SPAIR or Anchor Technique? (photo)

Question

I have seen 2 different PS with different ideas. The first suggested anchor technique due to asymmetry and severe sagging. The second suggested SPAIR technique because the results are more long lasting and offer a more natural breast. I don't like the boxy look of the anchor technique, but was told that I had too much excess skin for the SPAIR technique from the first doctor. Which would be more appropriate? I want a lift on the left and reduction/lift on the right.

William T. Stoeckel, MD · Answer

I would not use either of the techniques that you listed, but that does not mean that they would be wrong to use. Every surgeon is going to have a technique that works best for them. And I would agree that the surgeon is more important than the technique. I personally have seen the best results using a vertical breast reduction technique popularized by Elizabeth Hall Findlay. This technique allows for internal shaping of the breast tissue and minimizes scarring. Check the before and after photos of the surgeon's that you are considering.

Ronald J. Edelson, MD · Answer

In my hands, I would do the anchor technique. I feel this method is better at providing fullness in the upper portion of the breast because it repositions breast tissue in the upper portion of the breasts better than short scar technique. Overall ,however, you are best off with an experienced surgeon using the approach he or she feels they can obtain the best result with. Good luck!

Daniel A. Medalie, MD · Answer

HI,

	The best technique for breast reduction is the one your doctor is most comfortable with. What this means is that there are several good and equally effective ways to reduce a breast while lifting it at the same time. If your doctor is used to the SPAIR technique, then by all means go with that. In general, I personally find (especially with the way that your left breast looks) that the wise pattern "inverted T" or anchor technique is the most straight forward and reproducible technique. The scar at the inframammary fold is longer but is hidden in the fold. Make sure that your surgeon feels very comfortable with handling the volume differences between your two breasts.

	All my best,

	Daniel A. Medalie, MD

Gerald Minniti, MD, FACS · Answer

Hello,

	Having seen many of his surgeries and presentations, and after reading his book, Dr. Hammond's SPAIR seems unnecessary and offers no real advantage over the standard anchor/Wise pattern technique in a woman with your breast type (especially your left breast).  In the best of hands (Dr. Hammond's?), you will have horizontal extensions of both your vertical incisions to the outer part of the inframammary fold (the J pattern). 

	The suggestion that the SPAIR offers more natural or long lasting results is just unfounded. The anchor technique does not always yield a boxy shape to the breast either; that is merely a result of insufficient skin and tissue resection on the sides.  The best and most durable results are gotten when the breast is made smaller and lighter, regardless of the technique.

	In my practice, scars are almost always a non-issue, and I am used to the anchor/Wise pattern lift/reduction.  I think you will be best served by a very experienced cosmetic breast surgeon who has done hundreds of reduction and lifts who performs the lift of his choice on you (most likely not the SPAIR).

	Best of luck!

Steve Laverson, MD, FACS · Answer

In agreement with other responders, technical execution of your procedure should be the domain and responsibility of the surgeon you select. Both techniques you mention are standards, and, in my opinion, both can provide a good result. One surgeon feels more comfortable with "anchor," the other with "SPAIR." Look at "before and after" photos demonstrating results of each technique, and decide for yourself based on breast shape, scars, symmetry, and also based on your confidence in the surgeon to produce your desired outcome. Regardless of who you select and what techniques are incorporated, there is no perfection.

Remus Repta, MD · Answer

Hello,

	Thank you for the question.  I think the right answer for you would be to choose a plastic surgeon that has before and after results of breast reductions that you like regardless of the technique they use.  Vertical breast reduction and SPAIR techniques can also be used on large breasts.  They tend to shape and cone the breast tissue better and can lead to a rounder looking breast....at least in the early healing period.  The WISE pattern (anchor) is somewhat more straightforward to learn but it does not cone the breast so it naturally leads to a more boxy appearance after surgery.  Breast reduction techniques are often debated among plastic surgeons but the newer techniques as mentioned above are becoming the more commonly utilized breast reduction techniques.

	All the best,

	Dr. Remus Repta

Peter E. Johnson, MD · Answer

All techniques are very good for breast reduction, and even a 'T' pattern will not have a 'boxy' shape if done well. The issue is selecting a surgeon who you have a good relationship with and you have the confidence in to adequately correct your asymmetry.

Tom J. Pousti, MD · Answer

Although it is commendable that you are learning about the different types of breast reduction procedures available, I think you will be better off spending the time doing your due diligence in selection of plastic surgeon. This decision will be of greater importance, in my opinion, than  exactly what procedure is performed.

	 Start with the American Board of Plastic Surgery,  meet with a few plastic surgeons and  ask to see lots of examples of each plastic surgeon's  “work”  helping patients in your situation.   Once you have done this research you may feel very comfortable with your plastic surgeon  based on the quality of work that he/she can demonstrate. Once you have done so, allow him/her to guide you in selecting the procedure that will best meet your goals. Of course, communicating your goals will be an important part of the preoperative planning.

	 I hope this helps.

Scott L. Replogle, MD (retired) · Answer

Although I agree with the advice that the surgeon needs to be experienced and comfortable with a breast reduction technique, what's being missed here is that there is a significant asymmetry between the two breasts and one approach could be used for your right breast (which you're referring to as your left) and a different one for the left breast (which you're calling your right). There is also a difference in how the internal breast gland is handled compared to the issue of how the external skin envelope is handled that results in the vertical or anchor-type scars. 

	Your right breast could be lifted without a reduction and a lollipop incision used with one of the vertical lift techniques including the SPAIR technique. For example, I use the inferior glandular pedicle technique with a vertical skin approach and this would be quite suitable for your right breast. The left breast needs a significant reduction as well as a lift and this might require more than just a vertical (lollipop) type incision because of the greater degree of elevation of the nipple-areola and the reduction in volume of the breast itself rather than just lifting it.

	Obviously this would require the surgeon to have experience with both types of techniques and not be locked into one technique for all breasts.

Margaret Skiles, MD (retired) · Answer

I agree with my colleagues that your choice of surgeon is probably more important than the technique. Each of us as surgeons is more familiar and comfortable with some techniques than others. And you should be comfortable with the surgeon you choose. So choose a surgeon who is certified by the American Board of Plastic Surgery and who you feel understands your concerns and can answer all your questions and let him or her choose the technique that he or she can use to best accomplish your goals. Good luck to you.

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