Vertical Sculpted Pillar Reduction Mammoplasty

Abstract

The vertical sculpted pillar technique evolved from incorporating different maneuvers that collectively result in a stable breast cone fashioned from carefully tailored breast tissue. The key concept is to visualize and shape the volume of the breast tissue that one leaves behind, not the tissue that is taken away. To determine the best pedicle, a simple preoperative maneuver is performed. If the nipple-areolar complex (NAC) easily glides upward to its new position, then the superior pedicle popularized by Lassus [1, 2] via a vertical approach is used. Otherwise, if the NAC cannot be manipulated in this manner, then we convert to the superomedial pedicle popularized by Hall-Findlay [3, 4]. The other rule of thumb is that if the NAC is below the “the mosque dome” portion of the keyhole, then we begin to think in terms of a superomedial pedicle as opposed to a strictly vertical one. The sculpting of the medial and lateral pillars is modified from the technique of Chiari [5]. Other unique features of this technique include the shaping sutures in the superior pole of the breast, originally described by Marchac [6, 7], and the lateral shaping suture, described in an unpublished communication with Alex de Souza, a Brazilian plastic surgeon. Lastly, the reflected inframammary fold (the “A-point” of Pitanguy) becomes the superior-most point of attachment of the new areola, not the nipple.