The S-Flap Modification: A Short-Scar Reduction Mammaplasty

BACKGROUND: Despite the documented advantages of short-scar reduction mammaplasty, its broad applicability remains debated. Critics argue that it does not manage lower-pole skin excess as effectively as the T-scar technique. The S-flap modification of the Hall-Findlay technique potentially retains the advantages of the short scar while providing a stabler lower pole. METHODS: Out of 147 single-surgeon consecutive cases operated on between 2016 and 2022, 58 (39.5%) completed at least 1 year of follow-up and answered a reduction mammaplasty BREAST-Q. They were divided into 3 groups: vertical scar, J scar, and S scar. The S-scar modification was analyzed in relation to the previously used vertical and J-scar techniques. RESULTS: The S-scar group was characterized by a significantly ( P = 0.002) higher mean resection weight (456 ± 226 g) versus the vertical scar group (317 ± 158 g), longer preoperative nipple-intramammary fold (IMF) distance (20 ± 3 cm) than the V-scar and J-scar groups (both 16 ± 2 cm), and shorter follow-up time (57 ± 3 weeks versus 128 ± 80 and 110 ± 55 weeks, respectively). Long-term improvement rates in nipple-IMF distance in the J-scar, V-scar, and S-scar groups were 12.44% ± 13.08%, 13.01% ± 13.63%, and 21.83% ± 8.8%, respectively ( P = 0.003). BREAST-Q scores across all measures ranged from 72.35 to 98.63, with no significant differences among the groups, except for general outcome and information criteria, which were higher in the S-scar group ( P = 0.001 for both). CONCLUSIONS: The S-flap modification maintains short-scar advantages in terms of shape, projection, and lower pole stability, as reflected by a shorter nipple-IMF distance and a better general outcome score. Studies with a follow-up period exceeding 1 year and a larger cohort are needed.