QuickScan Reviews in Plastic Surgery, August 30 2009

Classic Article Review Background: Inferior pedicle breast reduction techniques are reliable but have disadvantages (potentially bottoming out, long scars, etc). Newer "vertical reduction" or "limited-incision" techniques have shortened scar length but are considered technically difficult, with a long learning curve and possibly a higher complication rate. Objective: To survey plastic surgeons to determine the most commonly used techniques and measure surgeon and patient satisfaction as well as rates and types of complications. Methods: A survey was sent to 1500 members of the American Society for Aesthetic Plastic Surgery. Surgeons were asked to choose which breast reduction techniques they used among choices of pedicles and incision types or specific surgeon techniques, ie, Hall-Findlay. Surgeons were not limited to one response. Surgeons were asked to rate their satisfaction with results on a scale of 1 to 5 as well as their patients' satisfaction (1 to 5). They were asked how long they had been performing breast reductions, how many breast reductions were performed in a year, and how many and what type of complications they encountered in their practice. Results: 554 surveys were returned (37%). The 5 most popular types of breast reduction were inferior pedicle (44.1%), Wise pattern (16.6%), limited incision (5.3%), Hall-Findlay (4.8%), and McKissock (4.8%). Of respondents, 41% chose >1 technique. Surgeons were categorized into 2 groups: those who favored inferior pedicle and Wise-pattern ("traditional incision" group, 56% of respondents) and those who favored "limited incision" technique (6.9%). The traditional group performed more breast reductions per year (42.0 vs 21.7) and had been using their technique longer (16.9 vs 6.3 years). The traditional group reported greater satisfaction with their operation (42.0% chose the level 5/5 vs 28.9% in the limited group) as well as greater patient satisfaction (68% of traditional = 5/5 vs 47% for the limited group). Respondents in the traditional group reported 60.9% with complications <5% versus 44.4% for the limited incision group. The most common complications for the traditional group were suture spitting, inframammary fold scarring, and skin loss; and for the limited incision group were suture spitting, nipple scarring, need for revision, and loss of sensation. Conclusions: Although limited incision techniques have gained popularity, traditional inferior pedicle/Wise pattern techniques remain most popular among plastic surgeons, with greater self-reported patient satisfaction and fewer complications. Reviewer's Comments: This paper was limited by respondent bias. Surgeons who returned the survey probably had a special interest in breast reduction. Also, surgeons using traditional techniques may have been older and more comfortable with their techniques and may have had a skewed view of their complication rate or patient satisfaction, while younger surgeons may have been hypervigilant about these things.