A simplified vertical reduction mammaplasty: shortening the learning curve

Although the vertical reduction mammaplasty is effective in reducing scarring, the technique has not achieved widespread acceptance in North America. There are several reasons for this. Some believe that the vertical reduction mammaplasty is only applicable to smaller breast reductions and that the learning curve is difficult. This article describes modifications to the standard Lejour vertical reduction mammaplasty that simplify the technique and make it more reliable and easier to perform. These modifications include using a medial (or lateral) dermoglandular pedicle, not undermining the skin, using liposuction only rarely to reduce breast volume, and not using pectoralis fascia sutures; the modified technique has been used in a series of 400 vertical breast reductions. In this series, scarring was reduced and the technique was easily learned and applied. It is useful for both small and large breast reductions, with a series average of 525 g removed per breast (range, 100 to 1425 g). By using these modifications, scarring in reduction mammaplasty was effectively reduced while the nipple and areola were safely transposed on a medial or lateral dermoglandular pedicle. Incorporating these technical modifications in a vertical reduction mammaplasty is recommended as a method of improving results and limiting complications.