Refinements of vertical scar mammaplasty: circumvertical skin excision design with limited inferior pole subdermal undermining and liposculpture of the inframammary crease.

Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Despite initial skepticism, vertical reduction mammaplasty is becoming increasingly popular in recent years because it best incorporates the two concepts of minimal scarring and a satisfactory breast shape. At the moment, vertical scar techniques seem to be more popular in Europe than in the United States. A recent survey, however, has demonstrated that even in the United States, it has surpassed the rate of inverted T-scar breast reductions. The technique, however, is not without major drawbacks, such as long vertical scars extending below the inframammary crease and excessive skin gathering and "dog-ear" at the lower end of the scar that may require long periods for resolution, causing extreme distress to patients and surgeons alike. Efforts are being made to minimize these complications and make the procedure more user-friendly either by modifying it or by replacing it with an alternative that retains the same advantages. Although conceptually opposed to the standard vertical design, the circumvertical modification probably is the most important maneuver for shortening vertical scars. Residual dog-ears often are excised, resulting in a short transverse scar (inverted T- or L-scar). The authors describe limited subdermal undermining of the skin at the inferior edge of the vertical incisions with liposculpture of the inframammary crease, avoiding scar extension altogether. Simplified circumvertical drawing that uses the familiar Wise pattern also is described.