Breast reduction surgery was performed as early as the sixth century AD by Paulus Aegineta for gynaecomastia. The first described breast amputations were performed in the 19th century and Dieffenbach in 1848 described a landmark reduction mammaplasty in a female patient (1). He removed the lower two thirds of the breast and left a scar in the inframammary fold.
The early 1900’s were marked by a range of new operations that elevated the breast mound and envelope without addressing the nipple-areola complex (NAC). Morestin in 1909 was the first to devise a mechanism for independently elevating the NAC. In 1922, Thorek described the partial amputation of breast tissue with free grafting of the nipple.
The next major advance was the consideration of blood supply to the skin and glandular tissue. Particularly, there was emphasis on keeping skin adherent on any remaining gland after excision to preserve the subdermal vascular plexus and reduce complication (2).
Subsequent operations focused on new patterns of incision to leave more aesthetically pleasing scars and pedicle design to preserve vascularity to the NAC. The seminal paper by Wise in 1956 described a pattern of skin and glandular excision that left an ‘anchor’ incision with reproducible results and minimal complications (3). Elements of this technique are still widely used today.
The 1960’s onwards saw an array of different combinations of incision for skin and resection for the breast mound with increasing consideration for preservation of innervation and vascularity to the NAC:
• horizontal dermoglandular pedicle:
o horizontal bipedicle to sustain NAC, inverted T scar (Strombeck 1960)
o horizontal unipedicle, inverted T scar (Skoog 1963)
• lateral dermoglandular pedicle and lateral scar (Duformentel 1965)
• vertical dermoglandular pedicle:
o bipedicled vertically, inverted T scar (McKissock 1972)
o superior pedicle (Weiner 1973)
o superior vertical pedicle, vertical scar only (Lejour 1990)
o inferior pedicle, inverted T scar (Robbins 1977)
o inferolateral breast resection, B-shaped scar (Regnault 1980)
Liposuction became prevalent as a means of reduction from the 1980’s. A more modern trend is to use it as an adjunctive procedure in addition to formal removal of glandular tissue and breast skin.
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