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Information about Vertical Mammaplasty

Mammaplasty surgery encompasses both breast reduction and breast uplift (mastopexy). With all modern mammaplasty procedures the nipple is transferred from its preoperative position to the ideal location above the level of the inframammary fold on a stalk of breast tissue which supports and retains the blood supply to the nipple and also its sensation. This stalk is known as the "pedicle". The most popular technique for this procedure is the inferior pedicle technique popularized by Robbins. The popularity of this procedure resides in the predictability of the outcome. The incision lines are marked before the surgery and once they have been described, the operation is carried out in a "recipe" fashion providing a regular and predictable result. However, there are problems with the inferior pedicle technique in that:

• There is an anchor shaped scar on the breast with a scar around the nipple, a vertical scar from the bottom of the nipple to the inframammary fold between the breast and chest wall and a horizontal scar in the fold beneath the breast where it meets the chest. This last scar can be quite long and can remain visible. It also has a tendency to become hypertrophic or keloid and, therefore, not only can it be unsightly, but also sometimes irritating or painful.
• In time the breast tends to develop a flat or boxy shape with a loss of forward projection and long-term droopiness of the breast beneath the inframammary scar can occur. The inferior pedicle techniques use the skin envelope to hold the breast shape and should the skin be subject to its natural stretching tendency, the shape can be lost with time.

  To combat these problems the vertical mammaplasty was developed and the operation generally favoured in Dr. Olbourne's practice is that described by Professor Le Jour. This operation utilizes a superior pedicle to elevate and reposition the nipple and in Dr. Olbourne's opinion gives a better long-term result. It has the advantages over the Robbins' type of procedure in that there is no horizontal scar in the submammary fold and, therefore, the risk of scar hypertrophy or keloid is eliminated. This procedure tends to produce a better shape with a conical breast which is more perky and forward projecting. The shape is better retained in the long term and there is less scarring. This outcome is achieved by the design of the operation which reduces breast size by the excision of a central pie-shaped segment of tissue. Resuturing the extremities of that glandular segment together reconstitute the breast shape which does not rely on the strength of the skin brassiere to maintain the long term result.

  The Le Jour procedure leaves the patient initially with a puckered vertical scar beneath the nipple which almost always resolves satisfactorily over a period of four to six weeks. This temporary drawback needs to be explained to prospective patients and accepted by them as the price of a better long-term outcome in terms of shape and scarring.

  An in depth consultation further explaining the principles outlined in this communication together with photographic evidence of the evolution of the procedure reassures almost every patient that the vertical mammaplasty for breast reduction and breast uplift is the preferred modern approach to the solution of this problem.