Dr. Hidalgo is in private practice in New York City.
The vertical reduction mammoplasty with superior pedicle is also referred to as the "lollipop" technique to distinguish it from an older method, the "anchor pattern" incision, Dr. Hidalgo says."I call it a lollipop scar, compared to the anchor pattern incision, because in that technique, the scar not only goes around the nipple and straight down, but there's a very long scar beneath the breast that is frequently troublesome," he tells Cosmetic Surgery Times.
"The 'lollipop' goes around the areola and straight down the middle to the crease beneath the breast. The old method had a big scar in the crease as well."
Culmination Dr. Hidalgo's procedure was featured in the April issue of the Journal of Plastic and Reconstructive Surgery, and the article is the culmination of a five-year effort that was in evolution since Dr. Hidalgo became familiar with the techniques of Dr. Madeline Lejour and Dr. Claude Lassus about five years ago.
The techniques of those doctors were, in some respects, very well established, Dr. Hidalgo says. Dr. Lassus has performed his procedure on thousands of European patients over 30 years, Dr. Hidalgo estimates.
"The difference is that Dr. Lassus doesn't lift the skin on the lower part of the breast after removing tissue in the lower part of the breast; rather, he sews several layers of the vertical incision together so that it tightens the skin and lifts the skin off the breast at the same time," Dr. Hidalgo says.
Some disadvantages Dr. Lejour's procedure is also different, according to Dr. Hidalgo. "She does a lot of liposuction of the breast before she makes any incisions, and then lifts the skin off the bottom of the breast very aggressively," he says.
The primary disadvantages of the older procedure were that it could produce an unsightly appearance in the breast, at least at first. "Immediately after surgery the breast had a very wrinkled and unnatural appearance that would take months before the shape normalized," Dr. Hidalgo says. "A potential long-term problem is that the bottom of the breast looked like it dropped out, or the nipple position was too high, an appearance which we call a long lower pole. Sewing the tissue to the chest wall muscle under the breast, because that also causes distortion, doesn't work so well.
"I preserve a central column of tissue inside the breast, while removing unwanted excess tissue from both the medial and the lateral portion of the breast. By moving that tongue of tissue, the nipple position can be lifted. This is all happening under the skin." Another purpose of the pedicle is to preserve blood supply and sensation to the nipple itself, he adds.
"This technique accomplishes two things: First, it will make a very wide breast more narrow. Number two, the central column preserves the shape of the breast and eliminates the prospect of early shape distortion seen with previous methods," Dr. Hidalgo says.
One drawback After having performed his new procedure on hundreds of women in the last five years, Dr. Hidalgo has encountered only one drawback. "You cannot do it in a breast of more than a certain size, and in breasts in which you take off more than 800 grams from each side. In those cases, it's better to use more traditional methods," he reports.
Disclosure: Dr. Hidalgo reports no financial interests in this article.