Technical refinements of the vertical mammaplasty: a modified lejour approach

Although recent refinements in vertical mammaplasty techniques have increased the popularity of the procedure, criticism has continued on the basis of perceived shortcomings in the results. In this paper, a step-by-step description of the author's preferred vertical mammaplasty technique, the modified Lejour approach, is presented. Detailed guidelines are given for preoperative markings to site the proposed new nipple position, ensure breast symmetry, delineate breast displacement and the final medial and lateral extent of skin incision, and minimize "dimple-like" skin indentations at the lower border of the skin excision during closure. Maneuvers for avoiding common pitfalls of the technique are also described, including minimizing the risk of nipple-areolar complex constriction or distortion and avoiding excessive lateral breast fullness. The described vertical mammaplasty technique is safe, reliable, and easily performed in smaller breast reductions and almost all mastopexies. These modifications to the Lejour approach resolve many of the criticisms of vertical mammaplasty procedures.