Horndeski Method? No scars, why aren't more doctors using this method?

Question

Have yet to get my first major plastic surgery done. I am told i will need a Vertical Breast lift. I search up many methods so i can understand it all more. I first wanted to just do an areola reduction ,but i see that my areolas will just widen over time so i was warned. [[ Horndeski method seems to good to be true why dont we here more of this method too. ? -Is anyone else doing these methods in Arizona ? ]]

Steven Teitelbaum, MD · Answer

I have not heard of Horndeski nor the Bellasoma(TM) procedure,  but no vertical scar reductions have been around for many decades.  Perhaps he has his own modification, but all of us have a personal twist on everything we do.  If I am incorrect I am will retract this post.  I did do a medical search to find articles on this and I do not see where the "Bellasoma(TM) Method" was ever published.  Getting a trademark does not mean that the procedure is actually novel nor does it mean it has been vetted in a proper medical journal.
The bottom line is that ALL well-trained plastic surgeons are aware of "no vertical scar" breast reductions and lifts.  Those that use them think the result is beautiful and are pleased to not create a vertical scar.  Those who do not use them - which is most of us - choose to use vertical scars because we think we can get a better shape with it.
Think about it: a horizontal scar can only reduce vertical laxity, and a vertical scar can only eliminate horizontal laxity.  That is why vertical-only and lifts and reductions look relatively overly-projecting and narrow, and why no-vertical lifts and reductions look relatively flat.
I've seen outstanding plastic surgeons use just about any of the procedures. Your decision should not be technique based, but surgeon based.  Who do you like personally?  Who shares your aesthetic?  Who do you trust?  Whose results do you like?  Those are the relevant questions, and not the technique.
BTW, the link below is to a site that discusses the history of the "no vertical scar technique."

Kenneth Hughes, MD · Answer

There is a periareolar scar and an inframammary scar.  This can be done if you are willing to accept a flatter, less projected breast with a boxier appearance.Kenneth Hughes, MDLos Angeles, CA

Gary M. Horndeski, MD · Answer

Hi Trinity,Thank you for your question. Allow me to clarify. The Horndeski/Bellesoma Method does have scars. They are found around the areola and in the infra-mammary fold. They heal very well due to minimal tension on the incisions. Unlike the Passot (and others), the weight of the breast is transferred to the pec major muscle to hold the breast in place for long term results. The traditional vertical techniques solely rely on the skin envelope to hold breasts in place. Neither the Passot nor the Robertson or any others construct an internal cone with straps to improve shape, projection and longevity. Breast surgery should consider both aesthetics and function. Not only should a breast be beautiful by minimizing number of scars, improving shape and tone, but care must be taken to preserve nipple sensitivity and the ability to breast feed; all of which are successfully achieved with my method. You are welcome to visit my gallery to see for yourself how this technique can be applied to a wide spectrum of breast sizes and degree of ptosis. This technique was presented in the Aesthetic meeting in April of 2016. Surgeons around the country including Canada have already been certified on The Bellesoma/Horndeski Method. Dr. Ramon Robles will be undergoing training late March of this year in Phoenix Arizona. I hope this helps.Best wishes and kind regards,

Joseph Mele, MD · Answer

It sounds like an oxymoron, but I call this the horizontal breast lift. It is not a new procedure, but it is only applicable for very specific breast shapes. The procedure uses incisions placed in the crease under the breast and a periareolar incision. The vertical scar is eliminated, and I can say, this makes patients very happy.The lower incision removes excess skin and pushes the breast tissue up. The periareolar scar is necessary to bring the nipple up on the breast. The vertical scar cannot be eliminated if the nipple needs a moderate lift in position, because the "hole" in the skin where the nipple used to reside needs to be closed vertically in these cases. Unfortunately, this is the most common situation, and why many women do not qualify for this type of lift.The horizontal breast lift is best for saggy narrow breasts with the nipple low on the breast or when the nipple is close to the ideal position, but the breast has bottomed out (pseudootosis). Paradoxically, your breast can be more saggy, in order to qualify for a smaller scar. It the in between position that leaves an opening that is closed as the vertical component of the inverted-T scar. The vertical component also allows for enhanced horizontal tightening of the breast skin, so wide breasts may be better treated with the anchor scar.Examples of this and other breast lifts can be found in the before and after pictures and videos available via the link below.

Robert J. Spies, MD · Answer

Hello and thank you for using RealSelf.com.Well, before I decided to answer this question, I had to research this type of breast lift.  I honestly never heard of it before, nor have I ever heard other colleagues discuss it as well (30 years performing plastic surgery).   Maybe there is a reason for that but I do not know that either.What is your concern is the vertical scar from the areola to the crease.  This scar is necessary if you have a saggy breast that is also too wide across the chest.  This scar allows the plastic surgeon to not only lift the breast but narrow the diameter for a more youthful appearance.  This scar fades as well as the other scars in my experience.  I just do not hear any complaints from my patients about the scar.  I do believe that implants allow a breast lift to last longer especially using textured implants.  His technique is supposed to avoid the use of implants.  Most lifts that I do include implants because most of my patients want to be a bit larger as well as lifted.I commend Dr Horndeski for his innovation.  He is pushing the envelope which is what needs to be done to continually make progress and advancements in plastic surgery.Dr Spies

Gary L. Ross, MBChB, FRCS · Answer

You need to see a PS and be taken through different results in different patients. There are pros and cons of each technique. A vertical scar will always tend to project the breast more and performed correctly the scars are often not an issue long term. Leaving excess skin the lower pole will lead to a less projected look. Of course you can always go down the no vertical scar route (if a suitable candidate) and see how this goes and consider a coning / vertical skin excision secondarily.

Curtis Wong, MD · Answer

as advocated by Dr. Horndeski is more of a marketing issue.  The vertical scar reliably heals well and helps improve projection and keep the areola size stable better than the 'no vertical scar' technique.  I really like the auto-augmentation vertical scar technique where your own tissue is used to boost the projection of your upper pole.

Donald W. Hause, MD · Answer

Most things that appear too good to be true usually are. Without pictures it is hard to say what specifically would be the best option. However, techniques that employ minimal or creative scars usually require a very specific anatomy to work well and otherwise compromise the ultimate result. Many times this compromise is worse than having a visible scar. The nice thing about Vertical Mastopexy is that the surgeon can easily address issues of shape and nipple position at the same time to give the best overall shape and result. However, all cosmetic surgery involves compromise and picking the best technique requires you seek advice from a well qualified and experienced surgeon. Best of luck.

Mark A. Brzezienski, MS, MD, FACS · Answer

"Sustained result" is the "holy grail" of breast lift.  Truth be known...there is no surgical intervention for breast lift that produces an unfailing result over time.  Gravity and time, simply cannot be overcome.  There is also no "scarless" method of breast lift. 
I suggest that you find a board-certified plastic surgeon with aesthetic breast experience who is going to give you an honest education regarding surgical breast lift and how it applies to your specific situation.
Be sure to discuss your expectations with the Surgeon.  There is nothing worse than when a patient is disappointed by a result because they had un-achievable expectations.

Millicent Odunze Geers, MD, MPH · Answer

The "no vertical scar breast reduction/lift" or "horizontal breast reduction/lift" is not a new procedure and it certainly wasn't created by Dr. Horndeski. The Passot (No Vertical Scar) Breast Reduction has been around since 1925 when it was described by Raymond Passot. I have done this procedure with successful results. There is a specific type of breast that will achieve a good result with this method. Not all breasts are a candidate for this specific procedure. More surgeons don't use this method because it's not widely taught. And you are wise to avoid an areola-only based lift. The projection of the breast flattens and the areola widens with time with this type of breast lift. Best of luck.

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