eMedicine Specialties > Plastic Surgery > Breast

Breast Reduction, Simplified Vertical: Follow-up

Author: Elizabeth J Hall-Findlay, MD, FRCS(C), Private Practice, Banff Plastic Surgery Centre
Contributor Information and Disclosures

Updated: Oct 21, 2009

Outcome and Prognosis

Without question, vertical reduction mammaplasty has improved scars.

Now that the author has had more than 16 years' experience, the results have proven that the shape is better and more durable with vertical reduction mammaplasty than with other techniques. The shape appears to resist the effects of gravity better with this method than with inferior pedicle. This outcome is believed to be because the tissue removed is the heavy inferior tissue and because the desirable superior breast tissue is preserved and left attached to the skin. This technique relies on the tissue resected, the shaping of the breast tissue, and the lack of reliance on the skin to hold and maintain the shape.

Vertical breast reduction follows the basic principles of plastic surgery, with a complete dermoglandular pedicle (rather than a dermal pedicle) and no skin undermining. Flap thickness and outward beveling are used to preserve the blood supply. This technique relies on breast resection and suturing for shaping and not on skin tension for shape maintenance.

Simplified vertical breast reduction is a variation on the vertical technique that uses a full-thickness medial pedicle for nipple circulation and breast shaping and resection of a vertical (not horizontal) wedge of tissue to improve the initial result and provide a long-lasting shape. The procedure is simple, fast, reproducible, and reliable. The learning curve is relatively short, and the improved results are well worth the change from the reliable inferior pedicle inverted-T techniques to the medial-pedicle vertical technique, in terms of both scarring and shape. Current techniques for coning of the breast tissue do not equal the increased projection and longevity of the shape possible with this type of vertical reduction.

Future and Controversies

Surgeons have been taught how to perform breast reduction by using a pedicle to carry the nipple areola and by avoiding undermining of the skin. Several variations have been adopted, but most rely on the skin brassiere to hold the shape.

Vertical breast-reduction techniques were initially adopted to reduce scarring. However, the future lies in a reassessment of the concepts. The skin brassiere can hold the shape initially, but it fails over the long term. The controversy is whether the skin brassiere or the breast parenchyma sutures are most important. Although both can be important, the key factors may be the nature of the resection and the reliance on the healing of the breast pillars to each other to hold the shape. Medial-pedicle vertical breast reduction removes the inferior tissue susceptible to the effects of gravity and leaves the superior tissue desired for shaping. Unfortunately, many Wise-pattern techniques leave tissue inferiorly. These techniques then rely on the skin brassiere to hold the shape. Therefore, the question that must be answered is this: Why should one rely on the skin to prevent ptosis when the skin fails and allows ptosis to develop in the first place?

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous editor Saleh M Shenaq, MD, to the development and writing of this article.



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References
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Further Reading

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Keywords

vertical reduction mammaplasty, breast reduction, simplified vertical, mammaplasty, mammoplasty, vertical reduction, medial pedicle vertical technique, vertical mastopexy, medial pedicle vertical reduction mammaplasty, mastopexy

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Contributor Information and Disclosures

Author

Elizabeth J Hall-Findlay, MD, FRCS(C), Private Practice, Banff Plastic Surgery Centre
Elizabeth J Hall-Findlay, MD, FRCS(C) is a member of the following medical societies: Alberta Medical Association, American Association of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, Canadian Medical Association, Canadian Society for Aesthetic (Cosmetic) Plastic Surgery, and Canadian Society of Plastic Surgeons
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

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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