vertical-mammaplasty-and-liposuctionAuthor: Madeleine Lejour, MD, PhD
Publisher:  Quality Medical Publishing – 238 pages
Book Review by: Nano Khilnani

Many of us know that mammaplasty is breast reduction, but what is vertical mammaplasty?

The author Dr. Madeleine Lejour explains this type of breast reduction surgery:

“Vertical mammaplasty is a technique that relies on an upper pedicle to the areola and involves a lower central breast reduction, glandular  reshaping, and suturing. Less scarring is involved than the inverted T incision but more than with the periareolar technique.

The tradeoff is that to ensure a fine-line periareolar scar, a vertical extension is added. However, this vertical scar will fade over time and be partly obscured by the breast. The submammary horizontal scar typical of the inverted T incision is avoided by the gathering of the excess lower skin in the vertical suture.

This gathering can be accomplished without increasing the length and consequently the tension on the periareolar suture. The vertical mammaplasty technique is safe and allows the precise reshaping of the breast with durable results. Its advantages largely compensate for the addition of a vertical limb to the periareolar scar.”

This book has been written for breast surgeons and those planning to specialize in breast surgery.  The contents of this book of about 200 pages are presented below to provide you an overview in the form of the titles of its seven chapters:

  1. Fundamentals
  2. Applied Anatomy for Vertical Mammaplasty
  3. Patient Consultation and Evaluation
  4. Operative Procedure
  5. Complications, Problems, and Secondary Revisions
  6. Special Applications
  7. Long-term Results

Dr. Lejour writes in her Preface to this 1994 book that breast surgery has been “an ongoing source of fascination” for her for about 30 years. Among her concerns in her search for the ‘optimal technique’ for breast reduction and mastopexy (breast lift) have been the following:

  • Safety
  • Reduction of associated scarring that flaws that mar the aesthetic appearance of the re-contoured, symmetric breasts
  • Reliable results

Vertical mammaplasty, when done correctly with the above objectives in mind, produces good results conforming to these desires of the patient as well as the surgeon. While there is frequently immediate distortion of the breasts after the operation, surgeons must accept this, and “look to the long-term superior results,” she writes.

Dr. Lejour emphasizes the importance of harmonious teamwork of the people involved in this mission, including planning meetings, presentation of videos slides to review the steps of the procedure, and overall close communication to achieve the goal of well-contoured breasts.

Let us take a look at what you will find in a typical chapter by providing you an outline of topics discussed in chapter 4, Operative Procedure. This is the longest among the seven chapters,  constituting 85 pages, more than  one-third of the 238 pages of this book. At the beginning of this chapter, Dr. Lejour shares her insight as a breast surgeon and writes these informed remarks:

“Mastering a new surgical technique challenges the skills of all surgeons, novice and expert. Basic principles are grasped with case, but the fine points and subtleties prove more elusive. To facilitate understanding of vertical mammaplasty and liposuction, this chapter details this procedure in its entirety with liberal use of photographs and drawing to guide the reader through the operative steps and to enable him to grasp the fundamentals of this operation as it applies to breast reduction and mastopexy.”

This chapter presents and discusses the following topics and subtopics

  • Markings
  • Breast Reduction
    • Deepthelialization
    • Liposuction
    • Lower Skin Dissection
    • Elevation of the Central Breast
    • Glandular Incisions
    • Resection
    • Reshaping and Suturing the Gland
    • Suturing the Skin
    • Postoperative Care
    • Result
  • Evolution of the Result
  • Clinical Examples
    • Operative Sequence: Moderate Reduction With Liposuction for Women With Large Breasts and Striated Skin
    • Breast Reduction for Older Women With Fatty Breasts
    • Vertical Mammaplasty With Liposuction in a Young Woman With Fatty Breasts
    • Vertical Mammaplasty With Liposuction in a Young Woman With Glandular Breasts
    • Weight Reduction After Vertical Mammaplasty With Liposuction
    • Vertical Mammaplasty and Abdominoplasty as a Combined Procedure
  • Mastopexy
    • Minor Ptosis With Clinical Example
    • Moderate to Major Ptosis With Clinical Examples
  • Caveats in Vertical Mammaplasty

Each chapter provides good coverage and discussion of its subject, as well as step-by-step descriptions of the relevant procedures in good detail, accompanied by before-and-after photos of patients, charts, and sketches. For those who want to explore topics in greater detail, each chapter contains lists of sources of more information at the end.

This useful, practical book is unique in the sense that it is on a subject on which very, very few books exist on the market. As a matter of fact, when did a search on Amazon on the phrase ‘vertical mammaplasty’ we found only two books: this and one other.



Madeleine Lejour, MD, PhD is Professor and Former Head of the Department of Plastic Surgery at the University of Brussels in Brussels, Belgium.



Kip Carter, MS, CMI