Why Hasn't the No-vertical-scar Breast Reduction and Lift Technique Gained Wide Acceptance?

Question

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?

Gary M. Horndeski, MD · Answer

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.

	Kind regards,

	Dr. H

Armando Soto, MD, FACS · Answer

Hi there-

	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:

Brent Moelleken, MD · Answer

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.

Christopher V. Pelletiere, MD · Answer

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.

Tom J. Pousti, MD · Answer

The no vertical incision breast reduction can be useful but only in a few percentage of patients who are seeking breast reduction surgery. The majority of patients seeking breast reduction surgery benefit from excision of skin and tissue in the vertical and horizontal dimensions.

	Fortunately, the majority of breast reduction patients are pleased with the results of surgery (despite scars).

	Best wishes.

Robert Oliver Jr., MD · Answer

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.

Steven Wallach, MD · Answer

I suppose there are two techniques you are talking about. 1) periareolar lift 2) inframammary incision only. The first is just a nipple lift usually with an implant and if the nipple has to be lifted alot the scar results are less than favorable. The inframammary only is really for bottoming out. A Benelli is also a periarola only incision but the skin has to adjust as well.

Barry Stuart Handler, MD · Answer

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.

Darryl J. Blinski, MD · Answer

Easy answer, it failed the test of time. Poor results, non reproducible results by a majority of PS, really a not well thought out operation. Sorry nice try.

	From MIAMI DR. B

Robin T.W. Yuan, MD · Answer

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.

Why Hasn't the No-vertical-scar Breast Reduction and Lift Technique Gained Wide Acceptance?

Answers (14)

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