Breast Reduction Also Known as Reduction mammoplasty
Breast reduction surgery is technically called reduction mammoplasty. This is the surgical correction of ptosis via the excision of fat, skin, implants and glandular tissues. It differs from mastopexy in that more than just excess skin is removed.
What are the indications for reduction mammoplasty?
Excessively large breasts may cause a woman head, neck, shoulder and back pain, significantly affecting her quality of life and negatively influencing her body image within her own mind. Gigantomastia (excessive and sudden grown of the mammary glands) can also be an indication for breast reduction surgery. If you are unhappy with the size of your breasts, find that they are too large, get in the way or cause you pain, you may be a candidate for breast reduction surgery.
What is the usual procedure for breast reduction surgery?
Usually, reduction mammoplasty if performed on a patient whilst they are under general anesthesia. Before surgery, usually during an office consultation, the surgeon and the woman having the surgery decide upon which technique will be used and the re-positioning of the nipple-areola complex (NAC).
Breast reduction techniques:
- Inferior pedicle technique - This technique involves and anchor-shaped incision that extends up and around the areola. The technique is often called a keyhole, inverted-T or "Wise Pattern" reduction. During this procedure, excess glandular tissue, fat and skin is removed. The nipple and areola are then moved into a higher position on the breast. Inferior pedicle procedure sometimes produces "square" looking breasts but is the most commonly favored technique in the United States. It is also the most commonly performed option for women with the largest, droopiest breasts. The inferior pedicle technique is largely favored due to its predictable and reliable results.
- Vertical scare technique - These techniques involve less scarring and may or may not involve a horizontal scar. Usually, however, they can be done without a horizontal incision and involve the use of superior, inferior, medial or laterally based pedicles to the NAC. Vertical scar technique is better suited for smaller reductions with les excess skin as it limits the scar length. This technique does have the advantages of increased projections, shorter scar length and quicker surgery times. Vertical techniques also tend to have the best long term results, being reduced through the removal of the lateral and inferior tissues, leaving the upper poles mostly untouched.
- Horizontal scar technique - These involve the use of a scar along the inframammary fold and a round cutout for the NAC (no vertical incision between the two). Horizontal techniques provide a shorter scar option in women who are too large for vertical scar techniques. Advantages for the technique include the absence of a visible scar on the meridian of the breast and better scar results of the NAC inset. Boxy shaped breasts are more likely with this technique than with the vertical techniques and the IMF scarring may be more extensive.
- Liposuction-only technique - Liposuction is rarely used alone as a reduction mammoplasty technique, though occasionally, it's an appropriate approach to breast reduction surgery. It's appropriate for use in women whose breasts aren’t as large as with the other procedures and who may have anesthesia risks for longer procedures. The best candidates for this procedure have little ptosis, good skin and breasts that are made up of a higher concentration of adipose (fatty) tissue than glandular tissue. The results of this technique do not tend to be drastic; however it involves less healing time and very little scarring.
- Free nipple graft technique - A technique that is primarily used for patients at high risk for ischemia to the NAC, this involves the complete removal of the nipple and areola which are then replaced further up the breast as a skin graft. This procedure does not preserve areola or nipple sensation and it destroys the ability to breastfeed therefore, it’s wise to leave this procedure, if possible, until there are no plans for pregnancy or breastfeeding.
What risks are involved with breast reduction?
Apart from the risks associated with all surgeries, reduction mammoplasty also includes a few others. While most techniques seek to preserve functionality for breastfeeding and sensitivity in the areola and nipple, scarring, asymmetry, delayed wound healing, fluid retention (seroma), diminished erogenous response, change to the shape and contour of the breast and the recurrence of ptosis are all possible negative outcomes of surgery. Most of the risks are rare occurrences but it’s good to be informed of all possible risks before making a decision to undergo reduction mammoplasty.
What about cancer prevention or dangers?
Many people have heard the rumors that breast reduction surgery can either make it harder to detect breast cancer or that it reduces the possibility of breast cancer. Neither rumor is entirely accurate. The concerns for detection have more to do with scar tissue occurrence and difficulty seeing results on a mammogram. Reduction mammoplasty absolutely will not increase your chances of developing breast cancer and a baseline mammogram about 6mo after surgery will eliminate most concerns about mammogram results. As far as reducing the possibility of developing cancer, there is no real basis for this assumption other than the fact that it’s not possible to develop cancer in tissue you no longer have. So while the removed tissue is no longer at risk of developing cancer, the remaining tissue is at no more or less risk of cancer development.