yond the breast onto the abdomen,which would clearly distract from the overall result of the reduction. The solution to this problem is to place the lower incision at an appropriate distance above the inframammary fold. We routinely use a distance of at least 4 cm above the fold and even higher for larger breasts. If the vertical scar turns out to be too long postoperatively, a small horizontal crescent-shaped skin excision can be used to relocate the scar.
Problems associated with shape include asymmetry, unusual form, and under- and overprojection. Solutions that we have found helpful in decreasing the incidence of these complications include careful attention to original markings, appropriate parenchymal resection, adjunctive SAL, and tailor tack techniques for skin resection. Meticulous attention when performing the original markings can help avoid asymmetries in skin resection and, therefore, postoperative irregularities. Appropriate breast parenchyma resection can aid in assuring similarities in shape as well as proper projection. Adjunctive SAL can be very useful in shaping the breast, and tailor tack techniques are extremely valuable in determining the correct amount of skin excision (Fig. 13.7).
There is a tendency with the vertical reduction technique to place the nipple-areola complex too high on the breast (Fig. 13.8). We recommend modifying the original markings to take this into consideration and to place the upper border of the new areola at the level of the preexisting inframammary crease, which will place the nipple 2 cm or so below that.
Was this article helpful?