ONCOPLASTIC SURGERY TECHNIQUES - VERTICAL MAMMOPLASTY

This oncoplastic technique is derived from vertical scar reduction/mastopexy and is used mainly for the excision of lower pole tumors in small to medium mildly ptotic breasts. The technique is based on three main principles: a central wedge resection of the tumor with the skin and glandular tissue with-out skin undermining, a superior nipple-areola complex (NAC) pedicle, and a final single vertical scar that ends above the inframammary fold (IMF). An instrumental advantage of this technique is that the breast lifting relies on the suturing of the glandular tissue rather than the tucking of the skin envelope, as in the inverted T technique. This technique requires a longer vertical scar to accommodate the extra projection. Vertical mammoplasty is a simple procedure with a short learning curve. Compared to the inverted T technique, it avoids the bottoming out deformity and produces less scarring, better projection, and long-lasting aesthetic results. The main limitation of this technique is that It may take three months for the aesthetic results to settle. With certain modifications, vertical mammoplasty can be used to recon-struct the defects of tumors excised from the central or upper pole of the breast. The surgical complica-tions are very rare; nipple necrosis can occur at a very low rate of 1 in 300-400 cases due to anatomical variation in the dominant blood supply. Fat necrosis is a rare complication of this technique owing to the limited glandular tissue mobilization and the absence of skin undermining. Other rare complications include seroma/hematoma and skin Puckers, which usually disappear over weeks to months. Proper patient selection and mindful surgical technique are essential elements for the success of this procedure.