Reduction mammoplasty has been traditionally done using the Wise pattern. Because of the boxing effect in breast shape, lack of projection and long scars, two techniques have emerged as alternatives: the vertical reduction of Lassus/Lejour and the "round block" periareolar technique popularized by Benelli. Each one of these techniques has its pros and cons.
Inverted "T" Scar - Old Method
Inverted "T" Scar - Close up
The "Owl" incision combines the features of large periareolar reduction (Benelli's) and the vertical reduction Lassus/Lejour). The horizontal inframammary scar is minimal or completely eliminated. The mobilization of the vertical pillars toward the center of the breast gives excellent projection and diminishes the lateral fullness. The enlarging of the periareolar resection diminishes the length and pleating of the vertical scar, conversely the inclusion of the vertical component in the periareolar technique, eliminates the pleating effect of the "round block". This way the length of the scars is better redistributed. Excellent results are obtained immediately on the operating table. Large volumes of glandular resection and correction of severe ptosis can be accomplished without compromising vascularity of the nipple-areola complex or the skin flaps. To that end, the parenchymal resection has also been modified from the original vertical technique.
In a personal series of approximately 150 cases in 12 years, reductions up to 1,900 gm per breast and corrections of severe ptosis have been successful. Complications are rare with only one case of partial nipple lose unrelated to the technique. No conversion to free grafts was done even in the larger resections. Only one case required minor revision under local anesthesia. 98% of the cases were done as outpatient procedures.
The "Owl" incision technique for reduction mammoplasty provides excellent projection and shape with minimal visible scars and takes advantage of the positive features of the periareolar and vertical reduction techniques while minimizes their negative features.
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