One of the trends in breast reduction surgery is the trend towards "short-scar" procedures which minimize or eliminate the traditional horizontal part of the incision.
Seen below is a figure of the traditional "Wise Pattern" reduction using tissue from the lower part of the breast (an 'inferior pedicle technique') to keep the nipple & areola alive. It produces a scar that looks like an upside-down anchor and has been the standard procedure used in breast reduction for decades.
Work from surgeons in Europe & South America has trickled down to the United States using both shorter vertical scars with pedicles often oriented superiorly or medially. Below is a figure of a superior-medial pedicle which has been popularized by Canadian Plastic Surgeon, Dr. Elizabeth Hall-Findlay.
The advantages purported by this rethinking of the classic Wise-pattern/inferior pedicle surgery include using breast tissue (as opposed to skin) to maintain shape. Whether this holds up over time, we'll have to see. I've done a number of these & had some unpredictable results. They either are fantastic or just so-so. Unlike the traditional operation you rely on post-op settling of the breast to get the finished result which leads to some funky-shaped breasts leaving the table.
The most common problems I see are too high a nipple position & a persistant "pucker" at the bottom of the incision. Some puckers resolve, but a number require minor revisions in the office. It's always tempting to compromise the technique and use short-T's or j-shaped cut-outs of the pucker during the initial surgery.
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