Sometimes, The Kindest Cut May Be A Longer Incision

There has been a trend in all surgical fields to shorten incisions. This not only usually reduces post operative recovery and pain, but also offers the added benefit of minimizing the patient’s scar.

Consider the evolution of gallbladder removal surgery. Twenty years ago this procedure required a six- to twelve-inch abdominal incision, followed by a two- to three-night hospital stay. Today, gallbladder removal is accomplished on an outpatient basis with the patient receiving just three tiny incisions.

In plastic surgery, a prime example of this trend toward shorter incisions is vertical breast reduction. Developed over the last 10 years, this new technique promises less scarring, the elimination of drains, and the ability to send patients home the day of surgery. Sounds great, right? But it’s not for every breast reduction patient. Here’s why.

With traditional breast reduction the incision takes the form of an anchor on inverted T. The incision circles the nipple, travels to the crease under the breast, and then continues all the way under the breast, running from cleavage to nearly under the arm. With vertical breast reduction the long incision running under the breast is eliminated. This results in a scar that is roughly half the length. What vertical breast reduction cannot accomplish, however, is the correction of drooping (ptosis) and elimination of excess skin.

Although the goal of shorter scars is desirable, in my Boston-based plastic surgery practice I look at many factors when planning a patient’s breast reduction surgery. It’s also important that the patient understand the relative advantages of each incision technique to make a fully informed decision.

That said, I have found that older patients, those with larger body mass, and those with ptosis achieve better results with the anchor incision method. Most of these patients have a problem with excess skin which is corrected through the traditional technique, resulting in more of a “lift.” Conversely, younger patients requiring smaller breast reductions are happy with the results achieved through the vertical (short scar) breast reduction technique.

The majority of patients I see in Boston for breast reduction regard the surgery as one of the most empowering steps they have ever taken. If you are considering breast reduction, ask your surgeon which incision option would be best for you. The key is to customize the procedure to your individual situation.