Horizontal Breast Reduction - Technical Refinements and Patient Selection
Association of Breast Surgery ePoster Library. Manton R. 05/15/17; 166178; P111
Mr. Robert Manton
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Abstract
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Introduction: Breast reduction techniques differ according to skin incision and pedicle. Lower pole scarring is reduced through vertical or horizontal scars only. Vertical techniques are popular, but the scar may be less aesthetic and take time to settle, parenchymal excision is limited, and dog-ears may occur. Horizontal techniques were highlighted to the senior author in her Australian fellowship. When presented with a 19 year old with gigantomastia, grade 3 ptosis, Fitzpatrick type 6 skin and sternal notch to nipple distance of 50cm, rather than a Wise pattern with free nipple grafts, horizontal reduction was performed on an inferior pedicle. Following this success, other select patients have benefitted from the technique.
Methods: All patients undergoing horizontal breast reduction by a single surgeon (JH) were included. Patients all had ptosis and >6cm between new nipple position and upper resection margin. Demographics, breast measurements, resection weights, complications and peri-operative imaging were recorded. Steps to avoid devascularisation and improve breast aesthetics are outlined.
Results: Six cases are presented, each with excellent aesthetic outcomes. Demographics and clinical data (mean; range) of the cohort are: Age (40 years; 19-54 years); sternal notch to nipple distance (42cm;35-50cm); Tissue Excised (988g;510-2120g).
Conclusion: Horizontal breast reduction is advantageous in ptotic patients due to:
1. Scars: Minimally visible (useful in keloid susceptible)
2. Complications: No T-junction breakdown
3. Breast: Limited bottoming out (cf weak vertical scar)
4. Nipple: Avoids free nipple grafts and tear-drop nipple shape
6. Symmetry: Accurately match contralateral breast reconstruction
Methods: All patients undergoing horizontal breast reduction by a single surgeon (JH) were included. Patients all had ptosis and >6cm between new nipple position and upper resection margin. Demographics, breast measurements, resection weights, complications and peri-operative imaging were recorded. Steps to avoid devascularisation and improve breast aesthetics are outlined.
Results: Six cases are presented, each with excellent aesthetic outcomes. Demographics and clinical data (mean; range) of the cohort are: Age (40 years; 19-54 years); sternal notch to nipple distance (42cm;35-50cm); Tissue Excised (988g;510-2120g).
Conclusion: Horizontal breast reduction is advantageous in ptotic patients due to:
1. Scars: Minimally visible (useful in keloid susceptible)
2. Complications: No T-junction breakdown
3. Breast: Limited bottoming out (cf weak vertical scar)
4. Nipple: Avoids free nipple grafts and tear-drop nipple shape
6. Symmetry: Accurately match contralateral breast reconstruction
Introduction: Breast reduction techniques differ according to skin incision and pedicle. Lower pole scarring is reduced through vertical or horizontal scars only. Vertical techniques are popular, but the scar may be less aesthetic and take time to settle, parenchymal excision is limited, and dog-ears may occur. Horizontal techniques were highlighted to the senior author in her Australian fellowship. When presented with a 19 year old with gigantomastia, grade 3 ptosis, Fitzpatrick type 6 skin and sternal notch to nipple distance of 50cm, rather than a Wise pattern with free nipple grafts, horizontal reduction was performed on an inferior pedicle. Following this success, other select patients have benefitted from the technique.
Methods: All patients undergoing horizontal breast reduction by a single surgeon (JH) were included. Patients all had ptosis and >6cm between new nipple position and upper resection margin. Demographics, breast measurements, resection weights, complications and peri-operative imaging were recorded. Steps to avoid devascularisation and improve breast aesthetics are outlined.
Results: Six cases are presented, each with excellent aesthetic outcomes. Demographics and clinical data (mean; range) of the cohort are: Age (40 years; 19-54 years); sternal notch to nipple distance (42cm;35-50cm); Tissue Excised (988g;510-2120g).
Conclusion: Horizontal breast reduction is advantageous in ptotic patients due to:
1. Scars: Minimally visible (useful in keloid susceptible)
2. Complications: No T-junction breakdown
3. Breast: Limited bottoming out (cf weak vertical scar)
4. Nipple: Avoids free nipple grafts and tear-drop nipple shape
6. Symmetry: Accurately match contralateral breast reconstruction
Methods: All patients undergoing horizontal breast reduction by a single surgeon (JH) were included. Patients all had ptosis and >6cm between new nipple position and upper resection margin. Demographics, breast measurements, resection weights, complications and peri-operative imaging were recorded. Steps to avoid devascularisation and improve breast aesthetics are outlined.
Results: Six cases are presented, each with excellent aesthetic outcomes. Demographics and clinical data (mean; range) of the cohort are: Age (40 years; 19-54 years); sternal notch to nipple distance (42cm;35-50cm); Tissue Excised (988g;510-2120g).
Conclusion: Horizontal breast reduction is advantageous in ptotic patients due to:
1. Scars: Minimally visible (useful in keloid susceptible)
2. Complications: No T-junction breakdown
3. Breast: Limited bottoming out (cf weak vertical scar)
4. Nipple: Avoids free nipple grafts and tear-drop nipple shape
6. Symmetry: Accurately match contralateral breast reconstruction
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