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Breast Reduction: Modified “Lejour Technique” in 500 Large Breasts

Background: The “minimal scar technique” for breast reduction, developed by Marchac, Lassus, and Lejour, has become an increasingly practiced alternative to standard operative procedures. Methods: The authors introduced the modified “Lejour technique” in nearly 500 breast reductions in 250 overweight patients (adipose breasts) with a resection weight of more than 700 g. Their technique is a step-wise modification of the following procedures, resulting from their experience with complications and outcomes. Planning of the nipple-areola complex is carried out for each patient, and the glandular body is undermined only centrally and atraumatically, without liposuction. The superior mastopexy suture is waived in favor of the submammary fold being fixed using three H points. The three H points serve as a pivot by which later sagging is avoided. The skin closure does not have a shaping function without tension. The vertical pleated suture is not forced but adjusted to the retraction ability of the patient's skin. Use of the vertical pleated suture is limited; in cases of longer incisions, it is combined with a horizontal submammary transverse pleated suture. Results: In 250 patients with an average follow-up of 4.2 years, the average resection weight was 985 g for the right breast and 923 g for the left. The operation lasted from 120 to 180 minutes. The results were evaluated as very good in 75 percent, good in 19 percent, satisfactory in 5 percent, and unsatisfactory in 1 percent. The complication rate was 14 percent. Conclusions: The authors' experience has shown that this technique can be applied as a standard technique. It is particularly suitable for larger breasts, because it reduces aesthetic deficiencies and simplifies the reduction technique.