Asymmetric breast reduction with vertical plication short scar technique

Breast reduction

Most women request breast reduction because the sheer physical size and weight of their breasts causes significant physical discomfort. This may include back pain, neck pain, headaches from neck muscle strain, bra straps digging into their shoulders and fat atrophy beneath the bra straps. It may be difficult to exercise and to fit certain types of clothing. There may be skin irritation in the folds beneath the breast. Posture may be affected. Breasts may become particularly large during the menstrual cycle and when breast feeding.

Additionally the breasts may be a source of social embarrassment and unwanted attention. Many women will dress to hide the size of their breasts.

To learn more about breast reduction and see the gallery of before and after photos visit my website dedicated to breast surgery.

Frequently asked questions

General questions

Mr Davis does Breast reduction for a fixed cost. For the current fixed cost please either email us or phone us on 0800 268 526..

The quoted cost for surgery covers everything including anaesthetist fees, theatre fees, consumables, staying overnight in hospital after surgery, any additional consultations after the first consultation and all the follow up for dressings and checks in the first year after surgery. This cost includes GST.

Several insurance companies do assist with the cost of surgery. Usually you would have to be a member for a certain minimum period and then fulfill certain criteria. You should check with your insurance company first.

Following the consultation I write to the insurance company with the specific examination findings they request. Almost all cases of significantly large breasts would qualify. Those who simply need a breast lift with no removal of breast tissue do not qualify.

Examples of Mr Davis’ work can be seen at Specific examples of anatomic variations may also be shown during a consultation where appropriate.

It is normal for a lift (mastopexy) to be done at the same time as breast reduction surgery. This lifts the nipple and areola into a higher position if they have dropped.

Everyone 30 years and older should ideally have a mammogram prior to breast reduction surgery. All tissue removed at the time of breast reduction is sent for pathology analysis. I have found early stage breast cancer after breast reduction in women who have recently had a “normal” mammogram. The very earliest stages of cancer may be missed on a mammogram but it is still the best currently available screening test.

I usually only use this technique when performing very significant breast reductions (greater than 1kg per side) when a lot of excess skin needs to be removed.

The Wise pattern is a W-shaped pattern of skin incision that leaves a scar around the nipple and vertically down to the inframammary crease (like the vertical mastopexy) but also leaves a long scar running along the inframammary crease. Essentially the skin is cut out and reshaped like a bra.
There are a number of different ways of reducing the breast gland beneath a Wise pattern scar. The more common types include:

1.    Robbins (inferior pedicle)
2.    Central mound (central pedicle)
3.    McKissock (horizontal pedicle)

The advantage is that the initial result looks very good but the disadvantages are the increased likelihood of bottoming out with time and the long inframammary crease scar.

During surgery

Where possible, a short scar vertical gland plication is the main technique that I use. This is a technique that evolved in France and across Europe and more recent modifications have been made in Canada. Some of the more famous surgeons names associated with vertical plication techniques are: Claude Lassus, Madeline Le Jour, Daniel Marchac and Elizabeth Hall-Findlay.

The advantages of the vertical techniques are that the bulk of the breast tissue is removed inferiorly, the breast gland tissue itself is modified in shape to produce a cone shape, the breast shape tends to hold itself more securely over time with less “bottoming out than skin tightening techniques and the inframammary crease scar can be minimised or not used at all.

The disadvantages are that the techniques is more complex and there is a learning curve, it is not suitable for massive reductions, an inframammary crease scar is still required after massive weight loss cases, and a skin ripple can be left beneath the breast that in about 10-20% of cases may need to be removed under local anaesthetic three months later if it does not completely flatten. This is at no additional charge for my patients when this is required.

After surgery

Surgeons cannot guarantee a particular cup size after reduction surgery but it is essential to have a clear idea about a woman’s preference. Most women prefer a C-D cup but some have preferences smaller and occasionally larger than this.

Cup size is a ratio between breast and chest circumference. This ratio will change during the menstrual cycle and during weight changes. It will change during pregnancy and breast feeding and may change after menopause. Cup size therefore is not static.

The amount of reduction is usually limited by the need to keep the blood supply and nerve supply to the nipple intact.

This issue is not well discussed in the NZAPS brochure I give my patients to read about breast reduction surgery.  Regardless of the procedure performed, breasts will drop after surgery. I over-elevate the breast gland in anticipation of some drooping in the first six months after surgery. Once the vertical scar beneath the breast has softened, the over-elevated breast gland will drop. If the breast shape looks perfect after surgery, then I have not elevated it enough!

Scars after surgery run around the nipple areola complex and vertically down to the inframammary crease. In some cases a small scar may be needed in the inframammary crease and this will discussed with you before surgery.

The scars are permanent and will fade over time. They are most noticeable in the first 6-9 months after surgery. I show patients examples of other breast scars in the initial period so that they have a clear idea about what to expect.

Nerves that pass thought the skin surrounding the areola are severed but gradually regenerate over time. The nerves which enter deeply are kept intact however sensory disruption is common in the first few months after surgery. It may take a long time for the sensation to return to near normal and in some cases permanent changes occur.

A minor degree of asymmetry prior to surgery is normal. If the symmetry is marked then surgery will usually attempt to correct this but perfect symmetry of all aspects of the breast is unlikely. However previously symmetrical breasts should not be markedly asymmetrical following surgery.

Breast volume may change over time. I have patients who have requested breast augmentation following breast reduction when they were younger.

Residual breast tissue is significantly involuted following breast feeding. Although uncommon, repeat breast reduction is also possible many years later, particularly with weight or hormonal changes.

The risks

Smoking greatly increases the risk of surgery complications. I want my patients to have the best possible result so please don’t smoke!

A single cigarette will cause the small vessels in the skin to tighten (vasoconstriction) for about 50 minutes. This affects wound healing. The chance of nipple necrosis, a hypertrophic scar, wound edge separation and infection is much more likely in active smokers.

Smoking decreases the elastin content of the skin. Over time it will have less elastic recoil. This is most noticeable in the face with visible wrinkles but also affects breast skin.

Atelectasis, or collapse of the small air spaces in the lung, is much more common after an anaesthetic in smokers. Ideally smoking should stop a minimum of six weeks before surgery and needs to permanently stop to maintain the best results and tissue tone over time.

The main complications after breast reduction include:

  1. Scars
  2. Sensation change
  3. Asymmetry
  4. Breast feeding
  5. Volume changes
  6. Shape change after surgery
  7. Infection
  8. Bleeding.

Going forward

Most breast reduction techniques will permanently affect breast feeding because breast ducts will be cut. Some women report that latching on is very difficult prior to breast reduction surgery, and it is actually easier after surgery. Even if your breasts do produce a good volume of milk, you may still need to use supplement feeding.