Vertical Reduction and Mastopexy: Problems and Solutions

Abstract

To a certain extent all surgical techniques evolve over time as a consequence of attempts to improve results and prevent complications. The same can be said of the evolution of vertical mammaplasty. The early goals of breast reduction revolved around the search for a reliable technique to transpose the nipple-areola complex. The 1960s saw the introduction of the superior pedicle by Arie [1] and Pitanguy [2], as well as the horizontal bipedicle by Strombeck [3] and the lateral cutaneous pedicle by Skoog [4]. The vertical bipedicle method was popularized by McKissock [5, 6] in the 1970s. During the 1980s and 1990s the inferior pedicle [7–10] became the technique of choice for surgeons in North America due to its ease and reliability. Concurrent with the evolution of reliable pedicles for nipple-areola transposition was the implementation of the Wise pattern skin markings, which resulted in an inverted T-shaped scar. The unsightly appearance of the horizontal inframammary scar in some patients spurred the next step in the evolution of breast reduction techniques, the vertical scar mammaplasty.

It does a bullet no good to go fast; and a man, if he be truly a man, no harm to go slow; for his glory is not at all in going, but in being.

John Ruskin