Improving safety and aesthetic results in inverted T scar breast reduction.

Breast reduction using an inverted T scar skin design and a variety of glandular pedicle types is widely practiced and is the standard by which more recent limited scar techniques are judged. The inverted T procedures are attractive because they are predictable and versatile and permit great control over both the extent of reduction and the breast-shaping process. Despite these advantages, common criticisms of inverted T scar techniques include breast shape abnormalities, areolar malposition, hypertrophic scars, and poor long-term projection. Preoperative markings influence both safety and aesthetics. A method of skin marking that is based on a displacement method to determine vertical limb splay angle is described. This design concept must be modified to address certain variants, such as macromastia presenting with normal nipple position or large-diameter areolae, moderately severe macromastia, and macromastia involving radiated breasts. Safety in breast reduction is improved by paying attention to patient positioning issues, using techniques that minimize blood loss, raising flaps of appropriate thickness in the correct plane, and performing resection by observing the principles that reduce the risk of compromise of nipple and areolar circulation. Aesthetic results are improved by analyzing vertical breast meridian lengths during final breast shaping, modifying areolar shape as necessary, and carefully tailoring the medial inframammary crease. The latter is also important for minimizing the potential for scar hypertrophy. The principles presented have been refined during the course of a 12-year experience with several hundred breast reduction procedures. They contribute to improved results in inverted T scar breast reduction when practiced consistently.