The British Association of Plastic Surgeons (2004) 57, 12–19

Benefits and pitfalls of vertical scar

breast reduction
G.M. Beer*, I. Spicher, K.A. Cierpka, V.E. Meyer

Institute of Hand, Plastic and Reconstructive Surgery, University Hospital, Rämistrasse 100,
CH-8091 Zürich, Switzerland

Received 3 March 2003; accepted 21 October 2003

KEYWORDS
Vertical scar breast
reduction; Complication
rate; Evaluation scheme
Summary A quality assurance study was undertaken three years after beginning the
vertical scar breast reduction technique. We examined the rate of early and late
complications (major and minor) and compared these to the formerly used inverted-T
scar and L scar breast reduction techniques. Inverted-T scar breast reductions have an
early complication rate of up to 20% and a late complication rate of 20 –30%.
Our vertical scar breast reduction is a modified Lassus technique, incorporating a
geometrically based and measurable preoperative marking of the breast, a superior
pedicle, a central breast resection, an intraoperative positioning of the nipple-areola
complex, and occasionally a periareolar skin resection.
In the time span examined (September 1998 –December 2001) 153 patients could be
included in the study. The resection weight per breast ranged from 60 to 1262 g (mean
390 ^ 210 g, median 380 g).
The early complication rate (hematoma, seroma, wound dehiscence, wound
infection and necrosis) was 21.6%. Of these cases, 19.6% were minor complications.
The late complication or imperfection rate was evaluated very strictly using the
standardized, extended scheme of Ferreira (problems of volume, shape, symmetry,
areola, scars and position of the breast on the thorax) and was 26%. Major late
complications necessitating a reoperation occurred in 11.1% of cases.
These complication rates compare well to those of other vertical breast reduction
techniques and T scar reductions in our own clinic and in the literature. Given that the
vertical scar breast reduction method also results in shorter scars and a significantly
better, long-lasting breast projection, this technique is clearly justified to remain the
standard method at our clinic.
Q 2003 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights
reserved.

The use of vertical scar breast reduction tech-

*Corresponding author. Tel.: þ41-1-255-2178; fax: þ 41-1-
255-4425.
E-mail address: gertrude.beer@chi.usz.ch
niques is only slowly gaining in popularity, even
though Lassus introduced the method almost 40
years ago.1 In 1998, a questionnaire distributed
to members of the American Society of Plastic
and Reconstructive Surgeons revealed that out of
190 members, only 12% carried out a vertical
(Lejour2) breast reduction.3 Three years later,

S0007-1226/$ - see front matter Q 2003 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjps.2003.10.012
Benefits and pitfalls of vertical scar breast reduction 13

Table 1 Comparison of early and late complication rates (in %) from two T scar breast reduction series9,10 and several vertical
breast reduction series from the literature
Hematoma Seroma Wound Surgical site Necrosis (NAC, Volume Shape Symmetry Areola Scars Position
dehiscence infection wound edges, on
(SSI) fat tissue) thorax
Author Year n 1 2 3 4 5 6 7 8 9 10 11

Davis9 1995 406 – – 19 12 6 18 9 8 – 18 –

a
Dabbah10 1995 185 2 1 10 22 4 – – – – 4 –
b
Berg15 1995 70 4.3 – – – 18.2 – 11.4 – – 30 –
Lassus1 1996 710 0 0 – 0 1.8 – – – – 2.8 –
Asplund32 1996 57 0 0 5.3 1.8 0 – 15.8 – 1.8 – 1.8
Lejour12 1998 250 1.3 5 3.4 0.4 0.4 – – – – – –
Hammond33 1998 98 0 2 13 0 10 – 1 – 5 1 –
b
Menke13 1999 228 5.2 7.8 10.4 – 8.4 – 15.6 – – 13 –
Menke4 2001 424 1.7 3.1 13.2 3.8 5 – – – – – –

Early complications are listed more regularly and more systematically than late complications, –, means missing indication.
a
Surgical site infection and fast tissue necrosis together.
b
Fast tissue necrosis.

Menke4 published a preliminary report on con-
tinuous quality management of breast hypertro-
phy as a tracer diagnosis by the German
Association of Plastic surgeons. According to
this report, the vertical scar breast reduction
was carried out in 53% of 799 patients and had
surpassed the rate of inverted-T scar breast
reductions by 8%. At the moment, vertical scar
techniques seem to be more popular in Europe
than in the United States. However, if this
method proves to have a similar rate of early
complications (i.e. hematoma, seroma, wound
dehiscence, infection and necrosis) and late
complications (i.e. problems of volume, shape,
symmetry, areola and scars5) as that of the
inverted-T scar techniques, and at the same time
produces equal or better long-term results, it
may well become the universal procedure of
choice.6,7 Information on the surgical outcome of
T scar breast reductions was rare in the
literature, but has recently been increasing.8 – 11
Dabbah10 found a complication rate of 45% in
various forms of T reduction in a retrospective
study on 185 patients. The most common
complications were fat necrosis or infection
(22%) and wound dehiscence (10%). An even
higher overall complication rate of 53%, was
reported by Davis9 in a study on 406 patients.
Although most of these complications were
minor, 5% required surgical correction. At our
own clinic before we began using the vertical
scar technique, the complication rate of three
different T scar or L scar reduction techniques
was also about 50%, including 4.9% major
complications.11 In contrast, other authors6 have
reported a complication rate of about 20%. This
discrepancy of more than two-fold in the indi-
cated frequency of complication rates is due to a
heterogenous and varyingly stringent definition of
complication rate (i.e. early and/or late compli-
cations, minor and/or major complications). It is
also due to the general difficulty of defining late
complications systematically, a factor that
impedes the comparison of various breast
reduction studies with respect to complications
(Table 1). Despite this we obviously have to deal
with a rate of up to 20% early and up to 20 – 30%
late complications in T scar breast reductions.
Concerning the vertical breast reduction tech-
niques, there are already a considerable number of
outcome reports, yet they mainly refer to the
Lejour technique.12 – 16 Complication rates are
strikingly similar to those obtained with the T
technique, and range in general from 12 to 50%.
Pickford14 reports a minor complication rate (e.g.
delayed wound healing, fat necrosis and wound
infection) of 40% in his first 25 ‘Lejour patients’.
Berg15 even reports a rate of early complications of
37% using the Lejour technique in 70 patients. In
contrast, Lejour’s early complication rate12 in 250
women (personal cases) lies as low as 12%.
At our clinic, we evaluated the first group of 150
patients who underwent a vertical breast reduction
using our modified vertical Lassus technique. This
technique involves a geometrically-based and
measurable preoperative marking of the breast, a
superior pedicle, a central breast resection, an
intraoperative positioning of the nipple-areola
complex (NAC) and an occasional periareolar skin
resection.17 For the sake of quality assurance we
examined the overall rate of complications and
compared it to that obtained with our formerly
14
employed T scar or L scar breast reduction
methods.11,18
Patients and methods
All patients who had a primary bilateral vertical
breast reduction in the time period from September
1998 to December 2001 were enrolled in the study.
The examination consisted of a review of the
medical charts from a prospective study protocol
and a review of our digitally stored photographic
records. Excluded from the study were patients
with unilateral breast reduction or breast recon-
struction or mastopexy, or a follow-up of less than
half a year. Mastopexy was defined as a resection of
skin alone, not involving underlying tissues.
Patient characteristics such as age, weight,
height, co-morbidity score (as classified by the
American Society of Anesthesiologists (ASA)) and
factors possibly associated with an increased risk of
surgical site infection (SSI), such as diabetes, use of
steroids or immunosuppressives, adiposity and
operation time were noted. Adiposity was defined
as a body mass index (BMI) . 30 kg/m2.
Within one hour before the beginning of the
operation all women were given antimicrobacterials
(cefuroxim 1.5 g, cephalosporine of the 2nd gener-
ation, half-life of 1 – 2 h) as a single-shot prophylac-
tic dose.18 During the operation a drain was always
used, i.e. a negative pressure drain inserted
through a separate incision in the axillary region.
The resection weight of both breasts was recorded,
the number of surgeons carrying out the operations
was also recorded.
The wound dressing was changed once, usually
24 h after the operation. At this time the two drains
were removed. The postoperative follow-up plan
included direct examination of the patients’
wounds after one week, two weeks and 1, 3, 6
and 12 months. A firmly supporting bra had to be
worn day and night for the first three weeks post-
operatively, and during the daytime for a further
three months.
All early complications, such as hematoma,
seroma, wound dehiscence, wound infection and
necrosis (classified according to whether they
involved the skin edges, fat, part or all of the
areola and nipple) were recorded. Hematomas
were subclassified into clinical hematomas, i.e.
necessitating surgical evacuation, and subclinical
hematomas.19 Only the clinical hematomas were
included in the calculation of the complication
rate. Infections were defined according to the
guidelines for prevention of SSI,20 i.e. as a purulent
G.M. Beer et al.
discharge from the superficial incision and painful
spreading erythema indicative of cellulitis
(B . 5 cm) within the first thirty days of operation.
A stitch abscess alone was not reported as a wound
infection. All late complications, i.e. imperfections
of volume, shape, symmetry, problems of the NAC
and scars, were similarly noted. In addition, the
position of the reduced breast on the thorax was
recorded. The breast volume was estimated based
on the new bra-cup size and the symmetry of the
breasts was judged visually. Symmetry of areola
position was measured by the sternal notch to
nipple, nipple to inframammary fold and inter-
nipple distances; symmetry of the areola configura-
tion was also measured. Furthermore, special
attention was paid to complications that have
been attributed specifically to the vertical scar
technique, such as teardrop deformity of the
areola, residual wrinkling of the vertical scar,
inframammary dog-ears or a vertical scar reaching
beneath the new inframammary fold (i.e. a too high
positioning of the breast on the thorax). Criteria
such as breast function (breastfeeding), sensitivity
changes, general complications such as thrombosis
or emboli, relief of breast-related pain syndrome21
and patients’ satisfaction were not included in this
study.
Results were analysed using SPSS 11.0 (SPSS,
Chicago, IL) software. Continuous variables were
summarised as mean ^ SD and were compared
between the groups by using the Mann – Whitney
test. Nominal variables were presented as n (%). A
p-value of # 0.05 was considered significant.
Results
The demographic and other basic data of the 153
patients included in the study are listed in Table
2. All patients had an ASA score of one or two.
Six patients (3.9%) had the following comorbid-
ities: hypertension (2), diabetes (1), HIV (1),
multiple sclerosis (1), paraplegia (1). Adiposity
was present in 5% of women. The resection
weight per breast ranged from 60 to 1262 g
(mean 390 ^ 210 g, median 380 g). One-third of
the patients (52 cases, 34%) had a resection
weight less than 300 g, 108 patients (71%) less
than 500 g. Eighteen patients (12%) had over
700 g resection weight per breast. The mean
operation time was 3 h and 10 min. There was a
wide range, however, with some operations
lasting up to more than 5 h. Only four operations
were below two hours in length. The total
number of surgeons was 15 (11 trainees). Of
Benefits and pitfalls of vertical scar breast reduction 15

positioning of the breast on the thorax (‘too long’

Table 2 Demographic data of the patients with a bilateral
vertical breast reduction, n ¼ 153 vertical scar) in 15% of cases. The following re-
operations arose from major late complications:
Mean ^ SD Range volume reduction (0.7%), areola correction in 3.9%
with two ruptured periareolar purse-string sutures
Age 34 ^ 13 17–67
Weight in kg 65 ^ 9 47–92
and scar revisions in 5.2%. Altogether the rate of re-
Height in cm 164 ^ 6 150–181 operations was 11.1%. The results of our T- or L scar
BMI (kg/m2) 24.3 ^ 3.1 17.6–34.8 breast reductions are published elsewhere.11,18
Duration of OP (min) 190 ^ 60 100–320
Resection (g) 385 ^ 214 60–1262

Discussion

Our vertical scar breast reduction series had a 21.6%

the early complications, wound dehiscence was
encountered in 12.4% of women. Hematoma and
wound infections were less frequent, at 4% each.
The rate of seroma and necrosis was both below
1%. The one necrosis found was a partial areola
necrosis, no fat tissue necrosis was encountered
(Table 3). The overall rate of early complications
was 21.6%. Of these, only three cases (one
patient with a wound infection and two patients
with a hematoma) were classified as major
complications (2%) and had to be readmitted
and reoperated. The remaining 19.6% were
classified as minor complications. The rates of
late complications are listed in Table 3; often
more than one complication occurred in a single
patient. The overall rate of women with a late
complication was 26%. The problems that arose
were (i) a too large residual volume in 3.3%, (ii)
shape problems in 5.2% (persisting cranial con-
vexity), (iii) minor asymmetry of the breast and
areola in a 1/4 of cases, (iv) distortion or malposi-
tion of the areola in 17% with two purse-string
suture ruptures, (v) hypertrophied and broad
vertical scars or small dog-ears at the end of the
inframammary scar in 16%, and (vi) a too high
rate of early complications and a 26% rate of late
complications or imperfections. These results were
obtained in a teaching hospital, with a total of 15
different surgeons (among them 11 trainees) carry-
ing out the operations.
Whereas, the rates of hematoma, wound dehis-
cence and wound infection18 correspond closely to
the frequencies found with other breast reduction
techniques, two other parameters among the early
complications deserve to be examined in more
detail: the low rates of seroma and necrosis. We
attribute the low rate of seroma to the fact that we
did rarely liposuction and (with growing experi-
ence) did less and less undermining of the inferior
pole of the breast. Seroma is probably a compli-
cation associated with those techniques of vertical
reduction that use adjuvant liposuction and under-
mining of the breast. Lejour12 herself reports a 5%
rate of seromas; Menke13 found a rate of 7.8%. The
low rates of necrosis, both of fat and of the wound
edges, is also attributable to the central tissue
resection en bloc with no undermining of the
breast, even though the vertical scar is closed
under a certain amount of tension. The tension on
the rather delicate skin in the infra-areolar area

Table 3 Early (arising within the first 30 days postoperatively) major and minor complications (items 1–5) and late complications,
i.e. imperfections (items 6–11, modified from the evaluation scheme of Ferreira5) in vertical breast reduction

Overall complications Major complications

Hematoma 6 (3.9%) 2 (1.36%)

Seroma 1 (0.7%) –
Wound dehiscence 19 (12.6%) 1 (0.7%)
Surgical site infection (SSI) 6 (3.9%) –
Necrosis (NAC, wound edges, fat tissue) 1 (0.7%) –
Volume 5 (3.3%) 1 (0.7%)
Shape 8 (5.2%) –
Symmetry 40 (26%) 2 (1.3%)
Areola 26 (17%) 6 (3.9%)
Scars 24 (15.6%) 4 (2.6%)
Position on thorax 22 (15%) 4 (2.6%)

n ¼ 153: Complication rates are listed as % of patients.

16
made it rather prone to wound dehiscence (12.6% in
our series), but this was probably aggravated by our
usage of subdermal braided suture material (dis-
continued after the control study) that led to
foreign body reactions.15,22 Whereas, early compli-
cations are relatively easy to classify, one major
difficulty of this study was to define objectively late
complication rates, as these tend to be difficult to
measure. Ferreira proposed a reasonable scheme of
standardisation to evaluate the appearance of the
breast.5 He proposed five visual characteristics to
be evaluated on a score from 0 to 2 (0 ¼ poor,
1 ¼ fair (average), 2 ¼ good). We used his five
characteristics, but rather than scoring between 0
and 2, we regarded all imperfections that would
have resulted in a ‘fair’ or ‘poor’ result as
‘complications’. Additionally, we added a further
feature to this score, namely the ‘position’ of the
breast on the thorax.
In the conventional T scar breast reductions, the
position on the thorax is defined at the time of
operation by the incision at the inframammary fold
(later on, the inframammary scar tends to rise and
becomes situated on the inferior pole of the
breast). The situation is completely different in
vertical reductions. Lassus1 observed that in large
breasts the inferior portion of the vertical scar
appeared below the inframammary fold. This was
the reason why he recommended ending the
vertical incision 2 – 4 cm above the inframammary
fold for large breasts. Additionally, Lejour2 recom-
mended the temporary creation of a new, higher
inframammary fold at the end of the vertical
incision point. With this technique the breast is
raised in its position on the thorax. If the breast
remains in its higher position and the vertical scar
does not end at the new fold once the inferior pole
has been tightened (a risk especially in small
remaining breasts with good skin quality), the scar
appears ‘too long’ and becomes visible. This is
probably the biggest pitfall of the vertical scar
technique and is both vexing to the surgeon and,
more important, embarrassing to the women when
they wear a small bra or a bikini. Fifteen percent of
our scars appeared below the new, artificial higher
submammary fold. On the basis of this experience,
we now recommend—whenever there is no ana-
tomical need to raise the submammary fold—
leaving the submammary fold in its original position
and terminating the vertical incision at that point.
Further specific findings concerning late compli-
cations of the vertical scar breast reduction will be
discussed according to Ferrera’s evaluation
Scheme.
Volume (Size). The evaluative potential of this
item is diminished by the technical difficulty of
G.M. Beer et al.
measuring the exact breast size.23,24 Various
attempts have been made, using different forms
of water displacement or imitating bra-cup sizes
with calibrated, transparent plastic cups.15 Other
authors just use the woman’s normal bra size.21,25
However, irrespective of these technical difficul-
ties, there does seem to be a tendency to under-
resect breast tissue in vertical breast reductions,
leaving the final volume larger than in a comparable
T scar breast reduction.26 This is predominantly the
case in the Lassus vertical reductions, since the
tissue of the medial and lateral infraareolar
extremities is left in place and no liposuction is
carried out. At our clinic, a comparison between
our modified, vertical breast reduction (the stan-
dard procedure for all patients since 1998) and
previous T scar breast reductions performed by the
first author,18 showed a significant difference in
the mean resection weight per breast: 385 g in the
vertical scar group and 450 g in the T scar group
( p ¼ 0.0039 for the right and p ¼ 0.009 for the left
breast). Whereas, in the vertical scar reduction
group the majority of women postoperatively had a
Cup C breast size, the majority of the T scar group
had a bra size Cup B. No woman complained about
over-resection in the vertical group, but 3.3%
complained about under-resection. Hughes reports
the opposite experience27 in a series of 31 patients
with T scar reductions, where 25.8% of patients
thought, one month after the operation, that their
breasts had been over-reduced (the rate dropped to
15% after two months). In most other reports,
where the resection weight in the T scar group was
substantially higher than in the I scar group, the
latter group was composed of small to medium
breast reductions only.4,14
Shape. One of the main benefits of all vertical
forms of breast reductions is the enhanced, and
long-lasting better projection of the breast as com-
pared to the flatter appearance of the breast
following a T scar breast reduction (Fig. 1). How-
ever, the more tissue in the infraareolar region is
excised, the smaller the foundation of the breast
becomes, and the greater is the risk of producing
‘tube’ breasts with an overly raised projection.
Similarly, exerting too much tension on the infra-
areolar scars can produce, in predisposed patients,
a symmasty of variable degree. Such a deformity
can only rarely be corrected. Another tricky shape
problem in vertical breast reductions can be a
persisting cranial convexity if the breast is posi-
tioned too high on the thorax, and the NAC is placed
rather low. The cranial convexity results in a profile
that differs significantly from the ideal shape of a
smooth straight line in the upper pole of the breast
to the NAC and a decent convexity on the lower
Benefits and pitfalls of vertical scar breast reduction
Figure 1 Breast projection in the lateral view: apart
from the short scars the enhanced breast projection is
one of the most benefits in vertical breast reduction. (A
and B) Lateral views of a vertical breast reduction 12
months after the operation and after a resection weight
of between 450 and 500 g per breast with pronounced
breast projection. (C) For comparison: lateral view 6
months after a conventional T-scar breast reduction
(resection weight 500 g per breast) with the more flat
breast mound and the long horizontal scar visible in the
anterior axillary region.
pole. On the other hand, a low-set NAC will never
give the impression of a bottomed out breast at a
later date, as is sometimes the case in high-riding
areolas.28
17
Symmetry. Although various attempts have
been made,15 it is extremely difficult to define
breast symmetry.6 Stark29 defines excellent sym-
metry of the breast as a contralateral deviation
of , 1 cm in the distance between (i) the sternal
notch and the cranial border of the areola, (ii)
the midline of the sternum and the areola, and
(iii) the inferior border of the areola and the
submammary fold in postoperative patients.
However, these measurements actually define
the symmetry of areola position rather than
true breast symmetry. Additionally, breast asym-
metry only becomes noticeable when there is a
certain proportional right-left weight difference;
i.e. the bigger the breast, the bigger the
difference must be to become noticeable. The
goal of obtaining complete symmetry is a
challenge irrespective of the method of breast
reduction. It requires experience and can best be
achieved by operating on the women in a semi-
sitting position and using measurements rather
than freehand drawing as the basis of the
preoperative markings.
Areola. The rate of 17% dissatisfaction with
areola configuration in our study parallels the
literature.27 Besides horizontal and vertical mal-
positioning, irregular and asymmetric areolas and
distortions due to the superior pedicle in most kinds
of breast reductions, there are three possible
complications specific to our modified vertical
technique: (1) distension of the areola as a result
of a periareolar skin resection, (2) rupture of the
‘Benelli’30 purse-string suture, (3) a palpable
circular purse-string suture and (4) a tear drop
deformity of the areola31 if the vertical infraareolar
suture is pleated too strongly.
The position of the areola is decisive for the
appearance of recurrent ptosis, which happens
nearly always after breast reduction (dependent
on the residual volume and the quality of the skin).
Besides preventing a bottomed out appearance of
the breast, the placement of the NAC relatively low
on the breast mound is certainly one of the main
reasons why NAC necrosis has become very rare
(below 1% in our group and in others14 as well).
Whereas, in many of the T scar breast reductions
the nipples had a tendency to be placed too high,27
we had a few complaints (during the first three
months following the operation) that the nipples in
our reductions had been placed rather low.
Scars. One of the main pitfalls of the vertical
Lassus reduction is the susceptibility to produce
hypertrophied and spread scars (. 2 cm)15 as there
is considerable tension on the vertical and peri-
areolar scars (in the case of a periareolar resec-
tion), despite using a purse-string suture. Yet, in
18
contrast to the T scar reductions, the scar is
significantly shorter and in an area less prone to
hypertrophy than in the medial and lateral extrem-
ity of an inframammary scar. The short scar is a real
benefit and despite a rate of 15% unsatisfactory
scars we would not change our operative design
towards a wound closure involving less tension but
producing a significantly worse shape. As there is no
need to significantly shorten the vertical scar in the
Lassus philosophy, the problem of wrinkling of the
scar with inferior dog-ears is small.
The standardised scheme of Ferreira5 probably
lead to the discovery of more (minor) long-term
complications than would otherwise have been
detected. We found this scheme to be a very
versatile and powerful quality assurance tool, even
for experienced surgeons, to systematise their
postoperative long-term follow-up.
Although using a stringent screening system, our
complication rate is comparable to the compli-
cation rates of other types of vertical breast
reductions and T scar reductions at our own clinic
and in the literature. This is in contrast to Lassus,1
who stated that complications were rare in his
experience in 710 personal cases. This statement
gives us the certainty that with growing experience,
the complication rates will diminish even at a
teaching hospital with ever changing surgeons.
Given that the drawbacks (complication rates) are
comparable to other techniques, and the benefits
significantly greater (shorter scars and a signifi-
cantly better breast projection) in vertical breast
reductions, the decision to adopt this method
seems well justified. Vertical breast reduction will
continue be the standard technique used at our
clinic.
References
1. Lassus C. A 30-year experience with vertical mammaplasty.
Plast Reconstr Surg 1996;97(2):373—80.
2. Lejour M. Vertical mammaplasty and liposuction. St Louis:
Quality Medical Publishing Inc; 1994.
3. Hidalgo DA, Elliot LF, Palumbo S, Casas L, Hammond D.
Current trends in breast reduction. Plast Reconstr Surg 1999;
104(3):806—18.
4. Menke H, Eisenmann-Klein M, Olbrisch RR, Exner K.
Continuous quality management of breast hypertrophy by
the German Association of Plastic Surgeons: a preliminary
report. Ann Plast Surg 2001;46(6):594—600.
5. Ferreira MC. Evaluation of results in aesthetic plastic
surgery: preliminary observations on mammaplasty. Plast
Reconstr Surg 2000;106(7):1630—8.
6. Schnur PL. Reduction mammaplasty—the Schnur sliding scale
revisited. Ann Plast Surg 1999;42(1):107.
7. Georgiade NG, Serafin R, Riefkohl R, Georgiade GS. Is there a
G.M. Beer et al.
reduction mammaplasty for all seasons? Plast Reconstr Surg
1979;63:765—73.
8. Egmont DB, Isselstein KI, Ramselaar JM. A comparison
between two methods of reduction mammaplasty. Eur J
Plast Surg 1992;15:75—8.
9. Davis GM, Ringler SL, Short K, Sherrik D, Bengtson BP.
Reduction mammaplasty: long term efficacy, morbidity, and
patient satisfaction. Plast Reconstr Surg 1995;96(5):1106—10.
10. Dabbah A, Lehman JA, Parker MG, Tantri D, Wagner D.
Reduction mammaplasty: an outcome analysis. Ann Plast
Surg 1995;35:337—41.
11. Giovanoli P, Meuli-Simmen C, Meyer VE, Frey M. Which
technique for which breast? A prospective study of different
techniques of reduction mammaplasty. Br J Plast Surg 1999;
52:52—9.
12. Lejour M. Vertical mammaplasty: early complications after
250 personal consecutive cases. Plast Reconstr Surg 1999;
104(3):764—70.
13. Menke H, Restl B, Olbrisch RR. Vertical scar reduction
mammaplasty as a standard procedure—experiences in the
introduction and validation of a modified reduction tech-
nique. Eur J Plast Surg 1999;22:74—9.
14. Pickford MA, Boorman JG. Early experience with the Lejour
vertical scar reduction mammaplasty. Br J Plast Surg 1993;
46:516—22.
15. Berg A, Palmer B, Stark B. Early experience with the Lejour
vertical scar reduction mammaplasty technique. Eur J Plast
Surg 1995;18:214—8.
16. Palumbo SK, Shifren J, Rhee C. Modifications of the Lejour
vertical mammaplasty: analysis of results in 100 consecutive
cases. Ann Plast Surg 1998;40(4):354—9.
17. Beer GM, Morgenthaler W, Spicher I, Meyer VE. Modifications
in vertical scar breast reduction. J Br Plast Surg 2001;54(4):
341—7.
18. Kompatscher P, Planta A, Spicher I, Vetter S, Minder J, Meyer
VE, Beer GM. Antimicrobial prophylaxis for the prevention of
early infections after breast reduction. Aesth Plast Surg, in
press.
19. Asplund O, Gylbert L, Jurell G, Ward C. Textured or smooth
implants for submuscular breast augmentation: a controlled
study. Plast Reconstr Surg 1995;97(6):1200—6.
20. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR.
Guideline for prevention of surgical site infection. Infect
Control Hosp Epidemiol 1999;20(4):247—78.
21. Kerrigan CL, Collins ED, Striplin D, Kim HM, Wilkins E,
Cunningham B, Lowery J. The health burden of breast
hypertrophy. Plast Reconstr Surg 2001;108(6):1591—9.
22. Lejour M. Early experience with the Lejour vertical scar
reduction mammaplasty technique-invited commentary. Eur
J Plast Surg 1995;18:218—9.
23. Grossman AJ, Roudner LA. A simple means for accurate
breast volume determination. Plast Reconstr Surg 1980;
66(6):851—2.
24. Tegtmeier RE. A quick, accurate mammometer. Ann Plast
Surg 1978;1(5):625—6.
25. Gonzalez F, Walton RL, Shafer B, Matory WE, Borah GL.
Reduction mammaplasty improves symptoms of macromas-
tia. Plast Reconstr Surg 1993;91(7):1270—5.
26. Hall-Findlay EJ. A simplified vertical reduction
mammaplasty: shortening the learning curve. Plast Reconstr
Surg 1999;104(3):748—63.
27. Hughes LA, Mahoney JL. Patient satisfaction with reduction
mammaplasty: an early survey. Aesth Plast Surg 1993;17:
345—9.
28. Lejour M. Vertical mammaplasty as secondary surgery after
other techniques. Aesth Plast Surg 1997;21:403—7.
Benefits and pitfalls of vertical scar breast reduction
29. Stark B, Olivari N. Breast asymmetry: an objective analysis of
postoperative results. Eur J Plast Surg 1991;14:173—6.
30. Benelli L. A new periareolar mammaplasty: the ‘round block‘
technique. Aesth Plast Surg 1990;14(2):93—100.
31. Wallach SG. Avoiding the teardrop shaped nipple areola
complex in vertical mammaplasty. Plast Reconstr Surg 2000;
106(5):1217—8.
19
32. Asplund OA, Davies DM. Vertical scar breast reduction with
medial flap or glandular transposition of the nipple-areola.
Br J Plast Surg 1996;49:507—14.
33. Hammond DC. Short scar periareolar inferior pedicle
reduction (SPAIR) mammaplasty. Plast Reconstr Surg 1999;
103(3):890—902.