Short-Scar Mammaplasty in Severe Macromastia

Abstract

It is generally claimed that short-scar mammaplasty is limited to small-to-medium reductions. Its use in patients with severe macromastia has been associated with a high rate of complications. This report presents our experience of reduction mammaplasty greater than 1000 g per breast using a short-scar technique. The procedure is based on the following: a) modified breast marking method with conservative placement of the nipple-areola complex, determined not only by the level of the inframammary fold but also degree of upper pole volume loss; b) use of liposuction for contouring the inferior pole; c) vertical design dermoglandular resection; d) superomedial pedicle; and e) skin closure without undermining or gathering. A total of 69 patients were identified (n = 138 breasts). Mean age was 38.0 years with average BMI of 36.4 kg/m. Mean weight of breast removed was 1333.8 g (range, 1002-3275). New nipple position was determined to be inferior to the inframammary fold at a mean distance of 4.6 cm, as predicted by the degree of flatness of upper pole. Complications included delayed healing (7.2%), fat necrosis (10.1%), infection (5.8%), hematoma (2.9%), and seroma (1.5%). There were no instances of nipple-areola complex necrosis. Revision of dog-ears was necessary in 7 patients (10.1%). The authors conclude that in using a modified short-scar mammaplasty approach in cases of severe macromastia, the outcomes can be improved with reduced scar burden, pleasing breast shape, and a low complication rate.

Effect of Obesity on Complications in Short-Scar Breast Reduction: A Retrospective Study of 236 Consecutive Patients

“…A recent study from our institution demonstrated that a vertical pattern mammaplasty could be performed in patients undergoing larger reductions (>1000 g) with minimal complications and good aesthetic outcomes. 15 The current study investigated the rate of complications with increasing BMI to better understand the safety of performing a short-scar reduction mammoplasty in obese patients and larger volume reductions. Overall, there was a general trend for increased risk of complications with increased BMI.…”

“…A recent study from our institution demonstrated that a vertical pattern mammaplasty could be performed in patients undergoing larger reductions (>1000 g) with minimal complications and good aesthetic outcomes. 15…”

“…14 A recent study suggests that short-scar mammoplasty may be used in breast reductions of over 1000 g with low rates of complications and good aesthetic results. 15 There is limited data on postoperative complications after short-scar breast reduction among obese patients.…”

Re-evaluating the Lejour Technique for Breast Reduction in Patients with Macromastia

“…As demonstrated in our case series and by other authors, however, the Lejour can be used for large reductions. 10 , 15 , 16 Furthermore, this was reported more often by those who obtained training in the Lejour technique in a postgraduate course or conference ( P = 0.02), suggesting that training during residency or fellowship may be more effective and emphasizing the value of broad training in all techniques during residency.…”

“… 7 , 11 , 13 , 14 More contemporary research suggests that the Lejour method can produce successful outcomes even in patients with gigantomastia and severe ptosis. 10 , 15 , 16 The Lejour technique is associated with greater patient satisfaction and aesthetically pleasing results without a higher rate of complications compared with inverted-T techniques, 8 , 17 although complications are more frequent with either technique in overweight patients and in those who smoke. 18 – 20 While one study found a higher revision rate in patients managed with vertical scar techniques, 17 revision to correct minor skin redundancy should be considered a second-stage procedure rather than a complication.…”