Critical Appraisal of Nonvertical Mastopexy and Breast Reduction Techniques

Purpose

A 2006 survey revealed a high level of frustration among plastic surgeons using a variety of mastopexy and breast reduction techniques.¹  There has been little evidence to support one technique over another.  A new breast measurement system and terminology allow comparisons of breast shape before and after surgery, and between inverted-T and vertical techniques, using standardized photos.

Methods

Patients with “typical” results were selected from a patient database using low z-scores to determine those patients whose measurements were closest to the mean for each treatment group.  Patients treated using the inverted-T technique, inferior pedicle, were compared to those treated with the vertical technique and a medial pedicle.²

Results

Measurements demonstrated an increase in breast projection and upper pole projection for vertical mastopexy.  The inverted-T mastopexy provided no significant increase in breast projection or upper pole projection.  The upper pole contour after vertical mastopexy was linear; after an inverted-T mastopexy, the contour was slightly concave.  The inverted-T mastopexy reduced the lower pole distance (length along the lateral curve from maximum breast projection to the posterior breast margin).  Both inverted-T and augmentation/mastopexy techniques provided increased breast projection and upper pole projection.

Breast reduction patients demonstrated a loss of breast projection (Fig.1), but there was a slight increase in upper pole projection in the patient treated with the vertical technique.  After inverted-T reduction, the upper pole contour was slightly concave, versus parabolic for the vertical reduction.  All mastopexy and reduction patients treated with the inverted-T technique had overelevated nipples and shortened lower pole distances.

Conclusions

The inverted-T, inferior pedicle technique uses a horizontal resection pattern that results in less breast projection and upper pole projection than the vertical technique and a constricted lower pole, consequences of a horizontal resection pattern (Fig. 2). The vertical design makes use of lower pole tissue to increase projection and provide superior shape. 

References

1. Rohrich RJ, Gosman AA, Brown SA, Reisch J. Mastopexy preferences: a survey of board-certified plastic surgeons. Plast. Reconstr. Surg. 2006;118:1631-1638.
2. Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast. Reconstr. Surg. 1999;104:748-759.

Legends

Fig. 1.  Vertical breast reduction.  (Left) Orientation-matched views of low-z-score 28-year-old patient before and (right) 6 months after vertical breast reduction using a medial pedicle. 

Fig. 2.  Resection Patterns.