title: Vertical Sculpted Pillar Reduction Mammaplasty in 317 Patients: Technique, Complications, and BREAST-Q Outcomes.
abstract: BACKGROUND
  The senior author (JCG) has described the vertical sculpted pillar breast reduction.
  
  
  OBJECTIVE
  This manuscript aimed to compare this technique's safety profile to other established techniques via complication rate reporting. Few studies have utilized the BREAST-Q for long-term outcomes reporting in bilateral reduction mammaplasty patients. BREAST-Q outcome comparisons, between cosmetic and insurance-based breast reduction cohorts, have not been previously reported.
  
  
  METHODS
  A retrospective chart review was performed on patients who underwent reduction mammaplasty using the vertical sculpted pillar technique. The BREAST-Q postoperative reduction mammaplasty module was administered. Complication rates and outcomes data were compared among patient cohorts distinguished by pedicle, scar pattern, and payor population. Statistically significant differences were set at P < .05.
  
  
  RESULTS
  Compared to the superior pedicle, use of the superomedial pedicle statistically increased rates of postoperative fat necrosis in this series. Complication rates did not differ among scar patterns, but use of a J, L-shaped, or short-T scar decreased the need for secondary/revisional surgery. Cosmetic and insurance-based outcomes did not differ in any domain of the postoperative reduction mammaplasty BREAST-Q module.
  
  
  CONCLUSIONS
  Complications data for the vertical sculpted pillar reduction mammaplasty were comparable to published results for other techniques. Complication rates are unaffected by scar pattern. Superomedial pedicle selection and larger insurance-based reductions may predispose to statistically significant increases in fat necrosis compared to use of the superior pedicle. Payor source neither affects the majority of complication rates, nor BREAST-Q satisfaction and quality of life domains. This information can be used to improve management of expectations during the preoperative consultation process.
  
  
  METHODS
  4 Therapeutic.
authors.affiliation: Dr Derby is a plastic surgeon in private practice in Sarasota, FL. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; a Clinical Professor, Division of Plastic and Reconstructive Surgery, University of Wisconsin, Madison, WI; and is the CME/MOC Section Editor for Aesthetic Surgery Journal. Dr Redden is the Chair, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Derby
authors.affiliation: Dr Derby is a plastic surgeon in private practice in Sarasota, FL. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; a Clinical Professor, Division of Plastic and Reconstructive Surgery, University of Wisconsin, Madison, WI; and is the CME/MOC Section Editor for Aesthetic Surgery Journal. Dr Redden is the Chair, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotting
authors.affiliation: Dr Derby is a plastic surgeon in private practice in Sarasota, FL. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; a Clinical Professor, Division of Plastic and Reconstructive Surgery, University of Wisconsin, Madison, WI; and is the CME/MOC Section Editor for Aesthetic Surgery Journal. Dr Redden is the Chair, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D016462:Mammaplasty / Q000009:adverse effects* / Q000191:economics / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000209:etiology* / Q000523:psychology; D017064:Process Assessment, Health Care / Q000191:economics / Q000592:standards; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult