PURPOSE: The no vertical scar method of mastopexy closure provides an inherent upward force with reduction in lateral stresses. This counteracts the usual forces which result in recurrent ptosis. It is this vector which is effective in the conversion of the deflated and ptotic breast into an aesthetically pleasing and durable shape.

METHODS: 193 mastopexies and 522 small breast reduction procedures are presented using the no vertical scar technique. This represents the combined experience of five plastic surgery centers. The technique utilized an inferior pedicle with a single, upper skin flap. The nipple is brought out through an incision centered 7-8cm above the inframammary fold. Mastopexies were performed for significant glandular ptosis and ≥ 5cm of nipple descent. The reduction group included patients with reduction volumes of 500 – 1000 grams per breast. All patients were followed post operatively for at least one year.

RESULTS: Ptosis correction in both groups was documented by photography during the first three months and at subsequent post operative visits. Maintenance of the breast shape was confirmed and documented at follow-up one year and beyond. The mean excision weight of the mastopexy group was 385 gm. The mean excision weight of the reduction group was 875 gm. The results of nipple sensation were comparable to those reported for other inferior pedicle techniques. The areolar scar was felt by the surgeons to be better than that seen in other techniques. The horizontal inframammary scar was comparable to the standard anchor scar. Skin loss was rare and usually represented a superficial injury. In a few patients with exceptionally tight closures, wound disruptions necessitated secondary closures. There was no loss of the nipple-areolar complex. Surgical complications of seroma, hematoma, and infection were rare. Revisions for problems of shape or scar were infrequent. Breast implants were not required in any patient. Patient and surgeon satisfaction was very good to excellent.

CONCLUSION: The no vertical scar technique is an excellent mammaplasty technique resulting in predictable and lasting results. The shaping of the breast during the closure of the inframammary incision is thought to restrict the lateral deforming forces which contribute to recurrent breast ptosis as seen with other mammaplasty methods. The technique is easy to learn and teach. It has proven to be a reproducible method in five separate plastic surgery centers.
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