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The “Y-Scar” Technique: Even Less Scarring Than the Lollipop?

The Quest for the Invisible Scar

In the world of breast surgery, the “Vertical” (Lollipop) reduction was a major leap forward because it eliminated the horizontal anchor scar. But for some surgeons, even the circle around the areola was too much.

In December 2007, Dr. David Hidalgo published a study in Plastic and Reconstructive Surgery proposing a radical modification: Deleting the top half of the scar.

He explains Breast Reduction with Minimal Y Scar

This work was done at Weill-Cornell University Medical College in New York.

This paper introduces a refined technique for patients who need a “mini” Breast reduction and want the absolute minimum amount of scarring.

He argued that for certain young patients with mild enlargement, the upper part of the incision is unnecessary and actually harms the aesthetic result.

The Innovation: Saving the Upper Border

The “Y-Scar” technique is essentially a vertical reduction where the surgeon leaves the upper half of the areola completely untouched.

  • The Theory: The transition between the darker areola skin and the lighter breast skin is often soft and natural. When you cut through it (as in a standard donut lift), you replace that soft transition with a sharp white scar line.
  • The Solution: By leaving the top half of the areola attached to the skin, the surgeon preserves that natural “blur,” making the breast look virtually untouched from the top down. The resulting scar looks like a “Y” (or a lollipop with the top of the circle missing).

Who is the “Y-Scar” Candidate?

This technique is not for everyone. Dr. Hidalgo specifically designed it for a “niche” group of patients who often fall into the gap between a lift and a reduction:

  1. Mild Macromastia: Patients who only need a small amount of weight removed (the study average was 198 grams, compared to 500g+ for standard reductions).
  2. Minimal Ptosis: Women with only mild drooping.
  3. Young Patients: Younger skin has better elasticity, which is crucial for this technique to settle smoothly without bunching.

The Results: High Satisfaction for “Mini” Reductions

The study reviewed 10 patients (8 reductions/lifts and 2 augmentations/lifts).

  • Aesthetic Outcome: All patients were pleased with the reduced scar burden. The removal of the upper scar significantly reduced the “perception” of having had surgery.
  • Minor Issues: Because the skin is less managed than in full reductions, some patients experienced “inferior fullness” (fullness at the bottom of the areola), but this was considered a minor trade-off for the lack of scarring.

Conclusion

For young women seeking a “perk-up” and a small reduction, the full Lollipop or Anchor scar might feel like overkill. The Y-Scar Vertical Mammaplasty offers a tailored, minimalist approach that respects the natural anatomy of the areola, leaving the upper breast looking completely natural.

Ask yourself “Who is the Best Plastic Surgeon Near Me?”.

Revera Clinic caters with the Best Plastic Surgeon in Hyderabad!

Breast Reduction Surgery Cost varies between individuals!

Contact us to know if you are a suitable candidate for Breast Reduction Surgery!

Frequently Asked Questions (FAQ)

Q: Can this be done if I have very large breasts?

A: Likely not. The study specifically focused on “mild macromastia” (under 400g removal). Larger reductions usually require the full skin tightening power of the Anchor or full Vertical patterns.

Q: Is this different from a “Circumvertical” lift?

A: It is a variation of it. Most vertical lifts cut all the way around the areola. This specific “Y” variation spares the top 180 degrees of the areola rim.

Q: Does it affect nipple sensation?

A: Since the upper skin bridge is left intact, the nerve supply is generally well-preserved, similar to other vertical techniques.

References

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Woman in a Grey Shirt Giving a Thumbs up and holding a measuring tape in another hand. Dr. John Tebbetts Vertical Skin Excess measurement for Breast Reduction and Breast Lift Surgery
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Math Over Art: How Quantifying Your Skin Prevents Surgical Errors in Breast Reduction and Breast Lift!

The Problem: The “Artistic” Guess

For a long time, breast reduction and lift (mastopexy) planning relied heavily on the surgeon’s “artistic eye.” A surgeon would pinch the skin, draw some markings, and estimate how much tissue to remove.

While often successful, this subjective approach has a flaw: Imprecision. “Eyeballing” the skin excision can lead to nipples that are too high, scars that stretch, or breasts that “bottom out” because the skin envelope was left too loose.

The Solution: The Tebbetts Process

In March 2014, Dr. John Tebbetts published a landmark study from his practice in Dallas, Texas, detailing a strictly mathematical approach to planning these surgeries.

This paper represents a major shift from surgery as an “art” to surgery as an “objective science”.

Instead of guessing, he developed a process to quantify the skin envelope—measuring exactly how much excess skin exists down to the millimeter. He applied this rigorous measuring process to 124 mastopexy and 122 breast reduction patients.

1. Measuring “Vertical Skin Excess” (VSE)

The core of this technique is measuring Vertical Skin Excess. This is the specific amount of skin between the nipple and the breast crease that needs to be removed to lift the breast correctly.

Dr. Tebbetts found that this number—not a guess—should dictate which incision pattern is used:

Simple Formula:

VSE=Actual Nipple-to-IMF Distance−Desired Nipple-to-IMF Distance (typically 8-10 cm)cap V cap S cap E equals Actual Nipple-to-IMF Distance minus Desired Nipple-to-IMF Distance (typically 8-10 cm)

Quantified approach (More Detailed Calculation):

VSE=Existing Nipple-to-IMF Dimension−(Desired Nipple-to-IMF Distance+Areola Diameter2)cap V cap S cap E equals Existing Nipple-to-IMF Dimension minus open paren Desired Nipple-to-IMF Distance plus the fraction with numerator Areola Diameter and denominator 2 end-fraction close paren

Illustration showing Nipple to IMF distance (Inframammary Fold)

2. Designing the “New” Envelope

Once the excess is measured, the surgeon calculates exactly where the new nipple position should be. In Dr. Tebbetts’ study, the planning was so precise that 0% of the 246 patients required nipple repositioning after surgery.

The Results: Why Math Wins

The study followed patients for an average of 4.6 years, providing long-term data on how these “quantified” breasts aged.

  • High Accuracy: As mentioned, no patient needed their nipples moved again.
  • Low Complications: “Bottoming out” (excessive lower pole stretch) occurred in only 4% of cases.
  • Learning Curve: Interestingly, the reoperation rate dropped from 6.5% in the first five years of using this method to just 1.6% in the later years, proving that once a surgeon masters the math, the results are incredibly consistent.

What This Means for You

If you are considering a breast reduction or lift, you want a surgeon who plans, not one who guesses.

This “Quantified Dimensions” approach ensures that the surgery is tailored to your specific skin elasticity and measurements. It removes the “surprise” factor, ensuring that the incision chosen is exactly the right one to handle your specific amount of excess skin.

Ask yourself “Who is the Best Plastic Surgeon Near Me?”.

Revera Clinic caters with the Best Plastic Surgeon in Hyderabad!

Breast Reduction Surgery Cost varies between individuals!

Contact us to know if you are a suitable candidate for Breast Reduction Surgery!

Frequently Asked Questions (FAQ)

Q: Does “quantifying” mean I get a cookie-cutter breast?

A: No, it means the opposite. Because the measurements are specific to your body, the surgical plan is customized to your exact anatomy rather than a generic template.

Q: Can this method prevent all stretching?

A: No surgery can stop gravity completely. However, this study showed that “excessive restretch” was rare (4%), meaning the results are stable for years.

Q: Is this technique used for implants too?

A: Dr. Tebbetts is famous for applying similar mathematical principles (“High Five” system) to breast augmentation, ensuring that implants fit the patient’s footprint perfectly.

References

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The Hidden Skeleton: How “Würinger’s Septum” Revolutionized Breast Reduction Surgery

The Discovery in Vienna

Before the late 90s, breast anatomy was often viewed simply as a mass of glands and fat. Surgeons knew where the blood vessels generally were, but the internal “architecture” was not fully mapped.

In April 1999, Dr. Elisabeth Würinger published a groundbreaking study in Plastic and Reconstructive Surgery based on her work at the Wilhelminenspital in Vienna, Austria. Through meticulous dissection of 20 female breasts, she discovered a distinct connective tissue structure that acts as a “suspension apparatus” for the breast.

This structure is now known globally as Würinger’s Septum.

What is the Ligamentous Suspension?

Dr. Würinger found that the breast is not just a loose bag of tissue. It has a constant, definable internal structure:

  • The Horizontal Septum: A strong band of tissue that originates at the level of the 5th rib.
  • The Curve: This septum curves upward, turning into vertical medial and lateral ligaments.
  • The Superhighway: Most importantly, this septum acts as a “guide,” carrying the main blood vessels and nerves directly to the nipple.

The Technique: Refined Central Pedicle

Using this new anatomical map, Dr. Würinger refined the Central Pedicle technique. Instead of relying on the skin to carry the blood supply (dermal pedicle), this method relies entirely on the internal ligaments.

1. Maximum Sensation & Safety

Because the septum contains the primary nerve supply, keeping it intact provides a “predictable and reliable” way to preserve nipple sensation. It also guarantees blood flow, making the surgery safe regardless of the patient’s risk factors or the size of the reduction.

2. True Symmetry

The study revealed that the horizontal septum divides the breast into regular, measurable sections. Surgeons can use this septum as a built-in ruler, ensuring that the left breast matches the right breast internally, not just externally.

3. Better Shape, Smaller Scars

Because the blood supply comes from deep inside (the septum) rather than the skin, the surgeon does not need to leave a thick bridge of skin attached to the nipple. This allows for:

  • Smaller Scars: The skin can be tightened more effectively.
  • Better Projection: The ligaments maintain their “suspending function,” acting like an internal bra to hold the shape long-term.

Conclusion

Dr. Würinger’s work proved that understanding the breast’s “ligamentous suspension” allows for safer, more precise Breast Reduction surgery. For patients, this translates to a lower risk of complications, better nipple sensation, and a more natural, perky shape that lasts.

Ask yourself “Who is the Best Plastic Surgeon Near Me?”.

Revera Clinic caters with the Best Plastic Surgeon in Hyderabad!

Breast Reduction Surgery Cost varies between individuals!

Contact us to know if you are a suitable candidate for Breast Reduction Surgery!

Frequently Asked Questions (FAQ)

Q: Is this technique used today?

A: Yes. The “Septum-Based” or “Würinger’s Septum” technique is considered one of the most anatomically sound methods in modern plastic surgery, used for both reductions and lifts.

Q: Does this help with very large breasts?

A: Absolutely. The study explicitly states that this approach allows for safe resections “irrespective of the amount of resection,” making it ideal for patients with gigantomastia.

Q: Why does the septum matter for sensation?

A: The septum acts as a conduit (protective tunnel) for the anterior branch of the 4th lateral intercostal nerve, which provides the primary feeling to the nipple. If the septum is saved, the nerve is saved.

Reference

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The Anti-Gravity Lift: Why Vertical Breast Reduction Surgeries Don’t “Bottom Out”

The Fear of the “Droop”

One of the biggest concerns patients have about breast reduction is: “Will they just sag again in a few years?”

In traditional Anchor (Wise Pattern) reductions, a phenomenon called pseudoptosis (or “bottoming out”) is common. This happens when the breast tissue slides down the chest wall, stretching the lower skin and leaving the nipple looking too high.

However, a landmark study published in Plastic and Reconstructive Surgery confirms that the Vertical Scar (Lollipop) technique behaves very differently. In fact, it seems to defy gravity. It was conducted at USA and Canada. The Study was published in 2007.

The Anti Gravity Lift with Vertical Breast Reduction Surgery

The Study: 4 Years of “Settling”

Dr. Lista and Dr. Ahmad analyzed 49 women who underwent Vertical Scar Reduction Mammaplasty. They measured the breast position before surgery, 5 days after, and again 4 years later.

They wanted to answer two questions:

  1. Does the bottom of the breast stretch out?
  2. Does the nipple stay where we put it?

Discovery 1: The “Shrinking” Bottom

Contrary to the “bottoming out” seen in other techniques, the researchers found that the bottom of the breast (the inferior pole) actually tightened over time.

  • The Data: The distance from the breast crease (inframammary fold) to the bottom of the nipple decreased by 0.4 cm over four years.
  • The Result: Instead of sagging, the vertical technique relies on skin retraction that maintains a tight, perky lower breast shape for years.

Discovery 2: The Rising Nipple

This was the most surprising finding. In most surgeries, surgeons expect gravity to pull everything down. In the Vertical reduction, the nipple actually moved up.

  • Post-Op Day 5: The nipple was found 1.3 cm higher than where it was marked on the skin before surgery.
  • 4 Years Later: It remained 1.0 cm higher than the original markings.

This “upward migration” is unique to the way the vertical technique reshapes the internal tissue (coning), pushing the breast mound upward.

The Surgeon’s Secret: “Marking High”

Because of this study, Dr. Lista changed the way he marks patients. To ensure the nipple lands in the perfect “sweet spot,” he anticipates this upward movement.

  • The Old Way: Marking the center of the nipple at the breast crease.
  • The New Rule: Marking the superior border (top edge) of the nipple at the level of the breast crease.

By placing the nipple lower initially, it naturally rises into the perfect position as the breast heals and settles.

Conclusion

If you are looking for long-term projection and want to avoid the “bottomed out” look, the Vertical Scar technique has the data to back it up. Unlike other methods where gravity wins, this technique uses the skin’s own elasticity to keep the breast lifted and compact for years after surgery.

Ask yourself “Who is the Best Plastic Surgeon Near Me?”.

Revera Clinic caters with the Best Plastic Surgeon in Hyderabad!

Breast Reduction Surgery Cost varies between individuals!

Contact us to know if you are a suitable candidate for Breast Reduction Surgery!

Frequently Asked Questions (FAQ)

Q: What is “Pseudoptosis”?

A: It is a condition where the breast tissue sags below the nipple, while the nipple itself remains high on the chest. It creates a “snoopy nose” deformity. This study proved that pseudoptosis does not occur with the vertical technique.

Q: Why does the vertical scar technique heal differently?

A: It relies on “coning” the tissue and allowing the skin to retract (shrink-wrap) around the new shape, rather than just cutting away skin and stitching it tight.

Q: Will my nipples look too low right after surgery?

A: They might! Because your surgeon knows the nipple will migrate upward by about 1 cm, they may intentionally place it slightly lower during the operation.

References

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Why Do Nipples Sometimes “Shift” After Breast Reduction Surgery?

The Mystery of the Moving Nipple

One of the most frustrating issues after a successful breast reduction is seeing the nipple position change months after the surgery. A patient may leave the operating room with perfect symmetry, only to find that 3 to 6 months later, the nipples appear to be “riding high” on the breast mound.

Surgeons Dr. Melvyn Dinner and Dr. Lawrence Chait studied this phenomenon in 50 patients who underwent the McKissock vertical dermal pedicle technique. While the technique was excellent for nipple health and sensation, they discovered a consistently recurring problem: the “high-riding nipple”.

The Cause: Gravity and the “Skin Brassiere”

The study revealed that the nipple doesn’t actually move up; rather, the breast tissue moves down.

  • The Slump: Over the first few months, the breast tissue settles and “slumps” due to gravity.
  • The Stretch: The “skin brassiere” (the skin holding the breast) naturally stretches under the weight of the remaining breast tissue.
  • The Scar: In some cases, the vertical scar itself can stretch significantly—sometimes by as much as 2 cm.

As the bottom of the breast drops and the skin stretches, the nipple—which is anchored higher up—appears to “ride” too high in relation to the new breast mound.

Proven Success: Safety is Still High

Despite this aesthetic challenge, the McKissock technique proved to be incredibly safe in this series of 100 breasts:

  • 100% Nipple Viability: There was no nipple loss or even minor skin peeling.
  • Full Sensation: Every patient maintained nipple sensation to light touch.
  • High Satisfaction: Patients were generally satisfied with the shape and the resulting scars.

How Surgeons Prevent the “High Ride” Today

To avoid this long-term shift, modern surgeons have refined how they plan the surgery:

  1. Lower Initial Placement: Some surgeons intentionally place the nipple-areola complex slightly lower than the “ideal” spot during surgery, anticipating that the breast will settle into a perfect position later.
  2. Internal Support: Using techniques like the “Internal Bra” or specialized suturing helps anchor the breast tissue so it doesn’t slump as much.
  3. Accurate Marking: Preoperative markings are done with the patient standing up to account for the natural pull of gravity on the tissue.

Conclusion

If your nipples look slightly “low” immediately after a reduction, don’t worry—your surgeon may have planned it that way. Understanding that the “skin brassiere” will stretch over the first six months allows surgeons to compensate for gravity and ensure your nipples stay in the perfect spot for years to come.

———————–

Ask yourself “Who is the Best Plastic Surgeon Near Me?”.

Revera Clinic caters with the Best Plastic Surgeon in Hyderabad!

Breast Reduction Surgery Cost varies between individuals!

Contact us to know if you are a suitable candidate for Breast Reduction Surgery!

Frequently Asked Questions (FAQ)

Q: Is a high-riding nipple dangerous?

A: No, it is purely an aesthetic concern. It does not affect the health of the breast or the success of the surgery in terms of pain relief.

Q: How long does it take for the breast to “settle” into its final shape?

A: Most of the stretching and slumping occurs between 3 to 6 months after the procedure.

Q: Can a high-riding nipple be fixed?

A: Yes. If the nipple position is significantly off after the breast has fully settled, a minor revision can often be performed to adjust the placement.

Reference

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Preventing the “Sag”: How to Keep Your Breast Shape After Breast Reduction Surgery

The Problem: The “Bottoming Out” Effect

Many patients are thrilled with their breast reduction results immediately after surgery. However, a common long-term concern is “pseudoptosis,” better known as bottoming out.

This happens when the breast tissue sinks toward the bottom of the breast over time. It can leave the nipple looking too high and the lower part of the breast looking overly heavy or stretched.

Is this inevitable? According to a study published in Plastic and Reconstructive Surgery, the answer depends on the surgical technique used – Which could help Preventing Sagging After Breast Reduction Surgery!

The Solution: The Medial Pedicle Technique

Researchers in New York analyzed 88 consecutive patients who underwent a specific type of surgery: the Medial Pedicle with a Wise Pattern resection.

  • Medial Pedicle: This refers to the “bridge” of tissue that keeps the blood supply to the nipple coming from the middle of the chest.
  • Wise Pattern: This is the traditional “Anchor” shaped incision pattern.

By combining these two, surgeons found they could create a more stable internal structure that resists gravity better than older methods.

The Results: Stability Over Time

The study followed patients for a minimum of one year to see how their shape changed. They measured the distance from the nipple to the crease under the breast (inframammary fold).

The Findings:

  • Minimal Stretching: For moderate reductions (500g to 1200g per side), the distance increased by only 11% after a year.
  • Handling Massive Weight: Even in very large reductions (>1200g per side), the technique remained effective at preventing significant sagging.
  • Efficiency: The average operative time was fast—just 104.5 minutes.
  • Safety: The complication rate was low at 6.8%.

Conclusion: A Reliable Way to Lasting Results

If you are considering a breast reduction, you want a result that looks as good in five years as it does in five months.

The authors concluded that the medial pedicle approach is an effective and reliable way to treat a wide range of breast sizes. It offers a short operative time, a low risk of complications, and—most importantly—less “bottoming out” over the long term.

——————————-

Ask yourself “Who is the Best Plastic Surgeon Near Me?”.
Contact us to know if you are a suitable candidate for Breast Reduction.

Revera Clinic caters with the Best Plastic Surgeon in Hyderabad!

Frequently Asked Questions (FAQ)

Q: What exactly is “pseudoptosis”?

A: It is the medical term for the appearance of sagging where the breast tissue falls below the crease, but the nipple remains relatively in place.

Q: Is this technique suitable for very large breasts?

A: Yes. The study included patients with severe hypertrophy and found the medial pedicle to be highly reliable even for massive reductions.

Q: Does a shorter surgery time mean it’s less safe?

A: Not at all. In this study, the short operative time was combined with a very low complication rate of only 6.8%.

Reference

Based on the research from Manhattan Eye Ear and Throat Hospital, here is a checklist of high-value questions you can ask during your consultation to see if the medial pedicle technique is the right approach for your surgery.

Consultation Checklist: Discussing Technique and Longevity

  • “What ‘pedicle’ do you typically use for my size of reduction?”
    • Why ask: While many surgeons use an inferior pedicle, the medial pedicle has been shown to be exceptionally reliable for both severe hypertrophy and aesthetic shaping.
  • “How do you address the risk of ‘bottoming out’ or pseudoptosis over time?”
    • Why ask: Research indicates that the medial pedicle technique results in significantly less long-term sagging—an average increase of only 11% in the lower breast length for standard reductions.
  • “Is the medial pedicle safe for the amount of tissue I need removed?”
    • Why ask: This technique is proven to be effective and safe even for massive reductions (over 1200g per side).
  • “What is your typical operative time for this procedure?”
    • Why ask: The medial pedicle with a Wise pattern is known for being an efficient procedure, averaging around 104 minutes, which can mean less time under anesthesia.
  • “Can I see ‘long-term’ before and after photos (at least 1 year post-op)?”
    • Why ask: Since “bottoming out” occurs over time, looking at results from patients followed for a year or more is the best way to judge the stability of the surgeon’s technique.

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More Than Just Shape: Restoring Feeling After Breast Reconstruction

The “Numb” Reality of Mastectomy

For millions of women undergoing mastectomy (breast removal) for cancer treatment or prevention, the primary focus is survival. The secondary focus is often reconstruction—restoring the physical appearance of the breast.

However, there is a “silent” side effect that is rarely discussed but deeply felt: Numbness.

During a mastectomy, the sensory nerves that provide feeling to the breast skin and nipple are often cut.

A Little Background on Anatomy

To understand why numbness occurs, we must look at how the breast receives feeling. The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves.Image of thoracic dermatomes and intercostal nerve distribution

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  • The Path of the Nerves: The third, fourth, and fifth intercostal nerves give off lateral cutaneous branches that pierce the chest wall (near the mid-axillary line, or the side of your rib cage). These branches divide into anterior and posterior parts, supplying the skin of the side and front of the chest.
  • The Anterior Branches: The anterior cutaneous branches (the terminal parts of these nerves) supply the skin on the chest wall toward the center (sternum).
    • The 3rd nerve covers the upper-mid chest.
    • The 4th nerve covers the central chest and the medial (inner) breast area – The Nipple Line.
    • The 5th nerve covers the lower-mid chest and the inframammary fold (where the breast meets the ribs).

These nerves provide sensory innervation (known as dermatomes) to specific chest and abdominal areas and are crucial for sensation and pain management (such as nerve blocks).

For years, women have accepted that their reconstructed breasts, while looking beautiful, would permanently feel numb—like “wearing a bra made of your own skin.”

Restoring sensation (Resensation) is possible. Surgeons can perform a “nerve transfer,” connecting a nerve from your chest wall to the nerves in the reconstructed breast.

So, why isn’t this done all the time?

One major hurdle has been the difficulty of finding the right donor nerve. The human body is complex, and searching for a tiny nerve (often only 2 millimeters wide) during a long surgery can be like finding a needle in a haystack.

The Breakthrough: A Roadmap for Sensation

A pivotal study published in Plastic and Reconstructive Surgery has provided surgeons with a reliable “treasure map” to find these elusive nerves.

Research conducted by Dr. Rebecca Knackstedt and Dr. Risal Djohan (along with their team in Cleveland and Toledo, Ohio), utilized precise anatomical studies to identify the exact hiding place of the nerve responsible for breast sensation.

What They Found

The researchers discovered that the Lateral Intercostal Branch (the nerve key to breast feeling) is located in a highly predictable spot:

  • It almost always exits from under the 4th Rib.
  • It sits consistently near the edge of the Pectoralis Minor muscle.
  • It travels safely underneath the thoracodorsal vessels (major blood vessels in the armpit area).

Why This Matters for Your Surgery

This study transforms a “search mission” into a precise procedure. Because surgeons now know exactly where to look, we can locate the nerve with much greater accuracy. The study identified the nerve’s location as:

  • 10 to 15 cm from the sternum (breastbone).
  • 8 to 16 cm from the mid-clavicular line.
  • Near the lateral border of the armpit muscle (Pectoralis minor) or within 2 cm from it.

By using these precise coordinates, surgeons can:

  1. Locate the nerve quickly, reducing surgery time.
  2. Preserve the nerve more effectively.
  3. Perform Nerve Allografts: Connect this sensation-carrying nerve to your reconstructed breast tissue using a nerve graft.

Moving Beyond “Looking Normal”

We believe that feeling whole means more than just looking in the mirror; it’s about feeling a hug, noticing a change in temperature, and reclaiming your body’s sensation.

Thanks to anatomical breakthroughs like this study from Ohio, Breast Neurotization (nerve repair) is becoming a more standard and successful part of breast reconstruction.

Frequently Asked Questions (FAQ)

Q: If I have this procedure, will my sensation be 100% normal?

A: “Normal” is a strong word. Nerve regeneration is slow and complex. Most patients do not regain perfect, pre-surgery sensitivity. However, the goal is to transition from “numbness” to “protective sensation” (feeling touch and pressure) and, in many cases, erogenous sensation. It is a vast improvement over having no feeling at all.

Q: Does this add time to the surgery?

A: Yes, nerve repair does add some time to the reconstruction surgery. However, thanks to the “mapping” provided by this research, the time taken to find the nerve is significantly reduced, making the addition of nerve repair much more feasible.

Q: Can this be done if I had a mastectomy years ago?

A: Breast reinnervation is most successful when performed at the same time as the mastectomy (Immediate Reconstruction). Doing it years later is much more difficult because the nerve endings may have scar tissue or have become dormant. However, it is always worth discussing with your surgeon.

Q: Is this only for implant reconstruction or flap reconstruction?

A: Nerve grafts can be used in both. In DIEP Flap (using your own tissue), surgeons connect the chest nerve to the nerve in the tummy tissue. In Implant reconstruction, the nerve is connected to the remaining skin or nipple nerves.

Reference

Knackstedt, Rebecca M.D., Ph.D.; Gatherwright, James M.D.; Cakmakoglu, Cagri M.D.; Djohan, Michelle M.S.; Djohan, Risal M.D. “Predictable Location of Breast Sensory Nerves for Breast Reinnervation.” Plastic and Reconstructive Surgery. February 2019. Cleveland Clinic & University of Toledo, Ohio.

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Thinking About a Second Breast Reduction? New Research Makes “Revisions” Safer Than Ever

When One Surgery Isn’t Enough

Breast reduction surgery typically has one of the highest satisfaction rates in cosmetic medicine. However, bodies change. Due to weight fluctuations, hormonal shifts, or pregnancy, breast tissue can sometimes regrow, or gravity may cause sagging to return years after the initial procedure.

Many women find themselves wanting a Secondary Breast Reduction (a revision surgery) but hesitate due to safety concerns.

Historically, performing a reduction on a breast that has already been operated on was considered risky. The main fear? Compromising the blood supply to the nipple.

The “Unknown Pedicle” Problem

In a primary breast reduction, the surgeon creates a “pedicle”—a bridge of tissue that keeps the nipple and areola attached to their blood and nerve supply while the surrounding tissue is removed.

The challenge with revision surgery is that the new surgeon often doesn’t know which technique the previous surgeon used. If they cut into the old “lifeline” by mistake, it can lead to Nipple-Areola Complex (NAC) Necrosis (loss of the nipple tissue).

The Austrian Solution: A Triple-Safety Technique

A new prospective study published in April 2025 in the Plastic and Reconstructive Surgery journal offers a reassuring solution.

A team of researchers from Linz and Innsbruck, Austria, led by Dr. Sandra Feldler and Dr. Manfred Schmidt, has developed a “Modified McKissock Technique” specifically designed for these complex revision cases.

How It Works

The classic “McKissock” technique uses a vertical bipedicle (a bridge with a top and bottom attachment) to supply blood to the nipple.

The Austrian team modified this by adding a third component: a Central Pedicle.

  • Superior Pedicle (Top)
  • Inferior Pedicle (Bottom)
  • Central Pedicle (Middle)

Think of it as adding an extra emergency power line. Even if the surgeon doesn’t know exactly how the first surgery was performed, this “triple-threat” approach ensures the nipple retains a robust blood supply from multiple directions.

The Results: 100% Safety Record

The study followed 25 breast revisions using this new technique. The results were remarkably positive:

  • Zero Necrosis: There were no cases of nipple loss or tissue death.
  • Significant Reduction: The average patient had roughly 300g of tissue removed per breast.
  • High Satisfaction: 84.6% of patients rated their aesthetic appearance as “excellent” after the surgery.

Why This Matters For You

If you have been told that a second breast reduction is “too risky” or that you aren’t a candidate because your previous surgical records are lost, this research changes the conversation.

This modified technique allows surgeons to navigate the “unknowns” of your previous surgery with a safety net, ensuring you can achieve the smaller, lifted shape you desire without compromising your safety.

Frequently Asked Questions (FAQ)

Q: Why do breasts get big again after a reduction?

A: While the fat and glandular tissue removed during surgery is gone forever, the remaining cells can expand. Weight gain, pregnancy, menopause, and certain hormonal medications can stimulate the remaining breast tissue to grow.

Q: Is a revision recovery harder than the first time?

A: Surprisingly, many patients find the recovery similar or even slightly easier, as less tissue is usually removed compared to the first massive reduction. However, strict adherence to post-op care is vital to protect the blood supply.

Q: Does this technique leave more scars?

A: This technique generally utilizes the “inverted-T” or “anchor” scar pattern. Since most primary breast reductions also use this pattern, the surgeon simply goes through the old scar lines, meaning you likely won’t have new scars, just refreshed ones.

Q: Can I breastfeed after a secondary reduction?

A: Breastfeeding after a primary reduction is already difficult (about 50% success rate). A secondary reduction involves further manipulation of the milk ducts. While the nipple is kept alive and sensitive, the ability to breastfeed is unlikely after a second procedure.

Reference

Feldler, Sandra MD; Zaussinger, Maximilian MD; Ehebruster, Gudrun MD; Bachleitner, Kathrin MD; Steinkellner, Theresia MD; Schmidt, Manfred MD. “Modified McKissock Technique for Secondary Breast Reduction: A Prospective Study on Safety and Surgical and Aesthetic Outcomes.” Plastic and Reconstructive Surgery. April 2025. Linz and Innsbruck, Austria.

Breast, Breast Reduction
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Regular Post
Written by revera-admin

Natural Volume Without Implants: A New Brazilian Technique for Restoring Breast Volume in Breast Lift & Breast Reduction

The Quest for the Perfect Profile

For many women considering a Mastopexy (Breast Lift) or Reduction Mammoplasty, the goal is simple: a lifted, youthful shape and a more manageable size.

However, there has always been a surgical dilemma. Traditional lifts are excellent at removing excess skin and reshaping the breast, but they often struggle to maintain “upper pole projection”—that desirable fullness at the top of the breast (the décolletage). Over time, gravity can cause the breast tissue to settle, sometimes leaving the upper breast looking flat.

Historically, the solution to this was using silicone implants to fill that upper volume. But what if you don’t want implants?

The “Implant-Free” Movement

While implants remain a popular choice, many of our patients are seeking natural alternatives. Some wish to avoid the maintenance of implants, while others are concerned about rare but documented risks associated with silicone, such as Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) or autoimmune symptoms.

If you desire fullness and lift but want to stay 100% natural, a groundbreaking new technique known as Triple-Plane Autologous Fat Grafting might be the answer.

Innovative Research from Brazil

We pride ourselves on staying up-to-date with global advancements in aesthetic medicine. This specific technique comes from a cutting-edge study titled “Breast codes: triple plane autologous fat grafting,” published in August 2025 in the prestigious Plastic and Reconstructive Surgery journal.

The study was conducted by Dr. Ricardo T. Nóra, a plastic surgeon based in Sinop, Mato Grosso, Brazil, in collaboration with Dr. Lydia M. Ferreira from the Division of Plastic Surgery at the Federal University of São Paulo, Brazil.

Brazil has long been recognized as a world leader in cosmetic surgery innovation. In this study, Dr. Nóra and Dr. Ferreira standardized a method to enhance breast shape without foreign bodies, addressing the limitations of previous techniques.

What is the “Triple-Plane” Technique?

Autologous Fat Grafting involves taking fat from an area where you have a little extra (like the abdomen or thighs) and transferring it to the breasts.

The innovation introduced by Dr. Nóra and Dr. Ferreira is the “Triple-Plane” approach. Instead of randomly injecting fat, this technique systematically places fat in three specific layers (planes) to build a lasting structural foundation:

  1. Submuscular: Deep placement under the muscle for foundational volume.
  2. Intramuscular: Placement within the muscle for dynamic shaping.
  3. Subcutaneous: Placement just under the skin for smooth contouring and softness.

Why This Matters for You

This innovative approach addresses the “flat top” issue without requiring a foreign object in your body. By strategically layering the fat according to these new “Breast Codes,” surgeons can now create that coveted upper-breast fullness during a lift or reduction.

Key Benefits:

  • Natural Results: Uses your own tissue, so the look and feel are entirely you.
  • Safety: Eliminates the risks associated with long-term silicone implants.
  • Body Contouring: You get the added benefit of liposuction in the donor area.
  • Scientifically Backed: Based on rigorous surgical protocols developed by leading experts in Brazil.

Experience the Future of Breast Surgery

If you are looking for a natural, long-lasting enhancement, let’s discuss if this technique is right for your body goals. Contact our clinic today at +919866224871 to schedule a consultation. Chat with us on WhatsApp.

We are located in Hyderabad – Himayatnagar and Gachibowli – Kondapur.

Reference

Nóra, Ricardo T. M.D., MSc; Ferreira, Lydia M. M.D., PhD. “Breast codes: triple plane autologous fat grafting in mastopexies and reduction mammoplasties without implants.” Plastic and Reconstructive Surgery. August 13, 2025.

Breast, Breast Reduction
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