In 1964, I started using vertical mammaplasty without a submammary scar for all breast reductions. This technique was based on the following principles: a central wedge resection, an upper pedicle for the areola, no undermining, and a vertical scar to finish off.
Because of the drawings, there was a pitfall: In large breasts, the inferior portion of the vertical scar was showing below the submammary fold. This is why, in 1977. I modified the technique with the addition of a short horizontal scar to eliminate this drawback.
At the time, I was respecting the dogma that the length of a vertical scar should not exceed 5.5 cm. Taking a look again at my patients after a few months, I was surprised to find that the horizontal scar had moved upward. This led me to verify that the distance between the inferior border of the areola and the inframammary fold was variable with the size of the breast. I was then convinced that it was possible to finish every mammaplasty with a vertical scar.
Thus I modified the procedure again to make the vertical scar stay above the inframammary fold in almost all patients.
In a personal series of 710 patients (1350 breasts) operated on from 1964 to 1994, mastopexy was performed in 439 breasts and breast reduction was performed in 911 breasts. There were few complications. This long experience with vertical mammaplasty indicates that it is a safe procedure giving long-lasting results. (Plast. Reconstr. Surg. 97: 373, 1996.)