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Juarez M.Avelar, Ed. Hipócrates São Paulo 8-237-266
Avelar JM (2018a) Asymmetrical Breasts: A Challenge for Aesthetic Repair. In: BREAST
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Martire L Jr (2018) Martire’s Technique for “L” Mastoplasty. In: BREAST SURGERY-Aesthetic
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Chapter 18
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L-Shaped Scar forReduction Mastoplasty
LybioMartireJunior
Abstract In this chapter, the author presents the characteristics of “L”-shaped scar
mastoplasty for reduction mastoplasty, showing that it is a procedure that can be
used in all sizes of breasts and all degrees of breast ptosis, with advantages over
other ways of performing mastoplasty. Since he has experience with his technique,
the martire´s technique, for over thirty years and has performed all types of mammoplasty with it. Among the advantages of the technique shown are the projection
and shape of the breast without using a silicone prosthesis, there is no risk of necrosis of the areola, and.
Keywords Mastoplasty · “L”-shaped scar · Martire’s technique
A mastoplasty for breast reduction with an “L”-shaped scar is one among several,
existing procedures in which it is possible to proceed with breast reduction.
It is important to note that there is no such thing as an “L” scar technique or a “T”
scar technique or a vertical scar technique, but there are different techniques that
can obtain scars with these shapes. The scar is the nal result. Performing the mastoplasty may have different approaches according to each technique, from the marking and treating of the breast tissue to the assembly of the breast. Therefore, a certain
technique may not be able to obtain the same result as another, even if the scars have
the same format.
L. M. Junior (*)
Plastic Surgery and Surgical Technique (Surgical Clinic) at Itajubá Medical School (FMIT),
Itajubá, MG, Brazil
Brazilian Society of Plastic Surgery, São Paulo, Brazil
International College of Surgeons, Brazilian College of Surgeons, Brazilian Society of
History of Medicine, The Medical Academy of São Paulo, Instituto Prof. Lybio Junior Plastic
Surgery and Health, São Paulo, Brazil
Switzerland AG 2023
J. M. Avelar, R. Cavalcanti Ribeiro (eds.), Body Contouring,
https://doi.org/10.1007/978-3-031-42802-9_18
305© The Author(s), under exclusive license to Springer Nature
306
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L. M. Junior
There are many different techniques which result in an “L” scar. However, what
they all have in common is the absence of the medial branch of the scar in the breast
crease, which gives all of them similar characteristics and principles.
Once this concept is established, we will then explore in this chapter some characteristics that are present in reduction mammaplasties with an “L”-shaped scar, so
that the reader can draw their own conclusions about the advantages it presents.
My experience with L-shaped scar reduction mastoplasty dates back to the
1980s. In 1988, I presented a study entitled “Care and Tactics in Mastoplasty in ‘L’,”
in which I showed my technique for mastoplasty, at the eighth Jornada Carioca de
Aesthetic Surgery, in Rio de Janeiro (Martire Jr 1988).
I presented the technique at other Brazilian and international plastic surgery congresses (Martire Jr 1990; Martire Jr 1991; Martire Jr 1994).
Since then, I have performed all mastoplasties with this technique with excellent
results. It can be used to reduce all breast sizes and all degrees of breast ptosis
(Martire Jr 2018).
Figure 18.1 shows the marking of our technique and the result right after we
completed the surgery. In an L-shaped scar mastoplasty, it is important that the scar
has a 90° angle.
The technique and the amount of breast tissue removed may vary depending on
the type and volume of the breasts. However, it is always important to empty the
medial and lateral poles of the manas in an L-shaped scar mastoplasty.
In our technique, these tissues are used as aps in the assembly of the breasts that
will be crossed to help shape and project the breasts.
A favorable feature of an L-shaped scar mastoplasty is, of course, the absence of
a medial scar.
With the L technique, one can achieve a perfect shape with a minimal scar and
avoid a medial scar toward the sternum (Meyer 1995).
Women like to show cleavage that can be more or less ample, so the absence of
scarring on the medial part of the breasts is an important and advantageous condition for women (Figs.18.2 and 18.3).
Another interesting feature in mastoplasty with an “L”-shaped scar is the ease of
ascending the nipple-areola complex (NAC), because when assembling the breast,
Fig. 18.1 (a) Marking of Martire’s technique for mastoplasty with an “L”-shaped scar. (b)
Immediate result at the end of the surgery; it can be observed that the scar is of small extension and
the shape of the breasts is graceful with good projection, and there was no need for the use of silicone prosthesis
bca
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Fig. 18.2 (a, b, c) Types of female necklines that can expose the medial part of the breasts, showing that the absence of a medial scar after a mammoplasty is a considerable advantage
Fig. 18.3 The photo
shows the space that could
be used in a neckline
without scarring in a
patient who underwent
mastoplasty with an
“L”-shaped scar using
Martire’s technique
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it undergoes rotation as the areola and the nipple rise naturally and very easily. The
distance between the areola and the breast crease is not as important, the areola must
be positioned at the apex of the breast cone simply (Fig.18.4a–c).
Another important feature of the L-shaped scar mastoplasty is the abundant
blood supply of the breast. The absence of a medial scar in the breast crease causes
the medial skin ap to have a much greater blood supply, which makes the possibility of suffering necrosis of the areola or nipple practically null, because the base of
the medial ap is much larger in a mastoplasty with an “L”-shaped scar (Fig.18.5).
The mastoplasty with an “L”-shaped scar also allows for greater projection of the
breasts; therefore, there is no need to include a silicone prosthesis to aid in the projection. The assembly projects the breasts satisfactorily, as they undergo rotation. In
Martire’s technique, the medial and lateral aps used in the assembly further favor
this feature (Martire Jr 2018) (Figs.18.6, 18.7, and 18.8).
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L. M. Junior
cba
Fig. 18.4 The images (a, b) show the ease of rise of the nipple-areola complex. The image (c)
shows that the distance from the nipple to the breast crease is not important, and the image (d)
shows that the nipple is at the apex of the breast cone
Fig. 18.5 The image (a) shows that the blood supply, represented by the arrows, is greater when
there is no medial branch of the scar in the breast sulcus, decreasing the base of the skin ap, and
the image (b) shows that the medial branch of the scar compromises blood supply at the base of the
medial ap. This is why the chance of areola and nipple necrosis is practically null in an L-shaped
scar mastoplasty (Martire 2016)
ba
b
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a
Fig. 18.6 The images (a, b) show that in a mastoplasty with an “L” scar, the breasts undergo
greater projection, which favors the result without the need to include silicone implants to project it
Fig. 18.7 The images (a, b) show the result of a mastoplasty with an “L”-shaped scar, using
Martire’s technique, with adequate projection without the need to use a silicone breast implant to
project it
Another advantage of mastoplasty with an “L”-shaped scar is the possibility of
correcting symmastia, that is, conditions in which the breasts are joined together in
the sternal region. The treatment of the medial poles necessarily performed in an
L-shaped scar mastoplasty promotes the correction and removal of the breasts naturally, without the medial scar (Martire 2016) (Fig.18.9).
Another interesting application of mastoplasty with an “L”-shaped scar that
proves to be very advantageous are cases in which there is breast dysmorphism. The
intervention is performed on only one side, and the smaller scar on the operated
breast is undoubtedly an advantage as can be seen in Fig.18.10.
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Fig. 18.8 The image shows the result of a mastoplasty with an “L”-shaped scar, using Martire’s
technique, to the left preoperatively and to the right postoperatively, with a 6-month evolution. One
can see the proper projection of the breasts without the need to include a silicone prosthesis to
project it
L. M. Junior
Fig. 18.9 The images show pre- and postoperative mastoplasty using Martire’s technique, with
7years of evolution, in a patient with symmastia, revealing that the mastoplasty with an “L”-shaped
scar enables the correction of this condition without the medial branch of the breast crease scar,
which is often joined in mammary surgery with an inverted “T”-shaped scar
The results of a mastoplasty with an “L”-shaped scar are very favorable and
long-lasting, as can be seen in the patient operated on using Martire’s technique,
26years after the operation (Fig.18.11).
It can be concluded, therefore, that the mastoplasty with an “L”-shaped scar is a
safe procedure, which presents excellent results and can be used in any type of
breast hypertrophy or ptosis with considerable advantages (Figs. 18.12, 18.13,
and 18.14).
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Fig. 18.10 The image shows the pre- and postoperative period, with a 1-year evolution, of a
patient with breast dysmorphism in which a breast silicone was included in the right breast and a
mastoplasty with an “L”-shaped scar using Martire’s technique was performed in the left breast.
The absence of the medial branch of the breast fold scar makes the breasts more similar and allows
the use of cleavage
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Fig. 18.11 The images show the durability of an L-shaped scar mastoplasty performed using
Martire’s technique. (a) Preoperative; (b) 30days postoperatively; (c) 1-year postoperative period;
(d) 26years postoperatively
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Fig. 18.12 The image
shows a pre- and
postoperative mastoplasty
with an “L”-shaped scar
performed using Martire’s
technique, with an
evolution of 4months
L. M. Junior
Fig. 18.13 The image shows a pre- and postoperative 1-year evolution of an L-shaped scar mastoplasty performed using Martire’s technique
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Fig. 18.14 The image shows a preoperative left and a right postoperative period with a 1-year
evolution of mastoplasty with an “L” scar performed by Martire’s technique
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References
Martire Jr L (1988) Care and Tactics in “L” Mastoplasty, 8th Carioca Conference on Aesthetic
Surgery, Rio de Janeiro, Brazil
Martire Jr L (1990) L-shaped mastoplasty – Our simple and objective systematization. 27th
Brazilian Congress of Plastic Surgery, Rio de Janeiro, Brazil
Martire Jr L (1991) “L” Mastoplasty. Annals of the 28th Brazilian Congress of Plastic Surgery,
Hotel Macksoud Plaza, São Paulo, Brazil
Martire Jr L (1994) Martire’s technique for L mastoplasty. Annals of the X Congreso Iberolatino
Americano de Cirugia Plastica, Viña del Mar, Chile
Meyer R (1995) “L” technique compared with others in mammaplasty reduction Aesthetic Plast
Surg Nov-Dec 1995;19(6):541-8
Martire Jr L (2016) Mammaplasty- Personal ‘L’ Technique, A Procedure for All Types of Breasts.
Annals of the X South Mineiro Congress of Plastic Surgery, Itajubá, Minas Gerais, Brazil
Martire Jr L. (2018) Martire’s Technique for “L” Mastoplasty. In: Avelar J. (eds) Breast Surgery.
Springer, Cham. https://doi.org/10.1007/978- 3- 319- 54115- 0_31
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