Evaluation of Hamdi's Algorithm for Optimal Patient Selection for Vertical Scar Mammaplasty - a Single Surgeon Experience.

Abstract

Vertical scar mammaplasty can minimize scarring while maintaining an uncompromised aesthetic outcome but may result in high revision rates. In 2005, an algorithm was introduced by the senior author to better define candidates for vertical scar mammaplasty. This study validates the algorithm's effectiveness over 13 years. A cohort study of consecutive breast reductions operated entirely by a single surgeon since 2010 was conducted. Inclusion criteria was primary bilateral cases as mandated by the healthcare reimbursement system criteria. Hamdi's algorithm was based on patient age, nipple-sternal notch distance and the quality of the skin. Data on demographics, surgical details, and outcomes were collected. Patients were grouped into vertical scar mammaplasty and inverted-T procedures for comparison. A total of 159 patients with complete follow-up data were included: 73 underwent vertical scar mammaplasty, and 86 had inverted-T procedures, with an average follow-up of 38.8 months. Inverted-T group patients were significantly older and had a greater sternal-notch to nipple distance with larger average gland reduction (680 gm) compared to (450 gm) after vertical scar mammaplasty (P:002). The inverted-T group had a significantly higher infection rate. Late scar revision was similar in both groups (6.3%). There were no other significant differences. This study demonstrates that, when guided by the proposed algorithm, vertical scar mammaplasty should be considered in eligible candidates without increasing complications or secondary corrections. It offers a comparable safety profile to the inverted-T technique, whilst reducing the scar burden.