INVITED COMMENTARY We have now available a reduction mammaplasty with which is somewhat higher than has been mentioned by minimal vertical scars described by Madeleine Lejour Lejour. They point out appropriately that the surgeon be- which is being accepted and perfected by many surgeons ginning the vertical approach should start with smaller throughout the world. While there has been considerable breast reductions and gradually move up to the larger interest in the vertical scar as well as the periareolar ones. pursestring reduction mammaplasty during the past few Concerning the periareolar pursestring approach for years, it seems that there is more versatility and predict- significant mammary hypertrophy, I have had some diffi- ability with the vertical scar approach. Lejour has clearly culties with this procedure such as flattening centrally, defined her technique which has a periareolar scar as well asymmetry of the nipple/areola, lack of long-term correc- as a vertical scar, and has published this in a fine book. tion, and an overall less than satisfactory aesthetic result. She has shown that the technique gives excellent breast Improved results in my hands can be obtained with the reduction appearance especially when the reduction is less Lejour vertical technique. Lejour has published extensive- than 1000 g per side. The advantages of her approach, in ly on her vertical technique which gives her beautiful re- addition to the reduced scar, is that the wide breast is nar- sults without the horizontal scar. rowed and reshaped, and she has shown that breast lipo- I have found that there is a high level of patient accep- suction when done with this technique is efficacious. tance and improved shape with the vertical approach to The authors of this report use liposuction of the breast breast reduction. There is definitely a learning curve con- in a more limited fashion. I find that lateral and axillary cerning the result. The beginning plastic surgeon should liposuction can enhance the breast shape and better define be familiar with Lejour's specific description of the tech- the lateral breast line. They also do not use the central fix- nique and I recommend her text and videotape. The plas- ation suture and I also agree that satisfactory results can tic surgeon should also select smaller breast reductions be obtained with modification of her technique. with better skin elasticity for the first few cases. This study by a group of accomplished surgeons re- J. Bostwick ports on their extensive experience with the vertical scar Division of Plastic, Reconstructive approach. They are careful and report in detail the prob- and Maxillofacial Surgery lems and complications with the technique, which ap- University School of Medicine proach 40%, and have also extended it to most of their Atlanta, Georgia breast reductions. Their reoperation rate is about 2% USA European Journal of Plastic Surgery Springer Journals


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Copyright © 1999 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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