Horndeski method, re: Scarless Breast lift

The Horndeski method is a combination of a circumareolar (Benelli) mastopexy and an inframammary skin resection.  This technique leaves scars around the areola and in the inframammary fold, therefore it cannot be called a "scarless" breast lift by definition.  Also, the inframammary resection of skin and resultant scar is usually the least attractive and thickest scar seen in a breast lift because it does not follow Langers lines.  Attempts at taking breast tissue inside the skin envelope and anchoring it to the periosteum of the ribs has been championed by many famous plastic surgeons, including Louie Benelli of Paris, France.  These attempts to give fullness in the upper quadrant by repositioning breast tissue, while valiant and well thought out, ultimately failed and drooped.  On the other hand, well positioned breast implants give excellent and long lasting upper pole fullness.  The circumareolar or Benelli mastopexy is excellent for minor breast lifts, especially as seen in tuberous breasts, but unfortunately truly droopy breasts, which are corrected with circumareolar lifts, lead to very unacceptable periareolar scarring due to significant pleating and a starburst effect.It has been my personal experience that the vertical scar on a standard breast lift is a very forgiving scar which tends to fade significantly with time.  Also, this vertical lift can decrease both the tension on the circumareolar scar and also bring in tissue from the margin giving the breast its natural, cone-shaped appearance.In addition, the circumareolar and the inframammary scars both decrease the vertical length of a droopy (ptotic) breast.  When you decrease the vertical length of a breast, you add to the horizontal width, and only the vertical scar from the standard Wise pattern corrects this widening of the breast by pulling the tissue in towards the midline and then resecting it.  This same concept can be seen in tummy tucks where, when you pull the tummy tuck downward and consequently bring the vulva and anterior thigh tissue upward, this leads to bulging towards the sides, and without a secondary liposuction, many patients complain that their waist is thicker after an abdominoplasty.  As a sidebar note, this thickness in the lateral abdomen can be corrected by secondary delayed liposuction.  Some have claimed that the Wise pattern breast lift depends on skin support to lift the breasts.  This was probably true in the 1970's, but after Ted Lockwood, MD from Kansas City taught plastic surgery that the SFS (superficial fascial system) below the skin is where the true strength is, I doubt seriously if any well-trained Board Certified plastic surgeon would depend on skin only when doing a breast lift in the 21st century.Breast lifts, just like all cosmetic plastic surgery procedures, depend less on the technique and more on the quality of the surgeon.  In choosing a plastic surgeon to do your breast lift, check out before and after pictures, videos, and online reviews, and then consult with at least three Board Certified plastic surgeons in your area.  Choose the surgeon and not the technique.    

Dear Carlcarl,Thanks for your question.I am very fortunate to be the first surgeon that Dr. Horndeski has trained in his technique.  The amazing results were what drew me to contact him and undergo extensive training to learn how to do the procedure.The traditional breast lift techniques depend in large part on the skin to support the lifted breast.  In addition, breast tissue that is low on the chest cannot be lifted to degree necessary for good results.  The Horndeski method is a totally new technique that uses a revolutionary internal support mechanism and a mathematical formula to guide the surgeon.  The scars are hidden around the areola and under the breast.  There are other techniques that have the same pattern of scarring.  Only Dr. Horndeski's procedure has the internal support that makes his surgery so unique.  The scar pattern isn't as advantageous as the shape and lift that is obtained with the Horndeski method.  Prior to learning his technique, I would have thought breast implants to be essential in patients with significant drooping that desired fullness in the upper half of the breasts.  There is now an alternative for these patients who do not want implants.Aloha,Shim Ching, MD

If there was a really good method for performing breast lifts without scars, we would all be doing it. Furthermore, the Horndeski Method only gets rid of the vertical scars. Whether it would be a viable option in your case is impossible to say without seeing you in person. Best, Dr. Nazarian

I have seen Dr. Horndeski 's website and I think his results are nice.  In truth, the method only eliminates the vertical scar blew the areola.  That vertical incision also serves to create a cone shape out of the breast.  I think his method is valid, but I don't know if many other plastic surgeons have adopted it.

If there was a GOOD way to perform a breast lift without a scar we would all love to do it for you.  I have dabbled with some of these techniques, but they just don't work to my (or my patients) satisfaction.  You are better off sticking with the mainstream.Good Luck!

Hello,Unfortunately, we must abide by the laws of the physical universe, and you can't reduce skin excess without removing skin, which in turn produces a scar, and you can't lift a breast without removing skin, and sometimes breast tissue too.Go see some great cosmetic breast specialists and look at their photos. You may be pleasantly surprised that scars can become quite inconspicuous. Best of luck!

I appreciate your question.The best advice is rather than focusing on scars, focus on the proper procedure to get the best long term results. This can be around the areola, vertical, anchor and non-vertical to name a fewWhen you limit the scars, you limit the procedure and increased your risk for a second revision surgery.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

The fundamental problem with breast lifts that place a lot of the burden of lifting the breasts in a short area (i.e. short incision) is physics.If the breast needs minimal lift, or if there are problems with the location of areolar tissue, a nipple-crease operation may be just the right thing.  However if you have a lot of breast tissue to lift, by sewing a big circle to a small circle, it will gather, and not look good.The most important part of the breast that has to look good is the nipple.  That is why the vertical incision is so useful:  it allows the surgeon to distribute the extra tissue into the vertical incision.  It also allows the surgeon to tighten axillary skin, give the breast extra projection, and generally make the breast prettier.That's why aggressive Benelli (just incisions around the nipple) for moderate to major drooping generally look flattened and have a 'sun-burst' effect.  Many have since been redone to Wise pattern breast lifts.So rather than focusing on a particular technique, focus on a surgeon who is going to give you a great result.

Since the majority of surgeons will tell you the vertical scar on the breast is much less problematic than the scar in the fold, the "scarless" method is seen as a sales technique, other techniques or at least as good and may be better if the scar is a big concern. 

This technique eliminates the vertical scar but still has the areolar and crease scars so to call it "scarless" is completely false. I find that with the central pedicle procedure as described by Hester in the mid-80's an artistic surgeon can do so much more in shaping than with what I see from the Horndeski results. The vertical scar allows the surgeon to pull the tissues and skin in from side to side giving more forward and conical shape to the breast - a more 3 dimensional result. Over time, the vertical scar practically disappears so I personally think it is a good tradeoff. Note in the Horndeski procedure that the final results tend to look flat in front and baggy at the bottom compared to what I can show you on my web site from the central pedicle. Just a matter of personal preference of better shape but a little more scar.