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Horizontal Breast Reduction

Minimal Scar Horizontal Breast Reduction

A word on breast reduction scar patterns

The scar of a breast reduction is the main thing that patients focus on however it is only one consideration.

The trend today is moving toward minimal scar breast reduction operations and certainly in my practice more than 95% of patients are suitable for a minimal scar technique of some description. There are many different types of breast reduction scar patterns and this article will go through my personal thoughts regarding these patterns and what the priority should be. The “old fashioned” way of doing the operation included a scar which looks like an upside down anchor called a “Wise pattern”. This operation stood the test of time, is reliable and is still commonly used today. The downside of course is the greater burden of scar tissue, wound breakdown at the T junction at the bottom and a tendency for the breast to look bottom heavy with time.
The most common minimal scar technique today in Australia is called the Hall Findlay vertical technique. It is otherwise referred to as the “Lollipop” technique as it has a circular scar around the areolar and a vertical scar straight down the breast such that is looks like a lollipop. The horizontal scar is avoided. The main advantage to this technique in my opinion is not the scar but the fact that the breast mound that is left at the end of the operation is in the upper part of the breast which prevent sagging long term.

In select patients the scar can be very difficult to discern on the frontal view

Let’s take a look at the different areas of the scar and critically evaluate them. Most photos and views of the breast are seen from the front and so this discussion will focus on the frontal view. So if you are going to have a proper breast reduction the nipple needs to be moved from its saggy position to higher on the chest wall and this necessitates a scar around the areola. This cannot be avoided but usually looks very good as it is placed in a natural transition between the lighter skin of the chest wall and the pigmented coloured skin of the nipple and areola. The only other scar which is visible from the front is the vertical scar so in an ideal world a minimal scar breast reduction would have a scar around the nipple, NO vertical scar seen in the other techniques and a horizontal scar that is hidden in the fold under the breast.

In an ideal world the only scars that you would have on a breast would a scar around the areola and a hidden scar under the breast.

Fortunately the author has modified and developed an innovative technique which does just this and can be used in select patients. It results in better scarring, less wound healing problems and a better long term shape and is called the Horizontal Breast Reduction.

This opinion piece was brought to you by Dr Damien Grinsell.

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