Why Do Hospital Consultations Differ for Breast Reduction Surgery? | Methods for Classifying Breast Reduction

If you are interested in reduction surgery, you have probably heard terms like anchor incision, vertical incision, and periareolar incision at least once.

If you search the internet, you will also find many videos and articles related to this topic.

Because of this, not only patients but even medical professionals may have a mistaken understanding of how breast reduction surgery is classified.

In fact, except for scar revision surgery, other fields do not classify surgical methods based on the shape of the scar.

Personally, I am quite negative about whether the final appearance of the visible scar is an appropriate way to explain the differences between reduction surgery methods.

This classification based on scar shape is not a scientific way to show differences in surgical methods.

That is because the shape of the scar is not an important factor in the surgery itself. Medical staff use it as a kind of shortcut because the externally visible scar shape makes it easier to explain.

The difference in scars does not reflect the fundamental differences in breast reduction methods.

It is only a minor issue in the final step of the surgery—how to manage the remaining skin after removing and repositioning the breast tissue and fat, which are the main parts of the operation.

For that reason, it cannot be said to be a method that explains the characteristics, advantages, and disadvantages of each surgery.

Then what element is the key factor that creates the fundamental differences in breast reduction surgery?

The original concept of breast reduction surgery was this: because the breasts are large and sagging, remove everything except the parts you want to keep. Then take the nipple and areola out, as if performing a skin graft, and attach them somewhere desired in the upper area. Even now, some surgeries still use this method.

However, when surgery is done this way, the detached nipple does not fully survive and attach the way a skin graft does. To be precise, part of the transplanted nipple and areola does attach, but side effects occur, such as mottled areolar color and changes in size.

Because the nipple and areola are complex tissues, it is difficult to make them survive by detaching and reattaching them like a skin graft.

So the development of breast reduction surgery afterward focused on this question: “Which blood vessels should be preserved so the nipple and areola can be moved intact?”

Among the blood vessels leading to the nipple from above, below, left, and right, which vessel should be preserved to maintain blood flow to the nipple? In other words, the choice of a flap that includes blood vessels became the core of the surgery.

Accordingly, it was classified into forms such as superior flap, inferior flap, medial flap, lateral flap, and central flap.

Therefore, the correct classification of breast reduction surgery is based on the method of using blood vessels, and the characteristics, advantages, and disadvantages of the surgery also vary depending on which blood vessels are used.

The difference in the scars visible on the outside is merely a very small difference in how the remaining skin is handled during the surgery.

When patients visit multiple hospitals for consultations, they often hear about the disadvantages of vertical incision techniques at places that focus on anchor incisions, and hear about the disadvantages of anchor incisions at places that focus on vertical incisions.

But when you actually go there and ask about this point, you usually get a blunt answer like, “That is not how we do it here.”

That is because even if an anchor incision is used, the characteristics can differ depending on which flap is used, just as they can differ with a vertical incision or even a periareolar incision.

Simple claims such as “an anchor incision does not create a rounded shape” or “a vertical incision cannot reduce the breast enough” can be sufficiently rebutted depending on the use of flaps.

In other words, if questions are framed around the visible scar shape, patients have no choice but to hear different explanations.

When the pros and cons of reduction surgery are explained through various media, they are all described according to this incorrect classification, so contradictions are very common.

Now that breast reduction surgery has become somewhat more common and a lot of information is openly available, the old primitive classification based on scar shape cannot provide accurate information about breast reduction surgery.

I think it is much more appropriate to place key value on the location of the blood vessels leading to the nipple and, based on that, classify the surgery into superior flap, inferior flap, medial flap, and lateral flap.

If you want to use the existing names to help patients understand, it would be much more helpful for patients looking for surgery-related information to list both and provide a more detailed explanation.