Breast Reduction

Reduction mammoplasty (also breast reduction and reduction mammaplasty) is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the woman's body, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold — physical, aesthetic, and psychological — the restoration of the bust, of the woman's self-image, and of her mental health.

While most women considering cosmetic breast surgery wish their breasts were larger than they naturally are, many women will attest that extremely large breasts can be too much of a good thing. Breasts that are too large for a woman’s frame can lead to back and neck pain, breathing problems, stooped shoulders, and stretched skin. Even in the absence of these complications, some women consider their breasts too large in proportion to their frames to be considered aesthetically pleasing. Given the cosmetic and potentially serious medical considerations, breast reduction surgery is often a wise course of action. In this procedure, incisions are made as inconspicuously as possible and then excess fat and mammary gland tissue are removed. The skin is tightened and sutured back together to give the patient a firmer, more shapely bust.

About The Procedure

Breast Reduction

Reduction mammoplasty, either surgery or lipectomy, proportionately re-sizes the enlarged, sagging breasts of a woman afflicted either with macromastia (>500 gm increase per breast) or with gigantomastia (>1,000 gm increase per breast). Breast reduction surgery has two technical aspects:

(i) The skin-incision pattern and the skin- and glandular-tissue excision technique applied for access to and removal of breast parenchyma tissue. The incision pattern and the area of skin-envelope tissue to be removed determine the locales and the lengths of the surgical scars;

(ii) The final shape and contour of the reduced breast are determined by the area of the tissues remaining in the breast, and that the skin- and glandular-tissue pedicle has a proper supply of nerves and blood vessels (arterial and venous) that ensure its tissue viability.

Surgical Techniques

  • Lejour technique breast reduction :- The treatment of macromastia and gigantomastia with the Lejour technique applies a vertical-incision, a superior pedicle, breast liposuction, and wide undermining of the skin of the lower portion of the breast. The technical efficacy of the Lejour breast reduction was established with the study Vertical Mammaplasty and Liposuction of the Breast (1994), which reported 153 reduction mammoplasties performed in 79 patients, wherein an average fat volume of 300 ml was removed from each breast, and the average resection of 480 gm of parenchymal tissue was removed from each breast.
  • Pre-operative matters:- The medical treatment records for the reduction mammoplasty are established with pre-operative, multi-perspective photographs of the oversized breasts, the sternal-notch–to-nipple distances, and the nipple-to–inframammary-fold distances. The woman is instructed about the purposes of the breast reduction surgery, the achievable corrections, the expected final size, shape, and contour of the reduced breasts, the expected final appearance of the breast reduction scars; possible changes in the sensation of the nipple-areola complex (NAC), possible changes in her breast-feeding capability, and possible medical complications. The woman also is instructed about post-operative matters such as convalescence and the proper care of the surgical wounds to the breasts.
  • Incision-plan delineation:- To the breasts of the standing patient, the plastic surgeon delineates the mosque dome skin-incision-plan, and the area representing the superior pedicle (composed of skin and glandular tissues), the breast midline, the inframammary fold (IMF), and the vertical axis of the breast, beneath the IMF. The upper-edge of the (future) nipple-areola complex (NAC) is marked slightly below the IMF-level, and a semicircle of 16-cm maximum diameter. In relation to the vertical axis, the mosque dome incision plan displaces the breast to the middle and to the side; the peripheral limbs of the incision plan are marked so that they approximate (join) at no less than 5-cm above the inframammary fold. The circumference of the (future) nipple-areola complex is delineated around the nipple, and a superior pedicle (10-cm wide minimum) is delineated at the upper-border of the future NAC circumference; the incision-plan delineation continues down as a cone, and around the marked circumference.
  • Operative technique:- The patient is laid supine upon the operating table so that the surgeon can later raise her to a sitting position that will allow visual comparison of the drape of the breasts, and an accurate assessment of the post-operative symmetry of the reduced and lifted bust. Afterwards, the pedicle epidermis surrounding the NAC (nipple-areola complex) is cut, and adipose tissue is liposuctioned from the breast. The medial, lower, and lateral segments of the breast are resected (cut and removed), by undermining the skin below the lower curved line. Then, the nipple-areola complex is transposed higher upon the breast hemisphere. The pillars of parenchymal tissue are approximated (joined), and the skin envelope is sutured.

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