SPAIR Breast Lift/Reduction Technique Overview
Breast hypertrophy (overly enlarged breasts) plagues millions of women with symptoms of neck, back, and shoulder pain, rashes to the skin, indentations and the shoulders, poor posture and problems with physical endurance, and, of course, emotional embarrassment. And despite attempts at weight reduction, physical exercise, or other forms of treatment such as physical therapy or even chiropractic medicine there is simply no alleviation of the symptoms. Indeed, surgery offers the only hope to the countless women who have suffered from this condition.
Spair Breast reduction surgery is an integral part of the specialty of plastic surgery and has been performed for decades. Time has shown an evolution in the techniques of breast reduction surgery. Currently in this country, the standard breast reduction technique uses an “inverted T” or “wise” pattern whereby the nipple and areola are kept attached to the central portion of the breast through what is called an inferior pedicle. This allows the blood vessels and nerves to stay connected to these structures thereby preserving the life and sensation to the nipple area. The new nipple location is marked and removal of excess skin and breast tissue is performed. The nipple (attached to its pedicle) is then moved upward to its new location and the incisions are then closed leaving a final scar that circles the nipple, continues vertically, and then extends along the base of the breast from the breastbone to the armpit area. Although this has proven to be a relatively reliable approach, there are concerns regarding excessive, unsightly, and thickened scarring, and open wounds that takes time to heal. In addition, changes in breast shape occur over time, which result in sagging of the breast from the bottom and hollowing out from the top. This results in flattening of the shape of the breast, which detracts from its normal full and round appearance.
In Europe, breast reduction surgery has been approached in a different way. Their focus has been to keep the scars confined to the nipple area. Although this is an appealing concept there have been limitations with regard to how large of a breast reduction could be performed and also concerns regarding the sensation and viability to the nipple. Moreover, attempts at reproducing the European results in this country have been met with inconsistent and mixed results and have, therefore, not been widely used.
As plastic surgeons, we are in constant pursuit of better results. Desires to achieve a more perfect breast reduction recently lead to the development of a technique that has combined the reliability of the American method of breast reduction with the European minimal scar techniques. This “SPAIR” (short scar peri-areolar inferior pedicle reduction mammoplasty) technique – developed by Dr. Dennis Hammond – combines the best of both worlds to achieve results that exceed either one alone. Through this approach, the inferior pedicle concept is preserved while the reduction of the breast tissue itself is performed within incisions that are confined to the area of the nipple and areola. In addition, shaping of the breast can be undertaken, thereby restoring its normal fullness to the upper portions of the chest and roundness to its overall shape – significantly reducing the previously observed long-term problems of bottoming and hollowing out. What’s more, scars are reduced by up to 50 percent or more over the traditional breast reduction methods used in this country. Finally, because the technique preserves certain aspects of breast reduction currently used by surgeons in this country, the results have been consistent and reliable. I have consistently been able to achieve superior reductions in women whose breasts have required 500-1500 grams of tissue (DD-FFF bra size) and just recently performed my largest reduction in a single breast of 3295 grams or just over seven pounds!
Just as exciting is the use of this SPAIR technique in women who have drooping or sagging breasts. In many cases, women simply want to have a Spair breast lift or mastopexy, whereby the breasts are returned to their normal position on the chest without any significant loss of breast tissue itself. And unlike many breast lift procedures where only the breast skin itself is removed, the SPAIR technique allows true breast reshaping (as is done during a reduction) so that fullness is restored. In addition, many of these women who may have lost breast substance with time or pregnancy (but still have loose hanging skin) may also want to have breast augmentation or the placement of breast implants performed simultaneously. The use of breast implants combined with breast lift procedures has sometimes been discouraged, but with the new SPAIR technique this can be easily performed in one operation. In addition, with the use of implants, the scars can often be reduced even further so that the only sign of surgery is limited to the scar around the nipple itself.
For men with gynecomastia or enlarged breasts, the SPAIR Breast reduction technique has exceeded my greatest expectations. Although many male patients are candidates for liposuction alone, there are circumstances where with large, ptotic (drooping) breasts removal of the excess breast tissue would leave redundant and unsightly skin. Experience with these situations has resulted in reductions whose final scars have been limited to the areola only when in the very recent past, these patients would have been destined to scars not unlike the traditional breast reduction methods.
Finally, and just as important, is the application of the SPAIR technique in women who have been diagnosed with breast cancer in whom breast reconstruction is planned. With many cancers, surgeons often have the ability to perform what is called a “skin sparing” mastectomy. With this approach, the breast tissue itself, including the nipple and areola, is removed while retaining all the surrounding skin. Preservation of the original breast size and shape is, therefore, maintained and reconstruction with a tissue implant, muscle flap from the back, or the lower abdominal skin (TRAM flap) can be performed. In women whose preserved breast skin has been fashioned using the SPAIR pattern (again eliminating the entire bottom horizontal scar), the final result is often virtually identical to the other normal breast, especially if that breast requires a mastopexy or reduction to achieve a match.
There are simply not enough accolades that can be given to this technique by both patients and myself who are witnesses to its results. The applications of the SPAIR technique are numerous and its potential is unlimited in achieving superior results in breast reduction, lifting, and reconstruction.