Breast Surgery: To "T" or not to "T" - That is the Question

Controversy over "Best" Breast Techniques Addressed at ASAPS Annual Meeting

NEW YORK, NY (May 16, 2003) — According to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), the fastest growing plastic surgical procedures since 1997 are breast lifts (up by 214%) and breast reductions (up 162%). Debate continues regarding surgeons' preferred incisions: the traditional inverted-T or the newer limited incision techniques. Leading experts will address this issue at ASAPS' Annual Meeting, May 16-21, at the Hynes Convention Center in Boston.

The major difference in the way breast lifts and reductions are performed is that breast reduction requires removal of breast tissue, fat and skin, while a breast lift removes only skin and reshapes the existing breast tissue. The pattern of incisions used for these operations is often identical.

Laurie Casas, MD, a plastic surgeon in suburban Chicago and chair of ASAPS Communications Commission, says patients often focus on scar reduction while failing to appreciate the importance of creating optimal breast shape. "The traditional inverted-T technique, which uses an incision around the nipple and extends vertically down the breast and then horizontally along the crease underneath the breast, is widely used today because many surgeons feel that it consistently produces the most aesthetically pleasing breast shape even though it leaves visible scars on the breast," says Dr. Casas. The scars fade over time, Dr. Casas adds, and in most cases become much less noticeable.

Panelist Foad Nahai, MD, of Atlanta, agrees that there will always be appropriate patients for the inverted-T technique - those with very large breasts or pronounced sagging of the breasts with stretched, inelastic skin. But, according to plastic surgeon Nahai, "the limited incision techniques are the wave of the future," and he predicts that more and more surgeons will adopt these newer methods.

Limited incision techniques use a variety of incision patterns. Compared to the inverted-T approach, limited incisions may eliminate only the horizontal incision underneath the breast crease, only the vertical incision, or both. Some techniques use an incision around the areola, the pigmented area surrounding the nipple, so that the resulting scar blends with the pigmented skin. Criticism of limited incision techniques focuses on the technical challenge of the procedures and the possible difficulty in achieving optimal breast shape. "The key lies in selecting the proper technique for each individual patient and also in the proper training and experience of the surgeon," says Dr. Nahai, who believes there will be wider use of limited incision breast surgery techniques as more plastic surgeons are exposed to training opportunities, such as the accredited Continuing Medical Education (CME) courses offered through the American Society for Aesthetic Plastic Surgery. ASAPS accredited instructional courses are available to American Board of Plastic Surgery (ABPS) certified surgeons who are already well qualified to perform breast surgery and other cosmetic plastic surgery.

Dr. Casas notes that while a lift can reposition and reshape the breasts, it cannot add volume; for that, breast implants must be added to the equation, and many patients opt for combining a lift with breast augmentation in the same operation.

Although the debate continues over which breast surgery technique is best, there is broad agreement among aesthetic plastic surgeons that techniques will continue to evolve that achieve elevated breast symmetry with an aesthetically beautiful breast shape and the least possible scarring. "Our ultimate goal is to achieve the best shaped breast with the least scar," says Dr. Casas.

About ASAPS
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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