Articles

SPAIR the Scars

April 2004

By Amy M. Ortega, M.D.

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. The procedure was developed in 1996 by Dr. Dennis Hammond at the Center for Breast and Body Contouring in Grand Rapids, Michigan. At the time, standard procedures for breast reduction and breast lift were plagued with problems such as unattractive scars and unnatural breast shape, which were frustrating for meticulous plastic surgeons.

Then and now, the most common method of breast reduction/breast lift is called a Wise pattern, after Dr. Wise of Houston, Texas, who published his technique in the 1950's. This technique involves an incision pattern that produces a scar shaped like an anchor. The scar runs around the areola (darker skin near the nipple), down and across the chest below the breast. If you were to look straight ahead at the breast as if it were a clock, the scar underneath the breast from a Wise pattern runs from about 3 o'clock on one side of the breast to 9 o'clock on the other.

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 over time, it can result in a dramatic drop in the breast tissue below its natural anatomic location, producing a very unusual shape.

As a young surgeon aspiring to produce better results for his patients, Dr. Hammond developed the SPAIR technique to accomplish the same results of a breast reduction or a breast lift but with less than half the scars. Below is a word-by-word description of SPAIR:

Short-scar: The SPAIR scar is often less than half the length of a traditional breast reduction or lift 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 method was originally designed as a breast reduction procedure.

Over the years, the SPAIR approach has evolved from a single procedure to a three-dimensional artistic approach to managing the breast skin and breast tissue for the optimal result—a breast with minimal scarring and a pretty, more natural shape.

Editor's Note: Prior to the SPAIR procedure, the Wise pattern was the most common method used, leaving a scar shaped like an anchor. Envisioning the breast as the face of a clock, the scar would run down and across, from about 3 o'clock to 9 o'clock on either side of the breast. With the SPAIR procedure (shown here), the scars are practically invisible.

In addition to breast reduction, the SPAIR concepts are now applied to a breast lift, a breast lift with augmentation, and breast reconstruction after a mastectomy (removal of the breast due to breast cancer).

The SPAIR breast surgery process enables the surgeon to accomplish the goals of changing breast size and shape, or reconstructing the breast entirely, with minimal evidence that the surgeon has been there at all. The most significant added benefit is a natural looking breast. Lifting a breast, or making it smaller or larger, is not enough; an attractive looking breast is not only a certain size, but it also has a beautiful, rounded contour. Ignoring this premise produces a less than optimal result.

Dr. Hammond has perfected this technique by adding what I believe to be another key advantage to the SPAIR procedure—internal breast shaping. This is accomplished by "sculpting" the remaining breast tissue and by suturing, or stitching, the tissue on the inside 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, they do not contribute to scarring. Instead, they greatly add to the surgeon's ability to create a beautiful, natural breast shape that stands the test of time.

I was very fortunate to work alongside Dr. Hammond from 1997-2002, during which he completed his Aesthetic and Reconstructive Breast Fellowship—extra surgical training to specialize in breast surgery. Women today are fortunate to have several options in breast surgery, and I am very excited to bring the beautiful option of SPAIR breast surgery to Atlanta.

Dr. Ortega worked with Dr. Hammond during her plastic surgery training from 1997-2002 and then completed six additional months of full-time fellowship work with Dr. Hammond to develop expertise in breast surgery techniques. During that time, Drs. Ortega and Hammond collaborated on many research projects to advance the field of plastic surgery of the breast. Dr. Ortega subsequently completed six months of fellowship training in facial cosmetic surgery with the Emory-affiliated Paces Plastic Surgery in Atlanta.