Short scar reduction techniques for breast reduction refer to operations trying to avoid the long inframammary scar in the design of the skin reduction pattern.
The idea of vertical breast reduction with short scars was first published by the German surgeon Lotsch in 1923 and with a modification in 1925. His two techniques were equally applicable to vertical breast reduction and vertical breast lifting. One of the eternal principles resulting from the revolution in breast surgery in Europe between 1920 and 1930 is the paradigm that reshaping of the breast and reduction of the skin envelope during breast reduction and breast lifting are the two pillars for successful cosmetically acceptable results in breast surgery. Thus the short, vertical scar can be employed in conjunction with almost all reshaping and nipple-areola repositioning techniques.
Some 60 years later Lassus and Marchac in France and Lejour in Belgium expanded upon Lotsch’s discoveries and made one more of its qualities apparent, which may not have been truly appreciated by Lotsch’s contemporaries (see also “Deformities and Cosmetic Operations of the Female Breast”, by Hermann Biesenberger). When breast reshaping was carried out by resecting the lower and lateral drooping and enlarged breast tissue and carrying the nipple-areola complex on one of the superior pedicles during breast reduction and breast lifitng durable uplifting, a smaller footprint of the breast base on the chest wall and a dramatic increase in projection could be achieved. Not only was the scar vertical, but the entire concept is one of movement in a vertical direction – namely up. Thus, “vertical breast reduction” is a term still in common use in Europe.
US surgeons for the longest time used to inferior pedicles somewhat stubbornly stuck to this concept and continued to produce long scars, bottomed out breasts, which were flattened and boxy. Fortunately, this trend seems to be reversing thanks to the efforts of numerous pioneers particularly from the Atlanta school.
The following presentation was given several years ago at a European breast meeting in modified form.