The Vertical Breast Reduction Technique

With decreased scarring and shortened operative time, the vertical breast reduction increases patient satisfaction.

Successful breast reduction addresses both the functional and aesthetic aspect of the procedure. The plastic surgery community has been working along these lines for many decades. The typical breast reduction technique commonly utilizes the "Wise" pattern, which results in an upside-down T with scars around the areola vertical and transverse components in the inframammary fold.

The markings for this procedure are also quite different from the conventional breast reduction technique. The two cardinal landmarks in this technique are the vertical markings that demarcate the medial and the lateral pillars, as well as the so-called "mosque" pattern for the areola. Additionally, the new inframammary fold level is marked, approximately 2 cm to 5 cm higher than the native inframammary fold. The technical maneuvers do not lend themselves easily to a pattern type of reduction. They require a more intuitive approach, making it difficult to teach and learn this technique.

The vertical breast reduction technique, however, leaves only circumareola and vertical scars, which run from the areola to the inframammary fold. This technique is gaining acceptance in the United States and can be performed in less time than the standard breast reduction. It also requires less anesthesia time, results in fewer scars, and allows for a shorter recovery period. In addition, the vertical breast reduction also produces shapely breasts with more projection. The late sequela of flattened and bottomed-out breasts seem to be significantly less.

Practicing Principles

The basic landmark for vertical breast reduction is the same as in the more conventional technique. Mainly, the inframammary fold, the level of nipple areola complex as it is transposed onto the anterior breast and midline of each breast, as well as the native inframammary fold are marked and compared for symmetry.

Other components of this technique are radically different from the more conventional reduction methods. In this technique, the new inframammary fold is created 2 cm to 5 cm higher than the native inframammary fold. This technique requires the creation of the medial and lateral pillars of the breast. These two pillars create the basis of the new breast shape and position on the chest wall. The entire procedure is dependent on glandular breast tissue for shaping as opposed to on the skin. The skin is simply redraped over the new breast mound.

Vertical breast reduction surgery has the same risk and complication profile as a conventional breast reduction. There does not seem to be any increase in incidents of nipple areola complex, vascular compromise, or wound healing difficulties. The main drawback to this procedure is that immediate postoperative appearance of the breast may have too much superior projection and takes longer for the breast to achieve its final shape. In my experience, this has not been a significant issue in regards to patient acceptance.

Patients are uniformly pleased with the results, despite an occasional need for revision surgery. The lack of the inframammary fold scar, as well as a pleasant breast shape that tends not to bottom out, contributes greatly to patient's satisfaction. Since breast contouring relies on shaping breast tissue and not on skin tension, scars tend to heal nicely.