Raleigh Plastic Surgeon Dr. Michael Law discusses:

 Breast Reduction: enhancing breast aesthetics and patient comfort

For several years I have been using a 'vertical scar' technique for breast reduction surgery which eliminates the long, horizontal incision in the fold below the breast. The modern vertical mastopexy was initially developed by Belgian plastic surgeon Dr. Madeline Lejour (who adapted her procedure from the work of two pioneering French plastic surgeons), and that technique has since been modified by a number of plastic surgeons. I use a modification of Dr. Lejour's technique that was developed by a Canadian plastic surgeon, Dr. Elizabeth Hall-Findlay of Banff, Alberta. I have been using Dr. Hall-Findley's technique for some time now, and have been extremely pleased with the results.

Not only does this approach to breast reduction surgery eliminate the horizontal incision, but it also produces much more dramatic breast projection, and better maintains breast projection over time. One important limitation of older breast reduction techniques has been that many of them tend to flatten the breast, and over time they may become excessively full in the lower pole of the breast (the ''bottomed out" look). The vertical breast reduction, because it preserves breast tissue in the upper and medial quadrants of the breast, and because it employs internal suturing to form the breast mound back into an aesthetically ideal shape, tends to produce quite impressive breast projection which is durable over time.

There are some patients with very large breasts for whom the vertical reduction technique may leave a patient with excessive skin, and ultimately excessive fullness, in the lower poles of the breasts. In these patients, once the vertical reduction is complete, I may add a horizontal skin excision hidden in the inframammary folds. This additional skin excision usually does not need to be as long as the inframammary incision used in older 'inverted T' breast reductions, and it prevents the development of excessive lower pole fullness over time.

For most patients, this operation significantly enhances patient comfort as well as overall breast appearance. The weight of excessively large breasts puts significant strain on the neck, shoulders and upper back, and may produce deep grooves in the shoulders from the impingement of bra straps. Many patients experience relief from back and neck pain, headaches, and other unpleasant symptoms following breast reduction surgery. Most also report that they are able to increase their overall physical activity and to enhance their exercise regimens once the excessive size and weight of their breasts have been corrected.

For many women, excessive breast volume exists independent of their overall size and weight. Others experience significant variation in breast volume with weight gain and loss. It is important that a patient undergoing breast reduction surgery be at a healthy and stable weight in order to experience the greatest possible benefit from the procedure. If a patient's Body Mass Index or BMI (a ratio of weight and height) is excessively high (greater than 30), an attempt must be made to bring the BMI within a healthy range before undergoing breast reduction surgery. It is worth noting that a high BMI can be due to either excessive fatty tissue OR to excess lean body mass (muscle mass), so the BMI is always considered in light of whether it excess fat or muscle development that is causing the number to be high.