Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The Wise pattern, or inverted-T incision, is the most traditional and versatile technique for breast reduction. It allows for the removal of significant amounts of skin and tissue, making it ideal for patients with severe hypertrophy or significant sagging (ptosis).
This technique involves three incisions: one around the areola, one vertically from the areola to the breast crease, and one horizontally along the breast crease. The resulting scar resembles an anchor.
While it leaves the most visible scarring compared to other methods, the shape and lift achieved are often superior for giant breasts. The horizontal incision allows the surgeon to effectively remove the lateral “dog ears” and excess tissue under the armpit.
The nipple is typically kept attached to a pedicle of tissue (blood supply) and moved upwards. This preserves sensation and blood flow while allowing significant transposition of the nipple.
The vertical reduction, often called the “lollipop” incision, eliminates the horizontal scar in the breast fold. The incision goes around the areola and straight down to the crease, but does not extend laterally along the fold.
This technique relies on the skin’s elasticity to shrink-wrap around the new breast mound. It is best suited for patients with moderate hypertrophy and good skin quality who do not require massive skin removal.
The vertical technique tends to create a significantly projected, perky breast. Initially, the vertical incision may appear gathered or puckered (pleated), but this smooths out over several months as gravity settles the breast tissue.
Surgeons favor this method for younger patients who want to minimize scarring. It creates a narrow, high breast footprint that is aesthetically very pleasing.
For specific candidates, breast reduction can be performed using liposuction alone. This is a scarless technique (aside from tiny poke holes) suitable for patients whose breast volume is primarily due to fat rather than glandular tissue.
This procedure does not remove skin or significantly lift the breast. Therefore, it is reserved for patients with good skin elasticity and minimal sagging who want a reduction in volume.
It is often used for older women with fatty breast involution or for minor asymmetries. The recovery is much faster than excisional surgery, but the degree of reduction is limited by the skin’s ability to retract.
If the skin does not shrink, the breast may look deflated. Proper patient selection is critical for the success of this technique.
The inferior pedicle technique refers to the method used to maintain the blood supply to the nipple. In this method, the nipple remains attached to a bridge of tissue at the bottom (inferior) part of the breast while the tissue around the sides and top is removed.
This is the workhorse of breast reduction surgery. It is incredibly safe and reliable for preserving nipple sensation and blood supply, even in substantial reductions.
However, because the tissue bridge is at the bottom, it can sometimes prevent the breast from having maximum projection, leading to a slightly “bottom-heavy” shape over time. Skilled surgeons modify the tissue to minimize this effect.
It remains the gold standard for safety in gigantomastia cases where preserving the nipple is a priority.
The superomedial pedicle preserves the blood supply from the top and inner (medial) side of the breast. This allows the tissue bridge to be rotated, which helps fill the upper part of the breast and create cleavage.
This technique is favored for its ability to create a “perky” shape with good upper pole fullness. It effectively rotates the nipple into a higher position without tethering it to the bottom of the breast.
The superomedial pedicle is highly versatile and can be used with both vertical and anchor incision patterns. It offers a balance of safety and superior aesthetic shaping.
It has become the preferred technique for many surgeons for moderate to significant reductions, where shape is a priority alongside size reduction.
In cases of extreme gigantomastia or where the nipple needs to be moved a significant distance (more than 30-40 cm), preserving a blood supply pedicle may be risky. In these cases, the nipple and areola are removed entirely and grafted back on as skin grafts.
This technique allows for the removal of massive amounts of tissue without the risk of the nipple dying due to poor blood flow. It is often the safest option for the most significant reductions.
The trade-off is the loss of nipple sensation and the inability to breastfeed, as the ducts are severed. Pigmentation changes in the areola can also occur. This method is reserved for cases where other techniques would be unsafe.
SPAIR stands for Short Scar Periareolar Inferior Pedicle Reduction. This technique combines the safety of the inferior pedicle with a short scar skin pattern. It avoids the horizontal scar in the crease while maintaining a robust blood supply.
It is designed to reduce scarring while still allowing for significant tissue removal. The scar runs around the areola and vertically down, similar to the vertical lift.
This technique requires specialized surgical expertise to perform correctly, without leaving excess skin at the bottom of the vertical incision. When done well, it offers durable results with less scarring than the anchor method.
While not a reduction technique on its own, liposuction of the lateral chest wall (the area under the armpit and on the side of the breast) is a critical adjunct to almost all breast reduction surgeries.
Removing this “side boob” fat streamlines the torso and allows the breasts to sit more centrally on the chest. It prevents the boxy look that can occur if the breast is reduced but the side fat remains.
This step is often omitted in insurance-based surgeries but is standard in aesthetic-focused reductions. It ensures that the bra band fits comfortably and the overall contour is harmonious.
In some cases, particularly for patients with poor skin elasticity or revision surgeries, surgeons may use a bioabsorbable mesh called Galaflex. This mesh acts as an “internal bra,” supporting the breast tissue and taking the weight off the skin.
The mesh dissolves over time but is replaced by the patient’s own collagen, creating a stronger support system. This helps maintain the lifted shape and prevents the breast from bottoming out or sagging prematurely.
For patients with significant asymmetry (anisomastia), different techniques may be used on each breast. One breast might require a standard reduction, while the other needs a lift with an implant or just a lift.
The surgeon tailors the approach to each side to achieve the best possible symmetry. This might involve removing different amounts of tissue, using different pedicles, or adjusting the skin excision patterns independently.
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The liposuction-only technique leaves virtually no scars but is limited to certain patients. Among excisional techniques, the vertical (lollipop) reduction leaves less scarring than the anchor (inverted-T) technique because it avoids the long scar under the breast fold.
Most techniques (inferior and superomedial pedicle) are designed to preserve sensation. Temporary numbness is common, but permanent loss is rare unless a Free Nipple Graft technique is used. Sensation typically returns within a few months.
You can discuss your goal size (e.g., a “C” cup) with your surgeon, but cup sizes are not standardized measurements. Surgeons think in terms of grams of tissue and proportion. They will aim for a size that fits your frame safely and aesthetically.
A dog ear is a slight pucker or fold of excess skin at the end of an incision, usually under the armpit. It can occur when the lengths of the upper and lower incisions don’t match perfectly. It often settles on its own, but can be fixed with a minor in-office procedure.
No, Galaflex mesh is bioabsorbable. It dissolves over 12 to 18 months. However, as it dissolves, it stimulates the production of your own collagen, creating a lasting support network that persists after the mesh is gone.
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