The Evolution of the Scar

For decades, the “Wise Pattern” (the Anchor scar) was the gold standard for breast reduction. However, many patients and surgeons were frustrated by the results: the breasts could look “boxy,” lacked projection (perkiness), and left very long scars.

While the “Lollipop” (vertical) and “Round Block” (donut) techniques emerged as alternatives, each had limitations. Dr. Oscar Ramirez combined the best features of both to create the “Owl” Incision.

What is the “Owl” Technique?

The technique gets its name from the shape of the preoperative markings, which resemble the eyes and beak of an owl. It is designed to maximize shape while minimizing the footprint of the scar.

Key Features of the “Owl” Method:

• Heart-Shaped Resection: Instead of removing tissue from the bottom, the surgeon performs a heart-shaped resection of the internal tissue.
• Supero-Central Pedicle: The nipple is kept on a central pillar of tissue. This ensures a robust blood supply and preserves nerve sensation.
• No Undermining: Unlike traditional surgery, the skin is not separated from the underlying tissue. This means no drains are needed and healing is much faster.
• The “Vertical Pillar” Move: The internal tissue is folded toward the center of the breast. This creates “excellent projection”—essentially building a natural internal bra to make the breasts look perkier.

Small Scars, Big Capacity

One of the biggest myths in plastic surgery is that you need a large scar for a large reduction. Dr. Ramirez’s study of 94 patients over seven years proved otherwise:

• Massive Reductions: He successfully removed up to 1,900 grams (over 4 lbs) per breast using the Owl technique.
• Outpatient Safety: Nearly 90% of patients had their surgery as outpatients, going home the same day.
• No “Dog Ears”: By adding a very short horizontal line at the bottom, the technique eliminates the bunching of skin (dog ears) often seen in other vertical methods.

The Benefits Beyond Aesthetics

Because the “Owl” technique avoids aggressive undermining and preserves the central tissue, it offers functional benefits that traditional “Anchor” reductions might not:

• Preserved Sensation: The nerves leading to the nipple are better protected.
• Breastfeeding Support: Because the central tissue and milk ducts are largely left intact, the ability to lactate is often preserved.
• Immediate Results: Unlike other vertical techniques that look “pleated” or gathered for months, the Owl technique provides excellent shape immediately on the operating table.

Conclusion

The Owl incision represents a “best of all worlds” approach. It offers the perkiness of a vertical reduction with the safety and volume capacity of a traditional one, all while keeping the scars to a minimum. If you are looking for a technique that prioritizes breast projection and sensation, the Owl method is a proven, reliable choice.

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Frequently Asked Questions (FAQ)

Q: Will I have a scar underneath the breast?

A: With the Owl technique, the horizontal scar is either completely eliminated or made very short, making it much less visible than a traditional “Anchor” scar.

Q: Why don’t I need drains with this technique?

A: Drains are typically used when skin is separated (undermined) from the tissue. Since this technique avoids that separation, there is no space for fluid to collect, making drains unnecessary.

Q: Is this technique good for “droopy” breasts (ptosis)?

A: Yes. The study specifically noted that it is excellent for correcting severe ptosis while maintaining high vascular safety for the nipple.

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Reference

• [1] Ramirez, Oscar M. M.D. “Reduction Mammaplasty with the ‘Owl’ Incision and No Undermining.” Plastic and Reconstructive Surgery 109(2):p 512-522, February 2002.