Medical & Trade Publications

February 2006

by Amy M. Ortega, M.D.
Medical / Plastic Surgery

SPAIR the scars for a beautiful shape

If I had to choose one word to describe my opinion of the best approach to breast surgery, it would be SPAIR.

SPAIR stands for Short-scar Peri-Areolar Inferior pedicle Reduction. I am very fortunate to have learned this technique from Dr. Dennis Hammond of Grand Rapids, MI, who developed the procedure in 1996. I worked with Dr. Hammond during my plastic surgery training from 1997 to 2002 and then spent six additional months of full-time fellowship work with him to develop expertise in SPAIR breast surgery techniques. At the time, standard procedures for breast reductions and breast lifts were plagued with problems such as unattractive scars and unnatural breast shapes.

Boxy and bottomed out

Then and now, the most common method of breast lift/breast reduction is the Wise pattern, named after Dr. Wise of Houston, TX, who published his technique in the 1950s. This technique involves an incision pattern that produces an anchor-shaped scar.

The scar runs around the areola (darker skin near the nipple), straight down to the breast's underside, and all the way across the breast's underside. If you were to look straight ahead at the breast as if it were a clock, the scar from a Wise pattern runs from about 3 o'clock on one side of the breast to 9 o'clock on the other.

The SPAIR offers one unique benefit that no other short scar procedure offers—internal breast shaping.

In addition to producing quite a lengthy scar, this technique can result in a flat, boxy breast shape. It can also weaken the breast internally, resulting in breast tissue that falls below the natural crease under the breast (inframammary fold). This unfortunate scenario is called "bottoming out," and in time, can result in a dramatic drop in the breast tissue below its natural anatomic location, producing a very unusual breast shape.

Benefits of SPAIR

The SPAIR approach can accomplish the same benefits of a breast reduction or a breast lift, but with a much prettier, more natural shape and less than half the scars.

Short-scar: The SPAIR scar is often less than half the length of a traditional breast lift or reduction scar.

Peri-Areolar: The first portion of the scar runs around the areola (the darker, pigmented skin near the nipple).

Inferior pedicle: The lowest portion of breast tissue is preserved, and this part is lifted to produce a rounded, natural look.

Reduction: The SPAIR was originally designed as a breast reduction, although now it is also used as an artistic, three-dimensional approach to breast lifts, breast lifts with augmentation, and breast reconstructions.

The focus of SPAIR breast surgery enables the surgeon to change breast size and shape, or reconstruct the breast entirely, with minimal evidence that the surgeon has been there at all. The most significant added benefit is a natural-looking breast.

Just making a breast smaller, or making it larger, or lifting it isn't enough. A truly "pretty breast" isn't just a certain size, but also has a beautiful, rounded contour. Ignoring this premise produces a less-than-optimal result.

Short scar breast surgeries

The SPAIR offers one unique benefit that no other short scar procedure offers—internal breast shaping. This is accomplished by "sculpting" the breast tissue and by suturing or stitching the inside tissue in a very specific way. The breast tissue is sutured to itself and to the chest wall for shaping and stability.

These sutures cannot be seen on the outside of the breast and therefore do not contribute to a visible scar, but yet greatly add to the surgeon's ability to create a beautiful, natural breast shape that stands the test of time.

Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast, and body. She can be reached for surgical consultation at her Franklin and Nashville Tennessee, GA, office at (404) 751-2500. For more information about Dr. Ortega, visit www.franklinplasticsurgery.net.