Revisiting the No-vertical-scar, Free Nipple Graft Breast Reduction

Abstract

Disclosure: Dr. Swanson receives royalties from SpringerNature (Cham, Switzerland).V azquez et al 1 promote a breast reduction with no vertical incision and free nipple grafting for women with large, ptotic breasts who do not plan to breastfeed. The authors claim that this technique offers aesthetic advantages, including elimination of the vertical scar and enhanced breast projection. 1 The authors do not discuss how commonly they use this method and what their alternative breast reduction approach may be.This operation was first reported by Thorek 2 in 1922. This American surgeon resected the lower pole of the breast and replaced the nipple/areola as a free nipple graft, with the horizontal scar tucked in the inframammary fold and no vertical scar. Thorek claimed that he was the first to graft the nipple, and Blair Rogers, in an editor's footnote to a 1989 republication, 3 confirmed it. Later, the operation was modified to include a midline tissue resection to improve shape. 4 The authors reference a 1997 article by Manstein et al 5 describing a lower pole resection and free nipple graft without a vertical incision, including a superiorly based dermoglandular flap. Manstein et al 5 reference Thorek's original article. Indeed, most comprehensive reviews of breast reduction reference Thorek's publication. 6,7 The 2022 article by Vazquez et al 1 is a testament to the observation that if one looks hard enough, one may find that many "new' operations are not so new after all. 8 The authors did not measure nipple sensation, but state that "all patients regained tactile sensitivity under the graft over time." 1 No patient surveys were conducted, and no breast measurement data were collected. The mean patient age for breast reduction was 58.6 years. Two of the patients featured in photographs were 42 years old and 43 years old. Based on notes in chart reviews over a 22-year period, the authors conclude, "all patients were pleased with their results and healing outcomes." The authors report one case of capsular contracture, which is puzzling because none of the patients received breast implants.

The Influence of Scar Patterns After Reduction Mammoplasty on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation

“…The possible explanation for this divergence might be that the inframammary scar caused the most discomfort by itchiness and irritation due to its proximity to the bra [ 8 ], while the vertical limb was deemed the most visually unacceptable due to its exposed position from frontal view, which was frequently reported as the primary source of postoperative patient discontent [ 8 , 10 , 11 ]. However, although the inframammary scar is generally located below the breast mound and not visible from the frontal view, when it extended beyond the concealed inframammary crease to the visible lateral chest wall, the axilla, or even the cleavage area, it might cause the complaint from the patients [ 6 , 8 , 11 , 22 ].…”

Combined superior and inferior dermoglandular flaps for projection enhancement in giantic breast amputation and free nipple areola graft

“…Numerous methods for correcting gigantomastia have been discovered. (1) amputation for decreased studied cases who complain of gigantomastia & severe ptosis (space among nipple & inframammary fold exceeds twenty-five cm) are only eligible for mammaplasty with free nipple-areola grafting. purpose of that surgery is to achieve breast shape size that is acceptable while also relieving pain & suffering brought on by excessive breast tissue hypertrophy.…”

“…By way of illustration, superior dermoglandular pedicles were modified to augment central projection for freenipple reduction mammaplasty with or without backfolding. (1) In contrast, all of the techniques previously discussed NACdirectly to their final position as standard after shaping & suturing flaps that increase projection. Even though our method resembles other methods that use superior flaps, all of them have flaps that range in thickness from one to four cm since authors felt that this was important for manipulating flaps.…”