A ^Retired Plastic Surgeon's Notebook

Recent breast reduction article makes me wanna holler.

Seattle Plastic Surgeon takes umbrage at recent article in the Journal of Aesthetic Surgery.

Illustrations and photos showing three breast reduction techniques.

Illustrations and photos showing three breast reduction techniques. The top technique is a horizontal breast reduction, the middle is a Weis pattern breast reduction and the bottom is a vertical breast reduction.

I came across this article in the August 2013 Aesthetic Surgery Journal.   I must share this article with my readership because I think it presents some astonishing flawed logic about prodedure selection.

Let me walk you through it: Prospective patients were given illustrations of  3 breast reduction techniques emphasizing the scar placement and were also shown early postoperative photos of  the techniques.  Early is important because early on, scars are red and obvious.   Most prospective patients prefered a technique that did not involve a vertical scar from the nipple to the bottom of the breast.  Not a big surprise.  Of course women would prefer to have well hidden scars.

Here’s the kicker:  First of all, almost all these scars will fade within a year of surgery and in many cases be almost invisible across a room. Second of all, take a look at these breast shapes.  The top case shows a really boxy shape that will only get boxier with time.  Yeah, the scars are hidden under the breast but the shape is bizarre.  The middle case has better shape but still a little boxy and again, this will get worse with time and gravity.  The bottom case shows the technique that I almost always use – the vertical breast reduction.  Yes, there is a vertical scar but look at the shape.  The breast is round and contoured the way a breast should be.  And because of where the excess breast tissue is removed and how the resultant breast is shaped, this vertical technique holds up much better over time compared to the other two techniques.

The author of this article thinks the top technique, the horizontal breast reduction,  is a good  technique because patients prefer not to have a vertical scar.  This is such flawed logic because the scars fade and the horizontal technique leaves such a weirdly shaped breast.

In breast and body contouring, it is shape and contour, not scar length or scar position that is the most important.  And we surgeons have a fiduciary duty to educate our patients on the trade offs between scars and shape and contour.  I can’t imaging any patient prefering a result like the top case over the result in the bottom case regardless of the scars.

I feel so much better getting this off my, er, chest.  Thanks for reading!  Dr. Lisa Lynn Sowder


Category: Breast Contouring, Breast Reduction | Tags: , , , , , , ,

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