A. De Mey Æ M. Greuse Æ C. Azzam
The evolution of mammaplasty
Received: 7 September 2004 / Accepted: 11 January 2005 / Published online: 11 August 2005
Ó Springer-Verlag 2005
Abstract Mammaplasty is now a very common opera-
tion. However, it took nearly a century from the ﬁrst
attempts to the latest evolution of techniques improving
safety and providing long-lasting results and minimal
scarring. As with any surgical technique, it has pitfalls
and complications, but a good knowledge of anatomy
and rigorous operative technique makes it possible to
obtain excellent results in the majority of cases.
Keywords Mammaplasty Æ History of mammaplasty Æ
Breast reduction and reshaping was born at the start of
the twentieth century, with the improvements of general
anesthesia allowing safe operations to be performed.
The surgeons had to face the fact that hypertrophic
breasts were not only an aesthetic problem but could be
a source of impairment of function in their patients. In
the early 1900s, diﬀerent techniques were tried, some
based on anatomical knowledge, others completely
ignoring the local blood supply, as the ﬁrst attempts of
Pousson  in 1897, who resected an area of transverse
semilunar skin and breast tissue in the anterior superior
part of the breast.
A contribution from this early period remains today
as the Thorek  procedure, this consists of a partial
inferior amputation of the breast with a free nipple graft.
This procedure is still performed for very large breast
reductions in old or debilitated patients.
The transposition of the nipple–areola complex to
a higher position was a major contribution in
breast-reduction surgery, proposed as early as 1911
by Villandre and later by Morestin , and by Aubert
and Passot  in the 1920s. In 1931, Biesenberger ,
in order to improve the ﬁnal breast shape, had the idea,
after complete dissection of the skin from the breast, to
resect the lateral part of the glandular tissue, rebuilding
the conical shape of the breast by anchoring the lower
portion of the remaining glandular tissue upwards and
outwards in the axillary area.
The skin was then redraped and the excess removed
with a ﬁnal inverted ‘‘T’’ scar. This method remained
popular for many years as it gave a nice long-lasting
shape. Unfortunately, it placed the nipple at high risk of
necrosis. The concept of de-epithelization of the areolar
pedicle was proposed by Schwatzmann in 1930, con-
sidering that the blood supply of the areola was carried
by the dermis.
From 1930 to 1950, large series of patients were
published, due to a better understanding of the blood
supply of the breast, which made the techniques safer. In
1956, Wise  proposed a pattern to plan his surgery
and to obtain more consistently symmetrical results.
In the 1960, fashion trends have emphasized more
exposure of the body. This trend increased the demand
and stimulated the need for breast corrections.
Reﬁnements in the techniques to obtain more pleas-
ant aesthetic results were described, and a high degree of
safety was the goal.
mbeck  in 1964 and Pitanguy  in 1967
presented new techniques for performing breast reduc-
tion with greater safety, even in large hypertrophies, by
leaving the skin attached to the gland. The remaining
gland is vascularized by the external and internal
mammary arteries, and thus the resection is performed
in the ptotic lower part of the breast glandular pedicle.
In 1972, McKissock  described a technique with a
bipedicled vertical dermal ﬂap. This technique was later
improved by Robbins , basing the areola on an
inferior dermofat pedicle, because he emphasized the
abundant vascularisation by the perforators of the
intercostal arteries in the lower part of the breast.
A. De Mey (&) Æ M. Greuse Æ C. Azzam
Department of Plastic Surgery, Hoˆ pital Brugmann,
4 Place A VanGehuchten, 1020 Brussels, Belgium
Eur J Plast Surg (2005) 28: 213–217