Breast Plastic Surgery - Breast Reduction

Breast reduction, or reduction mammoplasty, is a surgical procedure which involves the reduction in the size of breasts by excising fat, skin, and glandular tissue; it may also involve a procedure to counteract drooping of the breasts. As with breast augmentation, this procedure is performed most often on women, but may also be performed on men afflicted by gynecomastia.

Contents

Candidates 
Techniques 
Procedure 
Cancer -Prevention 
Risks 

Candidates

Breast reduction surgery is oriented toward women with large, pendulous breasts, since the weight of their breasts may cause neck, back, shoulder, circulation, or breathing problems. The weight may also cause discomfort as a result of brassiere straps abrading or irritating the skin. Even if physical discomfort is not a problem, some women feel awkward with the enormity of their breasts in proportion to the rest of their relatively smaller bodies. Reduction mammoplasty affords the recipient smaller, lighter, and firmer breasts. The surgeon may also reduce the size of and change the shape of the areola or nipples.

Except in unusual cases, this procedure is performed on individuals with fully-developed breasts. It is not recommended for women who desire to breastfeed, as it can impair the likelihood of breastfeeding success and significantly decrease the volume of breast milk produced because of the surgical disruption to the lactiferous duct system within the breast. However, a number of studies have demonstrated a similar ability to breast feed when breast reduction patients are compared to control groups.

Techniques

The two most popular techniques in North America are the inferior pedicle and vertical scar techniques. Both of which are more likely to leave both nipple sensitivity and capability to lactate for the patient as compared to other techniques of the past. It is now being studied and debated as to which of the two techniques results in a better quality of life for the patient in the long run.

The inferior pedicle technique, sometimes also known as a keyhole or Weiss pattern reduction, involves an anchor-shaped incision which circles the areola. The incision extends downward, following the natural curve of the breast. Excess glandular tissue, fat, and skin is removed. Next, the nipple and areola are moved into their new higher position. A drawback of this technique is sometimes "square" looking breasts, but this is a common option for women with the largest, droopiest breasts.

The vertical scar technique, however, is now widely gaining popularity due its minimal scarring and round shape post-surgery. To perform this, a doctor performs what is also known as a "lolipop incision" to the breast, resulting in the least amount of scarring. There are no horizontal incisions, and the scars are less likely to broaden with time, as with the Anchor-shaped technique. This technique keeps its results the best in the long term.

The free nipple graft technique, a less common procedure, is now typically used only in the most extreme cases of drooping. In this procedure, the areola and nipple are completely removed for relocation and replaced as a skin graft higher on the breast. In these cases, sensation from the areola area will be lost and it is most likely to impair lactation as compared to the two most popular procedures, although some women have been known to successfully produce some amounts of milk.

Procedure

Doctors almost always perform breast reductions while the patient is under general anesthesia. During pre-operative visits, the doctor and patient may decide on new (usually higher) positions for the areolas and nipples.

Patients may take a few weeks for initial recovery, however it may take from six months to a year for the body to completely adjust to the new breast size. Some women may experience discomfort during their initial menstruation following the surgery due to the breasts swelling.

Cancer - Prevention

Although not advocated as a cancer risk reducing procedure, a woman's risk of subsequently developing breast cancer will be reduced proportionately to the amount of breast tissue left. It is recommended that patients receive new baseline mammograms 6-8 months after breast reduction to accommodate expected radiographic changes and give a new basis to which future imaging studies can be compared.

Risks

Scarring from this procedure may be extensive and permanent. Initially, the scars are lumpy and red, but gradually subside into their final smaller sizes as thin lines. Though permanent, the surgeon can generally make the scars inconspicuous to the point that even low-cut tops may be worn without visible scars. Other common problems include: asymmetry, delayed wound healing, altered nipple sensation, fluid retention in the breast, altered erogenous function, and late changes in shape and recurrent ptosis (drooping.)