In May 1994 Prof Madelaine LeJour came to Hobart as the visiting Professor of the College of Surgeons. This was a turning point for me as far as mamoplasty was concerned. Her presentations and book convinced me to adopt this method. Subsequently I visited Prof. LeJour in Belgium, to learn the finer points of this method.

The ideal breast reduction/mastopexy operation produces very little scarring, a good shape and is safe. No one has invented such an operation but the LeJour Vertical method comes close.

Traditionally we have been using a method that has a scar around the areola and below this there is an inverted T shaped scar. In the last few years this has been challenged by many surgeons.

The problem with the T method is that the horizontal component, especially at the two ends, becomes hypertrophic in many patients. In some cases the areolar scar tends to stretch due to tension.

The basis of the method is that the gland and skin are reduced and the skin shapes the breast. The T method produces tension at the junction of the two lines. This has on many occasions produced wound breakdown and slow healing.

The method can be used for reduction as well as liftup (mastopexy). This method completely eliminates the vertical part of the scar. The concept behind it is that the gland is shaped and the skin is draped over it. This is not new but the undermining is limited and thus there is less danger of skin loss. This also eliminates tension around the nipple. Nipple location is easier.

There is a temporary problem with the vertical method - at the end of the operation the wound is puckered and looks unattractive. Not what we have come to expect at the end of an operation. The puckering takes several weeks to settle in most cases. The upper part of the breast at first appears too high and this also settles down under the influence of gravity. It is most important that this is understood. The patient's cooperation is most important during the healing phase.

A tight fitting sports bra is worn all the time for about one month. The constant compression of the scar is important.