A method to select patients for vertical scar or inverted-T pattern breast reduction

Vertical scar breast reduction (VSBR) is an increasingly popular technique but can carry a high complication and revision rate. We evaluate our complication rate when selecting patients for VSBR or inverted-T breast reductions (ITBR). We looked at 133 consecutive primary bilateral breast reductions performed by a single consultant from 1998 to 2003 (23 incomplete records). VSBR (82 breasts) and ITBR (120 breasts) were performed, with glandular or superomedial pedicle transposition of the nipple-areola complex (NAC), or free nipple grafts (FNG) (18 breasts). The pattern of skin excision chosen was determined by the degree of skin shrinking required to achieve the correct vertical height of the new breast. If the measurement from the inframammary fold to the lower border of the new areola position was < 18 cm the patient underwent VSBR. We assessed complication and revision rates in each group. The complication rate (haematoma, infection, delayed healing, nipple/fat necrosis) in VSBR was 11%, in ITBR 23% (P<0.05). Revision rate was 2.4% in the VSBR and 3.3% in ITBR group. The VSBR had no problem scars, while the ITBR produced problem scars in 16% of operated breasts (P<0.001). We feel it is possible to reduce skin to 40-50% of its original length. Attempting a greater degree of shrinkage produces a high rate of revision surgery. We suggest a method of selection of technique by a reproducible measurement of the vertical skin reduction to produce a low complication rate and low revision rate.