The best place to hide breast reduction scars [Dan Zegzula, MD, Portland]

Dan Zegzula. I'm a plastic surgeon, Portland, Oregon at the Portland Plastic Surgery Group.

So if I was thinking about breast reduction, I think one of the sort of initial pieces of common knowledge floating out around there is that incisions can really not look great. Or maybe we have an older, a memory of what incisions used to look like. So what does the breast reduction incision look like? Are there choices and is there something you usually do first? What is the primary approach that you personally do?

Unlike breast lifting, where there are several different ways that the scars might end up, breast reduction patients where you're really reducing volume and say you're going a minimum of two cup sizes, you're pretty much always going to have that, what they call the anchor scar or the plastic surgery term for it as a wise pattern. Dr. Wise, WISE developed that scar pattern back in the sixties, and that includes a scar that goes around the areolar, a scar that goes from the areolar down to the fold, and then a degree of scar in the fold. And that does scare people because if you think about how long those incisions are, if you count the number of centimeters of incision, it's pretty long, but it's hidden in a really nice way. Scars around the areolar hide very well because there's a color change and a texture change in the skin there, and the scar in the fold is well hidden by the contours of the breast.

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And then people worry about the vertical scar, but that's the scar that usually matures the fastest and is the flattest and least visible when it's all mature. So yes, patients are scared about the scars. I do think there's been improvements in suture technology and of course, plastic surgeons are always closing their incisions to as perfect as they can. And then we always put our patients in a postoperative scar program, and most times, 95 times out of a hundred patient scars are excellent. And that 5% of the time when they're a little thicker and a little heavier, we have all sorts of things that we can do from silicone gel sheeting, to steroid injections into the scar, laser, RF microneedling, and if we have to, we can just redo it. And that can usually be done under local anesthesia in the office if we have to do that.

How common is it also to reduce the size of the areolar when you do a breast reduction?

Almost every time, some women naturally have small areolas that don't need reduction, but the vast majority of large breasted women do. And we have adjustable devices that we use for that affectionately called cookie cutters and they're little round templates of varying diameters, because if you're going to leave somebody fuller, say a double D, a larger areola looks better on that breast. But if you're bringing somebody down to a B cup, then the areola is going to be a little bit smaller. So that is always done with the breast reduction that we have to make a decision about areola size, but we also have leeway as to what size we're going to make it.

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