Plastic Surgery>>>>>Breast, trunk and perineum
Question 9#

In the hands of an inexperienced plastic surgeon, vertical scar mammaplasty is more predictable except: 

A. In breast reduction of less than 500g per side
B. In breast ptosis with less than 30cm of nipple distance to the SSN
C. In a patient after massive weight loss (MWL)
D. In a young patient less than 30 years old
E. In a patient with good skin quality

Correct Answer is C

Comment:

In a patient after massive weight loss (MWL). The ideal candidate for vertical scar mammaplasty is one who has simple breast ptosis or who requires gland reduction of 400-500g or less. A patient of stable weight is preferable to an obese patient whose weight is constantly fluctuating. Young patients usually have good quality skin. Juvenile patients are more prone to unpredictable and hypertrophic scars. The vertical scar often has the least risk as compared with the peri-areolar and the horizontal scars, but all efforts should be undertaken to keep scars as short as possible. Patients with large breasts, where the amount of tissue resection exceeds 1000g per side, and older patients, where skin has lost its elasticity, are not good candidates for this technique. Patients after massive weight loss are better managed with an inverted-T scar technique. Using vertical scar mammaplasty will lead to early ptosis, residual skin excess, and lack of projection of the breast due to flaccid and loose tissue.

References:
1. Hamdi M, Hall-Findlay EJ. Pedicle choices in breast reduction. In: Vertical scar mammaplasty. Hamdi M, Hammond DC, Nahai F, Eds. Berlin, Germany: SpringerVerlag, 2004.