No-vertical-scar inferior pedicle breast reduction
using the dermal suspension sling
Erik M. Wolfswinkel
William M. Weathers
Received: 26 March 2013 / Accepted: 17 June 2013 / Published online: 10 July 2013
Springer-Verlag Berlin Heidelberg 2013
Background The authors previously presented favorable out-
comes with the use of the horizontal dermal suspension sling
and plication of the inferior pedicle in reduction mammaplasty
surgical cases. We propose a modification to this technique
tailored to patients with moderate to severe ptosis. The mod-
ification avoids the vertical scar inherent to the inverted T
Methods The surgical technique utilizes portions of the der-
mal suspension and plication technique previously described
by the authors. Minor modifications were made to take
advantage of the vertical excess of skin found in patients
with moderate to severe macromastia and ptotic breasts. The
modification leads to a superior skin flap that drapes the
inferior pedicle and newly constructed breast mound, result-
ing in a single inframammary scar.
Results Thirty-eight women have undergone breast reduc-
tion using the vertical scarless inferior pedicle with horizon-
tal dermal suspension and plication surgical technique.
Breast projection and shape were sustained during follow-
up with positive aesthetic results; the median follow–up time
was 7 months.
Conclusions The modifications to our surgical technique
allowed for an improved appearance in the postoperative
breast scar and in the overall cosmetic outcome in patients
who underwent large-volume breast reductions.
Level of Evidence: IV, therapeutic study
Dermal suspension sling
Breast reduction surgery for patients suffering from macro-
mastia can result in a significant quality of life improvement.
Macromastia results in both aesthetic and physical symptoms.
Physical ailments include lower back pain, shoulder pain from
overburdened bra straps, and intertrigo underneath the breast
folds. Additionally, social issues arise with poor fitting cloth-
ing, trouble exercising, and public scrutiny, resulting from their
enlarged breast. Many of these concerns can be managed with
breast reduction surgery.
Multiple techniques exist for reduction mammoplasty.
The senior author prefers the use of the dermal suspension
sling and plication technique previously described by the
authors . This technique addresses postoperative concerns
of lack of medial fullness, poor projection, migration of the
deep tissue, and bottoming-out associated with using the
popular inferior pedicle breast reduction technique. These
postoperative findings were attributed to the lack of deep
tissue suspension and skin envelope relaxation. The dermal
suspension sling allows for proper molding and reposition-
ing of the breast mound with an autonomous structural
support of the breast parenchyma that is independent of the
superior skin flap. Similar to the inferior pedicle reduction
technique, the dermal suspension sling and plication tech-
nique utilizes a Wise-pattern skin resection, which results in
the classic inverted T scar.
Considering the main area of aesthetic dissatisfaction for
reduction mammoplasty remains postoperative scarring [2,
3]; efforts to reduce visible scarring can help the final breast
appearance. Macromastia patients with moderate to severe
hypertrophy and ptosis will have a vertical skin excess above
the nipple–areola complex (NAC), which may be enough to
A. Echo (*)
Division of Plastic Surgery, The Methodist Hospital,
The Institute for Reconstructive Surgery, 6560 Fannin,
Suite 2200, Houston, TX 77030, USA
E. M. Wolfswinkel
W. M. Weathers
Division of Plastic Surgery, Baylor College of Medicine,
Houston, TX, USA
Eur J Plast Surg (2014) 37:21–28