CL, Miller BJ, Pantelis A, Morris SF. Prospective study of outcomes after reduction mammaplasty: long-term follow-up. Plast Reconstr Surg. Feb 2006;117(2):351-8. [Medline].

  18. Miller BJ, Morris SF, Sigurdson LL, Bendor-Samuel RL, Brennan M, Davis G, et al. Prospective study of outcomes after reduction mammaplasty. Plast Reconstr Surg. Apr 2005;115(4):1025-31; discussion 1032-3. [Medline].

  19. Mello AA, Domingos NA, Miyazaki MC. Improvement in Quality of Life and Self-Esteem After Breast Reduction Surgery. Aesthetic Plast Surg. Sep 19 2009;[Medline].

  20. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ, Walker LG. Effects of bilateral breast reduction on anxiety and depression: results of a prospective randomised trial. Scand J Plast Reconstr Surg Hand Surg. 2006;40(1):19-23. [Medline].

  21. Cherchel A, Azzam C, De Mey A. Breastfeeding after vertical reduction mammaplasty using a superior pedicle. J Plast Reconstr Aesthet Surg. 2007;60(5):465-70. [Medline].

  22. Heine N, Eisenmann-Klein M, Prantl L. Gigantomasty: treatment with a short vertical scar. Aesthetic Plast Surg. Jan 2008;32(1):41-7. [Medline].

  23. Lista F, Ahmad J. Vertical scar reduction mammaplasty: a 15-year experience including a review of 250 consecutive cases. Plast Reconstr Surg. Jun 2006;117(7):2152-65; discussion 2166-9. [Medline].

  24. Aufricht G. Mammaplasty for pendulous breasts; empiric and geometric planning. Plast Reconstr Surg (1946). Jan 1949;4(1):13-29. [Medline].

  25. Kreithen J, Caffee H, Rosenberg J, Chin G, Clayman M, Lawson M, et al. A comparison of the LeJour and Wise pattern methods of breast reduction. Ann Plast Surg. Mar 2005;54(3):236-41; discussion 241-2. [Medline].

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Further Reading

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Keywords

breast reduction lejour, Lejour reduction mammaplasty, vertical reduction mammaplasty, short scar breast reduction, Lejour vertical reduction technique, Lassus reduction, mammoplasty, mammaplasty, breast surgery, breast reduction pictures, breast reduction surgery, Lejour surgery, Lejour pictures, nipple-areola complex, inframammary fold, breast surgery scar, breast scar, surgical scar

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Contributor Information and Disclosures

Author

Antonio Espinosa-de-los-Monteros, MD, Staff Physician, Department of Surgery, Division of Plastic Surgery, University of Alabama, Birmingham
Disclosure: Nothing to disclose.

Coauthor(s)

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

Medical Editor

Pankaj Tiwari, MD, Assistant Professor, Division of Plastic Surgery, Ohio State University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Saleh M Shenaq, MD†, Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston
Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law Medicine and Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

James Neal Long, MD, Assistant Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, University of Alabama at Birmingham and Kirklin Clinics
James Neal Long, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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