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Plast Reconstr Surg Glob Open 2018 May 14;6(5):e1783. Epub 2018 May 14.

Dr. Michelle Copeland, New York, N.Y.

Background: Limited scar Lejour technique for breast reduction is conventionally used to remove less than 500 g of breast tissue per breast, but is effective for greater macromastia. Plastic surgery residents gain limited experience with this technique, and it is infrequently performed in the United States. To understand technique selection, we surveyed board-certified plastic surgeons and compared outcomes with the Lejour technique in 1 practice to those with other methods. Read More

Indian J Plast Surg 2016 May-Aug;49(2):166-171

St. Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK.

Introduction: Tuberous breast deformity is one of the most challenging congenital breast anomalies. Severe forms present as hypoplasia of lower medial and lateral quadrants and breast base constriction. We present a modified technique based on redistribution of breast tissue for single-stage aesthetic correction of this deformity. Read More

Clin Plast Surg 2016 Apr 3;43(2):359-63. Epub 2016 Feb 3.

Clinique du Parc Léopold, Rue Froissart 38, 1040 Brussels, Belgium.

In this paper, we describe our experience with the Lejour vertical scar mammaplasty from its description throughout 25 years of practice. Our work aims to focus on reducing vertical scar mammaplasty complications by examining results, studying how to avoid unfavorable consequences, and providing new tips to improve the technique and shorten its learning curve. Complications can be related to patient characteristics and habits, but adhering to a strict surgical protocol is essential to limit other factors. Read More

Plast Reconstr Surg Glob Open 2014 Jul 7;2(7):e177. Epub 2014 Aug 7.

Department of Plastic and Reconstructive Surgery, Westmead Hospital, Westmead, Sydney NSW, Australia.

Summary: Vertical mammaplasty for breast reduction has been widely popularized by Lejour. In her planning for the new nipple-areolar complex, she did not specify a method of drawing the periareolar curve, leaving it to the surgeon's creativity. We have designed a simple method using mathematics to draw the new periareolar curve consistently and reliably, not requiring any additional or complex devices. Read More

Aesthet Surg J 2010 Mar;30(2):201-10

Northwestern University, Division of Plastic and Reconstructive Surgery, Chicago, Illinois, USA.

Background: The ptotic breast deformity results from two synergistic forces: involution of breast parenchyma leading to a loss of volume, along with a converse laxity of the skin envelope, which becomes inelastic and accommodating. As the breast tissue descends inferiorly on the chest wall with gravity, there is an apparent volume loss in the upper pole and the central breast, and the lower pole becomes fuller and often wider.

Objectives: The authors propose a technique whereby the superior pedicle vertical mammaplasty technique originally described by Lassus is modified to include transposition of glandular tissue to restore central mound projection while simultaneously narrowing the lower breast base and raising the inframammary crease. Read More

Zhonghua Zheng Xing Wai Ke Za Zhi 2009 Nov;25(6):416-9

Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.

Objective: To report the reduction mammaplasty with vertical incision and superior wide pedicle.

Methods: Typical Lejour mosque-dome design was performed. The inferior part of glandular tissue and skin were excised. Read More

Can J Plast Surg 2008 ;16(3):157-61

Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia;

Background: Breast reduction is an increasingly common procedure performed by Canadian plastic surgeons. Recent studies in the United States show that use of the inferior/central pedicle inverted T scar method is predominant. However, it is unknown what the practice preferences are among Canadian plastic surgeons. Read More

Plast Reconstr Surg 2009 Feb;123(2):433-42

Department of Plastic Surgery, University of Turin, Turin, Italy.

Background: Breast reduction shows a greater risk of complications in peculiar cases such as those with gigantomastia, a high degree of ptosis, obesity, smoking, cardiovascular diseases, or metabolic disorders. The authors feel that a reduction in the complication rate can be achieved by safeguarding the vascular and nervous structures of the breast as much as possible.

Methods: The authors propose a breast reduction method based on a double central-superior pedicle that was used in 91 patients with a more or less elevated degree of obesity. Read More

Zhonghua Zheng Xing Wai Ke Za Zhi 2007 Sep;23(5):372-5

Department of Plastic and Reconstructive Surgery, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China.

Objective: To introduce a modification of Lejour reduction mammaplasty.

Methods: With the upper pedical flap as the base of mammaplasty, the lower part of breast was resected while excess skin was pushed to lateral and formed "L"-shaped scar after it was resected.

Results: From October 2005 to April 2006, the modified Lejour reduction mammaplasty was applied to 10 mammahypertrophic patients with 20 breasts in sum. Read More

Plast Reconstr Surg 2007 Oct;120(5):1095-104; discussion 1105-7

Ulm Klinik Rosengasse and the Plastic Surgery Institute, University of Padova, Italy.

Background: The "minimal scar technique" for breast reduction, developed by Marchac, Lassus, and Lejour, has become an increasingly practiced alternative to standard operative procedures.

Methods: The authors introduced the modified "Lejour technique" in nearly 500 breast reductions in 250 overweight patients (adipose breasts) with a resection weight of more than 700 g. Their technique is a step-wise modification of the following procedures, resulting from their experience with complications and outcomes. Read More

Aesthetic Plast Surg 2008 Jan 14;32(1):41-7. Epub 2007 Sep 14.

Department of Plastic Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.

Background: During the past 15 years, reduction mammoplasty with a short vertical scar has become increasingly common in the world of plastic surgery. Still, the indication for this technique often is limited to smaller reduction weights, so that the inverted T-scar techniques have yet to be regarded as the gold standard for excessive breast hypertrophy.

Methods: In the authors' department, their own modification of vertical scar reduction mammoplasty, based on the techniques of C. Read More

Aesthetic Plast Surg 2007 May-Jun;31(3):294-8

Department of Plastic, Aesthetic, and Reconstructive Surgery, Brugmann University Hospital, Place Van Gehuchten, Brussels, Belgium.

Since 1996, the original technique of superior pedicle vertical scar mammaplasty described by Lejour has been modified by decreasing skin and glandular undermining, limiting liposuction, avoiding tight glandular stitches, and adding a small horizontal scar for very large breasts. Between 1996 and 2002, 115 consecutive patients underwent a bilateral reduction mammaplasty of more than 500 g per breast using the modified Lejour technique. The early, late, and delayed complications were studied according to four parameters: glandular resection, age, smoking habits, and body mass index (BMI). Read More

J Plast Reconstr Aesthet Surg 2007 6;60(5):465-70. Epub 2006 Sep 6.

Centre Hospitalier Universitaire Brugmann, Department of Plastic Surgery, Place A. Van Gehuchten 4, 1020 Brussels, Belgium.

Between January 1996 and December 2002, 189 women underwent bilateral superior-pedicle breast reduction according to the Lejour technique, at Brugmann University Hospital (Brussels, Belgium). We conducted a retrospective study on the 18 women who gave birth since the operation. Our aim was to find out how many of them breastfed, the reasons for not breastfeeding from those who did not, and to look for parameters that might have interfered with breastfeeding success. Read More

Aesthetic Plast Surg 2005 Nov-Dec;29(6):519-31

Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Read More

Plast Reconstr Surg 2005 Mar;115(3):743-51; discussion 752-4

Department of Plastic and Reconstructive Surgery, Wilhelminenspital, and University of Vienna, Vienna, Austria.

The preservation of the sensitivity of the nipple-areola complex after reduction mammaplasty is an important goal. The authors performed this prospective study to accurately assess whether sensitivity changes are influenced by the weight of resection or the surgical technique. Eighty patients who underwent bilateral breast reduction (Lassus, 10 patients; Lejour, 13 patients; McKissock, 18 patients; Wuringer, 20 patients; and Georgiade, 19 patients) were tested for sensitivity changes of the nipple and cardinal points of the areola with Semmes-Weinstein monofilaments before surgery, at 3 weeks, and at 3, 6, and 12 months after surgery. Read More

Ann Plast Surg 2005 Mar;54(3):236-41; discussion 241-2

University of Florida, Division of Plastic Surgery, Gainesville, FL 32610, USA.

Supporters of the vertical mammoplasty state the resultant breast shape and scar are superior to the Wise pattern breast reduction. This study contains a comparison of the LeJour vertical reduction with the Wise pattern reduction by analysis of pre- and postoperative photographs, as well as a retrospective review comparing operative times, blood loss, complications, and a postoperative patient questionnaire. Of the 112 women who had moderate to large reductions (>500 g/breast) between 1999 and 2002, 65 subjects had adequate standard perioperative photographs. Read More

Aesthetic Plast Surg 2004 Mar-Apr;28(2):59-69. Epub 2004 May 28.

The patients seeking our help for breast reduction are very often young and probably planning to have children later in their lives. Therefore it is most important to offer them a method of reduction mammaplasty that leaves as little scars and as much physiological function as possible. The vertical reduction mammaplasty as we perform it is a method that leaves normal sensibility in almost all cases, the possibility of lactation, little scarring and a pleasant form. Read More

Aesthet Surg J 2004 Mar-Apr;24(2):171-5

According to the authors, a new marking design for vertical scar breast reduction avoids the tension at nipple level that may occur with the use of a mosque-shaped marking (Lejour technique). Furthermore, better symmetry may be achieved in placement of the areola and nipple. Read More

Ann Plast Surg 2003 Oct;51(4):345-50; discussion 351-2

Department of Reconstructive Surgery, Cambridge Breast Unit, Addenbrooke's University Hospital, Cambridge, UK.

An application of the LeJour vertical mammaplasty skin pattern for skin-sparing mastectomy is presented. The approach provides adequate access for the mastectomy, axillary dissection, and immediate breast reconstruction. The technique is ideal for patients with large or ptotic breasts undergoing a simultaneous contralateral breast reduction or mastopexy. Read More

Br J Plast Surg 2003 Jun;56(4):348-59

Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, 2K12C, Gent B9000, Belgium.

The relatively high number of complications and disadvantages of the conventional techniques in breast reduction combined with our expertise in restoring sensation in breast reconstructive procedures, led to the development of a new technique that was crystallised from the traditional techniques and is able to overcome most of their disadvantages. The key issue of the technique is that the nipple is vascularised and innervated on a column of glandular tissue that remains in contact in its posterior part with the pectoralis muscle and its perforators and in its lateral aspect to the lateral pillar of breast tissue. Due to the ptosis that develops during the process of hypertrophy, this column will gain sufficient length to be turned upwards into the new position of the nipple. Read More

Br J Plast Surg 2003 Apr;56(3):237-46

Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, UK.

Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is faced with a wide range of excisional and liposuction procedures. There is a paucity of literature describing an integrated approach to the management of this condition and the roles of the different treatment modalities. A review of all gynaecomastia patients operated on by one surgeon over a 2-year period was undertaken. Read More

Plast Reconstr Surg 2003 Jun;111(7):2192-9; discussion 2200-2

Department of Plastic and Reconstructive Surgery, Brugmann University Hospital, Brussels, Belgium.

Since 1989, superior pedicle vertical scar mammaplasty as described by Lejour has been used in the authors' department as the only technique for breast reduction. From 1991 through 1994, a series of 170 consecutive patients (330 breasts) underwent an operation. In these patients, minor complications were observed in 30 percent of the patients and major complications in 15 percent. Read More

Plast Reconstr Surg 2003 May;111(6):1860-70

Department of Plastic, Reconstructive, and Hand Surgery, Burn Center, University Hospital Aachen, Germany.

The problems of the vertical mammaplasty by Lejour (i.e., gathering the skin envelope in one vertical suture, frequent secondary healing problems, and later sagging of the inferior glandular part in the case of large and very large breasts) are well known. Read More

Ann Chir Plast Esthet 2002 Dec;47(6):623-32

CHL Service de chirurgie plastique reconstructrice et esthétique, 4, rue Barblé, 1210 Luxembourg.

Vertical mammaplasties for very large breasts and/or severe ptosis were evaluated in 124 patients who underwent operation in our unit between September 1993 and June 2001. In 119 cases it was reduction mammaplasty and in 5 cases unilateral symmetrization after contralateral reconstruction. The mean age was 36 years (13-62 years). Read More

Clin Plast Surg 2002 Jul;29(3):365-77

Clinica Van Thienen, Buenos Aires, Argentina.

The areolar-vertical approach (AVA) mammaplasty, derived from the Vertical Mammaplasty described by Lejour, offers us the opportunity to achieve good cosmetic results in breast reduction even in larger hypertrophies and makes it available to all patients. In marking, the skin there are certain fixed landmarks, but the final skin design is obtained by dynamic maneuvers (points A, V, and S). They do not follow a rigid pattern. Read More

Tumori 2002 Jan-Feb;88(1):41-7

Department of Plastic Surgery, European Institute of Oncology, Milan, Italy.

Aims And Background: Breast conserving treatment (BCT) should provide similar quality of local control as mastectomy and avoid psychological distress due to mutilation. Randomized trials have demonstrated the value of conservative surgery for small tumors. Several publications have indicated the possibility of improving the cosmetic result when quadrantectomy is combined with plastic surgery. Read More

Plast Reconstr Surg 2002 Feb;109(2):512-22; discussion 523-4

School of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Reduction mammaplasty has traditionally been done using the Wise pattern of incision. Because of the box-like effect in breast shape, the lack of projection, and the long scars associated with the inverted T incision, two techniques have emerged as alternatives: the vertical reduction of Lassus/Lejour and the "round block" periareolar technique popularized by Benelli. Each of these techniques has its pros and cons. Read More

Br J Plast Surg 2001 Jun;54(4):341-7

Institute of Hand, Plastic and Reconstructive Surgery, University Hospital Zürich, Zürich, Switzerland.

The use of vertical-scar breast reduction techniques is only slowly increasing, even though they have been advocated by Lassus and Lejour and are requested by patients. Possible reasons why surgeons are reluctant to use these techniques are that they are said to be more difficult to learn, they require considerable experience and intuition, and their applicability is confined to small breasts. Several surgeons have developed modifications, combining vertical-scar breast reduction techniques with details of the familiar inverted-T-scar technique. Read More

Plast Reconstr Surg 1999 Sep;104(3):764-70

Institut Médical Edith Cavell, Brussels, Belgium.

No surgeon likes to face complications. It takes effort to treat them personally and more effort to note, count, analyze, and demonstrate them. The author carefully followed 250 personal consecutive patients (476 breasts) who underwent vertical mammaplasties between 1990 and 1998; studying the complications and their relationship with the types of breasts and patients was very instructive. Read More

Plast Reconstr Surg 1999 Sep;104(3):748-59; discussion 760-3

Mineral Springs Hospital, Banff, Alberta, Canada.

Although the vertical reduction mammaplasty is effective in reducing scarring, the technique has not achieved widespread acceptance in North America. There are several reasons for this. Some believe that the vertical reduction mammaplasty is only applicable to smaller breast reductions and that the learning curve is difficult. Read More

Handchir Mikrochir Plast Chir 1999 Mar;31(2):134-6

Klinik für Plastische Chirurgie, Diakoniewerk Kaiserswerth, Düsseldorf.

In 1991, we started to use a new surgical technique for breast reduction with a single vertical scar incision as developed by Marchac, Lassus, and Lejour. The operative procedure wsa changed step-by-step according to the following significant modifications: Simultaneous liposuction is carried out only in the presence of extensive axillary fatty tissue. The undermining of the glandular tissue is limited to the extension of glandular resection. Read More

Br J Plast Surg 1998 Sep;51(6):444-9

Department of Plastic Surgery, West Norwich Hospital, UK.

The aim of this study was to assess the difference in opinion between patients and surgeons regarding the aesthetic outcome of reduction mammaplasty. A total of 34 women, who were more than 1 year post surgery, attended an outpatient clinic to assess their opinion of the aesthetic outcome of their breast reduction. A questionnaire was used to standardise their responses. Read More

Aesthetic Plast Surg 1997 Nov-Dec;21(6):403-7

Brussels, Belgium.

Vertical mammaplasty, a technique that avoids submammary scars, has proved to be a reliable method of breast reduction because it is adaptable to most cases and produces beautiful and durable results. What about secondary cases? In the last 14 cases referred for secondary mammaplasty, at 1-19 years after their initial surgery, patients' indications were poor shape (14), visible and improperly located scars (9), excess volume (8), asymmetry of the areolas (5) or the breasts (1), insufficient volume (2), and asymmetry with reconstructed breast (2). The original scars were inverted T (10), periareolar (2), oblique (1) or vertical (1). Read More

Plast Reconstr Surg 1997 Jun;99(7):2118-20

Plast Reconstr Surg 1997 Feb;99(2):386-93

Institute Medical Edith Cavell, Brussels, Belgium.

Breast liposuction, performed immediately prior to surgical reduction, has proven to be an efficient adjuvant method to reduce large breasts, even in young patients. Experience has shown, however, that liposuction is difficult or impossible in breasts in which fat is intimately mixed with glandular tissue. Clinical examination gives no information about the breast content. Read More

Br J Plast Surg 1996 Dec;49(8):507-14

Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, London, UK.

Vertical scar breast reduction is a well accepted technique which we believe improves the shape and projection of the breast and leaves no horizontal scars. Lassus and Lejour described superiorly based nipple flaps; we describe a medially based flap or glandular transposition of the nipple in small reductions. Fifty-seven consecutive patients are presented. Read More

Plast Reconstr Surg 1995 Sep;96(3):620-6

Department of Plastic Surgery, University Hospital Brugmann, Free University of Brussels, Belgium.

Liposuction of the breast in combination with vertical mammaplasty was applied to 250 breasts among 386 reductions of large breasts performed in 2 years (1989 to 1991). To evaluate the possible damage to the breast caused by this combined procedure, especially in terms of the occurrence of the postoperative development of calcifications, a comparative study of preoperative and postoperative mammograms was undertaken in 60 randomly selected cases (120 breasts), 34 with and 26 without liposuction. Altogether, 13 calcifications (11 percent) were discovered during the 6- to 30-month follow-up, representing the lowest rate reported in the literature. Read More

Plast Reconstr Surg 1994 Jul;94(1):100-14

Institut Medical Edith Cavell, Brussels, Belgium.

Since 1989, I have used vertical mammaplasty without a submammary scar for all breast reductions. This technique uses adjustable markings, an upper pedicle for the areola, and a central breast reduction with limited skin undermining. The shape of the breast is created by suturing the gland and does not rely on the skin. Read More

Ann Chir Plast Esthet 1990 ;35(5):369-79

Service de Chirurgie Plastique, Hôpital Universitaire Brugmann, Bruxelles, Belgique.

A better understanding of the vascular anatomy of the breast has drastically reduced the risk of postoperative necrosis in breast reduction. Scars however remain a major concern, and techniques to reduce these have often been considered to be less satisfactory in terms of the shape and stability of the result. Our experience with more than 1,000 breasts operated on between 1984 and 1989 with a short inframammary scar technique has proved the contrary. Read More