Evaluation of Hamdi's Algorithm for Optimal Patient Selection for Vertical Scar Mammaplasty: A Single-Surgeon...

Vertical scar mammaplasty can minimize scarring while maintaining an uncompromised aesthetic outcome, but it may result in high revision rates. In 2005, Hamdi's algorithm was introduced by the senior author (M.H.) to better define candidates for vertical scar mammaplasty. This study validates the effectiveness of Hamdi's algorithm over a 13-year period.

A cohort study of consecutive breast reductions performed by a single surgeon since 2010 was conducted. Primary bilateral cases as mandated by the health care reimbursement system criteria were included. Hamdi's algorithm was based on patient age, sternal notch-to-nipple distance, and skin quality. Data on demographic characteristics, surgical details, and outcomes were collected. Patients were grouped into vertical scar mammaplasty and inverted-T procedures for comparison.

A total of 159 patients with complete follow-up data were included: 73 underwent vertical scar mammaplasty and 86 had inverted-T procedures, with an average follow-up of 38.8 months. Patients in the inverted-T group were significantly older and had a greater sternal notch-to-nipple distance with larger average gland reduction (680 g) compared with after vertical scar mammaplasty (450 g) ( P = 002). The inverted-T group had a significantly higher infection rate. The late scar revision rate was similar in both groups (6.3%). There were no other significant differences.

This study demonstrates that, when guided by Hamdi's algorithm, vertical scar mammaplasty can be safely performed in appropriately selected patients without increasing the risk of complications or secondary corrections. It offers a comparable safety profile to the inverted-T technique while reducing scar burden.