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The sagging breast is the most formidable challenge in aesthetic plastic surgery of the breast. Not only because the scars needed for breast lifting create new aesthetic concerns but the sustainability of the lifted breast is not assured. While many women want their breast lifted, they are often understandably averse to the scars. But real breast lifting requires scars and they are an unavoidable trade-off for significant breast reshaping.

There are numerous methods for breast lifting or mastopexy and they all share two fundamental concepts; nipple elevation and an underlying pattern of skin removal and tightening. The skin reduction pattern is the most recognizeable aspect of a breast lift because of the scars that are left in its wake. Historically, the inverted-T scar pattern was the most common approach but more scar-sparing techniques have evolved in efforts to limit the size of the scar. This has led to vertical (lollipop) and periareolar (donut) breast lift designs. These work well when the degree of breast sagging is not severe. But severe sagging cases still require more extensive scars.

Innovations in breast lift surgery are needed as the perfect breast lift operation does not yet exist. In that spirit, a new glandular Z-breast lift technique was recently reported in the July 2011 online issue of Eplasty, This breast lifting technique borrows from the well known z-plasty technique used in contracture releases and scar revision. Using a fixed geometric pattern, the glandular breast tissue is lifted and reoriented. It was first tested in 15 female cadavers where it was learned that it could be completed in less than one hour per breast and the nipple moved upward an average of over 5 cms. By planning the inferior flap of the z-plasty to include the nipple, a natural superomedial pedicle is created and with transposition acts as internal support for the rotated nipple. How the excess breast skin is managed is still done completely independent of the glandular z-plasty. The skin is addressed by any of the standard designs whether it be periareolar, vertical or inverted-T.

This innovative breast lifting technique is both novel and interesting. It does appear to offer an improved method for nipple elevation and support. Making the sustainability of the lift based on the glandular tissue is likely to be more effective than relying on skin support alone. But from a patient’s perspective, it offers  no real advances in limiting scarring which is always the patient’s main concern. Perhaps having better gland support for some patients may decrease the need for external skin tightening. Until I use this technique or see a clinical report with its use, its benefits for breast lifting remain theoretical.

Dr. Barry Eppley

Indianapolis, Indiana

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