Most of the results of this technique seem to look pretty good. Yet doctors across the board seem keen on the anchor incision mastopexy. What gives?
Why Hasn't the No-vertical-scar Breast Reduction and Lift Technique Gained Wide Acceptance?
Doctor Answers 13
Technique to lift or reduce large breasts without a vertical scar
Thank you for your question.
I invite you to research the Ultimate Breast Lift/Reduction technique. This technique does not require a vertical incision nor does it require an implant to achieve upper pole fullness. It has been designed to give women projection and lift longevity by securing the breast mound permanently to the muscles below. This means that the skin envelope is not the only structure holding the breasts in place. Breast size is no longer a limiting factor with this technique. The UBL/R technique can be performed on patients with size M cups with no problem. The nipple/areola complex is never separated from the breast so women never loose nipple sensation and they have the ability to breast feed. The problem I've found with the vertical lifts is that the vertical incision weakens the skin envelope right at the point of maximum tension causing 'bottoming-out' or revisionary surgery sooner than expected. Look into it.
Hope this helps.
No vertical scar is an excellent technique in selected patients
I'm going to have to disagree with a lot of the comments. This technique is actually quite versatile and can be used with almost anyone large enough to need a breast reduction surgery. In my hands, it produce significantly better results with larger (>700-800 gram) breast reductions then does "short scar" vertical reductions. It is the best technique hands down for "deflated" breast shape you see with massive weight patients in whom you do not want to use an implant.
There is definately a learning curve to this operation, particularly with the markings to get a good result. The comments by other surgeons reflects (I think) our preference for predictability of result rather then innovation. When done right on appropriate patients, this type of reduction/mastopexy offers some distinct advantages.
Unlike the traditional wise pattern (anchor cut) or vertical reduction, you can produce a much more pronounced round shape with the vectors the closure produces such that it can almost look like an implant. I've found this type of incision to have much less bottoming out then my wise-patterns or vertical reductions when I follow them out 3-4 years.
Why the "no Vertical Scar" breast lift never caught on
It's best to first understand why a breast needs lifting in the first place- pregnancy, breast feeding, the aging process, gravity, and weight loss/gain cycles all contribute to the stretching of the breast skin and tissues that results in a sagging breast appearance.
Because these stretching forces occur in 3 dimensions, any technique that does not address all 3 dimensions in a well-balanced fashion will result in a funny looking breast...
So, as I sometimes ask my patients, if I asked you how you would feel about your surgery is you got the scar (technique) you wanted, but your breasts were funny looking? Probably not very good...
Furthermore, while most patient's scar concerns are greatest for the vertical portion of the scar (hence the desire to avoid the vertical scar), most experienced plastic surgeons would tell you that the vertical limb of the scar is usually the part that heals the best- with the least visibility.
Take a look:
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Liimited popularity of the no vertical scar breast reduction
Surgical techniques come and go. Then they are rediscovered, perhaps modified and then come and go. The "no visible scar" breast reduction of Passot has been around for a while but was rediscovered a few years ago. It never enjoyed much popularity because as noted above, it is only useful in distinct situations-specifically when the nipple is far below the crease of the breast.
Most breast reduction patients have breasts that are not only too long but also too wide. It is pretty easy to remove excess height and place the scar in the crease but narrowing the breast requires a vertical excision of tissue and results in a vertical scar. The "no visible scar" tehcnique will shorten the breast but not narrow it.
No vertical scar breast lift effectiveness
The around the areola breast lift is a nice lift, just weak. It is best for small cases. The physics of joining a large circle to a small circle creates a large amount of gathering when large lifts are performed with this technique and the nipple ends up looking bad.
Also, the effect of a purely around the areola lift causes a flattening effect of the breast.
If the patient has circulation issues (i.e. prior subglandular surgery), the around the areola lift can kill the nipple.
No vertical scar breast reduction and breast lift gives bad results.
1) This operation gives flat unattractive breasts.
2) Lollipop scar is best for breast lift and for most breast reduction. Best long term shape. Women accept the scars very well if they love their new perky breasts.
No Vertical Scar Breast Reduction?
The no-vertical scar breast reduction is just one of many tools available in the breast reduction toolkit. Unfortunately, it is not for everyone, and the patient must have the appropriate type of breast to undergo the procedure. When done correctly, the results can be very good. However, if done on the incorrect patient, the breasts can look boxy and distorted.
No vertical incision reduction
This operation has been seeing a renewed popularity especially with Dr. John McGraw who is an extremely respected plastic surgeon. The main problem with it is that in order to be a candidate for this your nipple has to be well below the crease below the breast. Many patients who want a reduction just aren't anatomically set up for this version. Also, without the vertical scar, it is hard to create a nice projecting conical breast shape.
Scars of breast reduction/lifts
There are techniques that do not use a vertical scar. However, most reduction and lifts of significance have an excess of skin in the horizontal or transverse direction. In order to reduce the amount of this skin, a vertical scar is necessary. Techniques that use only a peri-areolar incision and an inframammary incision cannot do much shaping to the breast mound. Likewise, a liposuction-only reduction does not permit much shaping, simply deflation.
The PASSOT (No Vertical Scar) Breast reduction and lift
Please see an earlier response I posted on this topic at - http://www.realself.com/question/passot-mccraw-lalonde-breast-lift-heard-passot-lalonde-breast-lift
The Passot (No Vertical Scar) Breast Reduction has been around since 1925 when it was described by Raymond Passot. It has not gained wide acceptance due to the ability of other operations to visibly and predictably better shape the breast. When it was resurrected by two outstanding surgeons, Drs. D. Lalonde of Canada and Dr. J. McCraw, a lot of surgeons tried using it again. By that time the debate shifted from focusing on skin pattern breast shaping to breast shaping breast lifting as exemplified in the Hall-Findlay Short Scar Breast Lift / Reduction technique.
I have shifted my practice to using the latter in 99% of my Breast Lift and Breast Reduction patients because the Hall-Findlay procedures (Lift or Reduction) give me
- a long lasting
- Perky Breast
- with only a Balloon / Lollipop scar
more than I was able to get with any of the older skin tailoring methods, including the Passot.
This said, There may be still room for this technique in certain patients but it will never displaced the much more versatile newer techniques.
Dr. P. Aldea