What are the main types of skin closure patterns used in breast reduction surgery?

Main Types of Skin Closure Patterns in Breast Reduction

The three main types of skin closure patterns used in breast reduction surgery are curvilinear (Langer's lines), radial, and periareolar incisions, each with specific indications based on breast anatomy and location of tissue removal. 1

Curvilinear Incision Pattern

• Curvilinear skin incisions following Langer's lines (the natural lines of skin tension) generally achieve the best cosmetic result and are considered the standard approach for most breast reductions 1
• This pattern is particularly effective in the upper portions of the breast where following the natural tension lines results in less visible scarring 1
• The incision should be placed over or close to the area being removed and of adequate size to allow complete removal in one piece 1
• Preservation of the subcutaneous tissue with separate closure improves the cosmetic result when using this pattern 1

Radial Incision Pattern

• Radial incisions are recommended at the three o'clock and nine o'clock positions (mid-inner aspect) and in the lower breast 1
• This pattern is particularly beneficial when skin removal is necessary, as it provides better cosmetic results in these specific locations 1
• For larger lesions in the lower breast, a radial incision often results in better cosmesis compared to other patterns 1
• The radial pattern helps prevent distortion of the nipple position or inframammary crease when tissue removal is needed in these areas 1

Periareolar Incision Pattern

• Periareolar incisions are appropriate only for specific cases, particularly small lesions in the immediate subareolar area 1
• These incisions are considered inappropriate for lesions in the periphery of the breast 1
• Partial areolar excision with careful approximation can provide adequate tissue removal and good cosmesis for small subareolar lesions 1
• The periareolar approach minimizes visible scarring but is limited in the amount of tissue that can be removed 2

Technical Considerations for All Patterns

• Regardless of pattern choice, the skin should be closed with a subcuticular technique to optimize cosmetic results 1
• Excision of skin segments should be avoided when possible as it may alter the position of the nipple or inframammary crease 1
• Meticulous hemostasis is critically important with all incision patterns to prevent hematoma formation, which can complicate postoperative evaluation 1
• A superior cosmetic effect is usually achieved when the breast tissue is not reapproximated, as reapproximation that appears adequate with the patient supine often results in distortion when upright 1

Modern Variations and Combined Approaches

• The "owl" incision combines features of the periareolar and vertical reduction techniques to minimize scarring while maintaining good projection 2
• The Wise pattern (inverted T) is commonly used for large reductions but may result in more visible scarring 3
• Vertical pattern techniques have emerged as alternatives to traditional approaches, offering reduced scarring in appropriate candidates 3
• Parenchymal suturing techniques can be combined with any skin pattern to maintain shape and decrease complications 4

Choosing the Appropriate Pattern

• Selection should be based on breast size, degree of ptosis, and location of tissue to be removed 5
• For moderate to large reductions, inverted T or short-horizontal inverted T incisions are typically recommended 5
• For smaller reductions, periareolar or vertical incisions may provide adequate access with less scarring 5
• The National Comprehensive Cancer Network recommends that skin incision patterns should be selected to facilitate complete tumor removal while optimizing cosmetic outcomes 6