Breast Reduction Methods & Incision Patterns
What are the different Breast Reduction Procedures and Incision Patterns?
Breast Reduction in women is the procedure done to decrease breast size for those suffering from the pain and discomfort of heavy breasts. It's also done to correct breasts that are of two different sizes. Bilateral breast reduction refers to the reduction of both breasts, while unilateral breast reduction refers to the reduction of only one breast - as in the case where one breast is noticeably larger than the other.
Men can also have breast reduction, and while they do not typically suffer from the pain and discomfort associated with the need for breast reduction in women, they do suffer from the visual appearance and embarrassment of this condition. One in three men suffer from Gynecomastia, which is most often caused by a subtle imbalance of hormone metabolism.
This is the method that the majority of women have had or will have. The pedicle method of breast reduction reduces breast appearance, volume, and contour, while maintaining breast function and nipple sensation. The pedicle method refers to the location of the blood and nerve supply - not where the incisions are placed. For example, the McKissock method looks the same from the incisions created during several other methods, but one of the differences is the fact that the blood and nerve supply is maintained at two places instead of one. When discussing methods you have to separate surgery methods and scar patterns. For example, while McKissock and Lejour are both pedicle methods, they have a different scar pattern.
Be sure to ask your plastic surgeon what method they are using, where your incisions will be, and what terms they use to define their method for you.
Other names that are used for the pedicle method are: Anchor method, T-Scar, T-Incision, Inverted T pattern, McKissock, Wise Method, Lollipop, VOQ, Vertical, Regnought, Lejour, Short scar, Circumareolar, Keyhole, Donut, and Robertson. There are surgical and scar pattern differences to some of these methods, and not everyone is a candidate for all of the different types of reductions.
Also, some reductions are modified, as with the case of the laser-assisted breast reduction, and the laser-assisted breast reduction can be done with or with out the Stevens LaserBra. We'll break the methods down in relation to their scar patterns a little later on.
One way pedicle methods vary is by the way the blood and nerves are maintained from different areas of the breast. They are:
Inferior pedicle maintains the blood and nerve supply from the bottom of the breast.
Superior pedicle - from the top of the breast.
Central pedicle - from the center of the breast.
Lateral pedicle - from the side of the breast.
Bi-pedicle - from both the superior and inferior locations.
As previously stated, in the pedicle methods of breast reduction, nipple-areola sensation and milk production are typically preserved. In the case of very large breasts, however, women are sometimes faced with the Free Nipple Graft procedure (FNG). The pedicle, along with its blood and nerve supply, must be severed, and the nipple-areola complex is detached and grafted back on after the reduction is completed. Function and sensation are lost with this method.
FNG - Free Nipple Graft
Free Nipple Grafts involve removing the nipple and grafting it in its new location as a skin graft. Here there is no pedicle because there is no blood supply from the breast itself. The blood supply to the free nipple graft comes from the deep dermis as with all skin grafts. Free nipple grafts are not necessary with laser-assisted breast reduction. If you have an FNG done and require more breast surgery in the future, be certain to tell the surgeon so that he does not mistake it for a pedicle method breast reduction. To do so would sever the blood supply to your FNG and cause the death of your nipples. The incision pattern with FNG reduction would most likely look like the anchor pattern - but ask your plastic surgeon if this is the surgery being presented to you.
There are a lot of unnecessary FNGs done today. While some are necessary due to the size of a woman's breasts, an unskilled plastic surgeon may do these routinely and think this is acceptable. It is not. You would want to avoid an unnecessary FNG with an unskilled plastic surgeon.
Variations of Incision Patterns within the Pedicle Methods
Anchor Incision Pattern of Pedicle Breast Reduction
This is the most common incision pattern of breast reduction done today. Names associated with this incision pattern are Anchor method, BiLateral Reduction Mammoplasty, T-Scar, T-Incision, Inverted T pattern, McKissock, and Weiss Method. Incisions are made in a circular shape around the areola, vertically from the areola down the front of the breast to the chest wall and and horizontally across the underside fold of the breast. See illustration A.
LeJour or Vertical Incision Pattern of Pedicle Breast Reduction
This is a fairly new technique that is gaining popularity and can only be performed on women who meet certain criteria, one of which is usually pre-operative size of DDD or less, though times are changing. Other names for this incision pattern of the pedicle method are Vertical Mammoplasty, VOQ, Vertical, Regnought, and The Lollipop Method. At BreastHealthOnline, we refer to this scar pattern as The LeJour method or Vertical Method. Incisions are made in a circular shape around the areola and vertically from the areola down the front of the breast to the chest wall. Some physicians are also performing a modified version of the LeJour or Vertical method whereby a very short horizontal incision is added to either side of the vertical incision. See Illustration B.
Stevens Laser Bra
Using a laser and the skin that would normally be discarded during surgery, Dr. W. Grant Stevens developed the technique that creates an 'internal bra' to produce a permanent support system and a more natural effect in the long term for patients. The incision patterns are the same as with most of the Anchor style pedicle methods, as is the preservation of the pedicle. The Laser Bra is attached internally to your chest wall, creating an internal bra support structure. You won't be able to see or feel it. Because it's your own tissue, you can't reject it. Patients who have had this technique have done extremely well and do not experience problems with things such as early sagging and bottoming out. Please visit The Laser Bra to learn more about this procedure.
Robertson Incision Pattern of Pedicle Breast Reduction:
This is another version of a pedicle method that seems to be predominately done by Kaiser Permanente surgeons in the U.S. The incision lines are circular around the areola and horizontally across the mid-area of the breasts. See illustration C. There have been women unhappy with the appearance of this method. Be sure to check with your surgeon about the method you will be having.
If you are unhappy with the prospect of your end result, be sure to get a second opinion. Don't rush into any surgery you are unsure about.
Keyhole Incision Pattern of Pedicle Breast Reduction
The Keyhole incision pattern of this pedicle method is sometimes also called the circumareolar or donut method. The incision goes around the areola only. It is more often used for breast lifts or small reductions. See illustration D.
Liposuction-Only Breast Reduction:
As its name implies, this reduction is done using only liposuction. It is sometimes called the 'scarless breast reduction', but in fact, there are small incisions, thus scars, where the lipocannula is inserted. Generally it is done as an outpatient procedure under IV sedation instead of general anesthesia. Typically, two small incisions are made on each breast and fluid is injected. This separates the tissue from the fat. Liposuction is then performed on each breast. This procedure takes less time than traditional breast reduction methods; however, there is not the benefit of breast lift associated with it. Some patients report a 'deflated balloon' type effect and that it also has left their breasts much more dense. We have had members have this procedure, only to end up having a surgical breast reduction and lift done later. We have also had reports of greater pain and similar recovery lengths as with surgical breast reduction - even though it's said that the pain and recovery is lessened with this procedure. The placement of the small incisions varies by plastic surgeon.
Not everyone is a candidate for all the different types of breast reductions. A patient's history and physical examination must be taken into account before deciding which method will give the patient the very best result. While you may have an idea which method you would like to have done, it's not in your best interests to dictate this to a plastic surgeon. You should have at least 3 consults with board-certified plastic surgeons so you can learn what they recommend for you. If you are facing a free nipple graft, or if you still do not feel comfortable or satisfied with the consults you've had and the methods recommended to you, please do not hesitate to seek another opinion. Not all plastic surgeons are the same, and some often specialize in one method over another. Take your time to select the right plastic surgeon, and procedure for you.