title: Vertical Scar Breast Reduction: Does Gathering the Incision Matter?
abstract: BACKGROUND
  The vertical scar bilateral breast reduction is a highly effective technique to reduce breast volume and create long-lasting aesthetic improvements. A cited disadvantage is the inability to adequately shorten the vertical scar, leading to chest wall scars or inframammary puckers. Gathering or cinching sutures have been described as a strategy to confront this issue. This article aims to determine if suture gathering is an effective methods to (1) reduce the incision length, (2) shorten the areola-to-inframammary fold (IMF) distance, and (3) reduce the pucker revision rate.
  
  
  METHODS
  All patients undergoing vertical breast reduction performed by the senior author (E.H.F.) from 2001 to 2007 were included. The patient population was divided into "gather" and "no gather" groups depending on how the vertical incision was closed.
  
  
  RESULTS
  There were 203 patients in the "no gather" group and 193 in the "gather" group. Age, body mass index, and resection weight were statistically but not clinically different. The percent reduction in vertical incision length was significantly greater in the "gather" group (34.2 ± 9.9% vs. 12.2 ± 5.9%). Both groups showed a gradual lengthening of areola-to-IMF distance postoperatively. Suture gathering had no impact on the pucker revision rate but increased healing complications.
  
  
  CONCLUSIONS
  Gathering sutures significantly reduce the incision length in the operating room but do not change the areola-to-IMF distance or pucker revision rate. Gathering negatively influences skin vascularity and wound healing. It is acceptable and necessary to have a longer areola-to-IMF distance in a vertical reduction to accommodate increased projection.
authors.affiliation: From the *Section of Plastic Surgery, University of Calgary, Calgary, AB, Canada; †Division of Biostatistics, Department of Surgery, University of Calgary, Calgary, AB, Canada; ‡Faculty of Chiropractic, D'Youville College, Buffalo, NY; and §Plastic Surgery, Banff, AB, Canada.
authors.forename: Jennifer L K
authors.initials: JL
authors.lastname: Matthews
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Oddone-Paolucci
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Lawson
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Hall-Findlay
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing