The Inverted Spade Skin Incision Pattern in Superior Pedicle Breast Reduction: A Modification of the Owl Technique
the Owl technique described by Ramirez is one of the common techniques in breast reduction; however, it is associated with significant dog ears in large breast reduction. In addition, the long vertical incision gives a false impression of bottoming out. This paper describes the inverted spade as a modification for the Owl skin pattern incision in superior pedicle breast reduction to overcome these limitations of the technique.
Methods/Technique: 84 patients (168 breasts) underwent the inverted spade technique over 4 years were included. The circumareolar incision is made in a ratio of 3: 1 and extends below the breast equator. The curvilinear incisions are converted into heart like shape without separation of skin parenchymal continuity.
Results/Complications: These modifications add more flexibility to the Owl technique without any morbidity. They allow larger reductions if needed, shorter vertical line without horizontal incision, satisfactory aesthetic outcome, no bottoming out, no dog ears, preserved nipple sensation, and good breast projection. This technique can be used safely and effectively in gigantomastia. Good to excellent results could be obtained with a long follow up period.
Conclusion: The inverted spade pattern technique offers more flexibility to the Owl technique in superior pedicle breast reduction. These modifications eliminate the problems of dog ears and the long vertical incisions. It showed satisfactory aesthetic outcome that could be maintained during long follow up periods.