Breast
reduction surgery or breast reduction mammoplasty
is a fairly common
procedure which involves the reduction in the size of breasts by
excising fat, skin, possible breast implants and glandular tissue. It
might also involve a procedure to prevent drooping of the breasts. As
with breast augmentation, this procedure is typically performed on
women, but might also be performed on men
afflicted by gynecomastia.
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Breast reduction
surgery is normally performed on women with large, pendulous
breasts, especially gigantomastia, as often the weight of the breasts
might cause chronic pain of the head, neck, back, and shoulders,
circulation and/or breathing problems. The weight can also cause
discomfort as a result of bra straps rubbing the skin. Due to this, the
surgery could be available on the nhs
. Even if physical discomfort isn't a problem, some women feel awkward
with the enormity of their breasts in proportion to the rest of their
bodies. Except in unusual cases, this procedure is performed on
individuals with fully developed breasts, and isn't normally suitable
for women that wish to breast feed.
Males with gynecomastia
might be embarrassed and unhappy with their condition. The surgical
methods employed might vary depending on whether the breasts in the
male patient are caused by adipose-fatty or glandular tissue, and the
degree to which any glandular tissue extends laterally along the sides
of the torso.
Surgeons
almost always perform breast reductions while the patient is under
general anesthetic. During pre-operative visits, the doctor and patient
might decide on new, usually higher, positions for the areolas and
nipples.
For males, excess tissue might easily be removed through a tiny
incision in each breast. This usually results in minimal scar tissue.
Patients might take a few weeks for initial recovery, however it might
take from six months to a year for the body to fully adjust to new
breast size. Some women will have some discomfort in their first
menstruation following the surgery due to swelling of the
breasts.
This traditional technique
bases the blood supply to the nipple and areola complex (NAC) from a
central and inferiorly based attachment to the chest wall ( "inferior
pedicle" or "central mound" technique), with variations of orientations
of such pedicles described.Better understanding of anatomy in terms of
innervation to the NAC has made it more likely to leave both nipple
sensitivity and capability to lactate for the patient in comparison to
other techniques of the past. It is now being studied and debated as to
which of the techniques results in a better quality of life for the
patient in the long run. Liposuction has been used as an adjunct to
other breast reduction procedures for quite some time, but liposuction
only techniques are not widely performed. All of the breast reduction
techniques produce some degree of breast lift, but have a tendency to
settle and stretch out the inferior skin envelope eventually.
Inferior pedicle technique or keyhole
breast reduction
The inferior pedicle
technique, sometimes also known as the keyhole breast lift, inverted-T,
or Wise pattern reduction, involves an anchor shaped incision around
the areola. The incision extends downward, following the natural curve
of the breast. Excess glandular tissue, fat, and skin is removed. Then,
both the nipple and areola are moved into a new higher position. A
drawback with this technique is sometimes "squarer" looking breasts,
however this is a popular option for women with the largest, most
droopy breasts. Inferior pedicle techniques can also be performed
through shorter scar incisions in some patients.
Vertical scar technique
These breast
reduction techniques are gaining popularity due to their
shorter scarring and projecting shape post-surgery. These procedures
can involve the use of superior, medial,
inferior or laterally based
pedicles to the NAC. As compared to traditional incisions, they might
have a limited or absent horizontal component. These procedures are
best suited to smaller reductions with less excess skin to limit the
scar length. Advantages include increased projection by the gathering
of tissue medially, shorter scar length, and quicker surgery times.
This technique keeps its results the best in the long ter. The breast
is reduced through removal of the lateral and inferior tissues, leaving
the upper pole mostly untouched.
Horizontal
scar technique
Horizontal scar techniques
involve the use of a scar along the inframammary fold
and a round cutout for the NAC. These procedures usually require a
inferior or inferior lateral pedical like traditional Wise pattern
surgeries but eschew the vertical wedge excision. They permit a shorter
scar option in women who are too large for vertical scar techniques.
Advantages include the absence of a scar on the visible meridian of the
breast and better scarring of the NAC inset. Disadvantages are the
potential for boxy shaped breasts and poorer scarring that can be
produced along the IMF.
The liposuction-only
technique does not have as noticeable outcome, but will usually leave
minimal scarring.
Liposuction only technique
The liposuction
only technique is used for women with breasts that are not quite as
large as with the other procedures or in patients who are anesthesia
risks for longer procedures. For the best outcomes, women who choose
this procedure have fatty, non-dense breast tissue with good skin and
not too great ptosis or droop. As not many women with larger breasts
have these characteristics, use of this technique can be limited. The
result is not as drastic as the other techniques, but it involves a
quicker healing time and relatively little scarring.This technique is
usually used in conjunction with some direct excision of dense tissue
for male gynecomastia surgery.
The Free nipple graft BREAST REDUCTION SURGERY technique
The free nipple graft
technique is used mostly for higher risk patients of ischemia to the
NAC to reduce the chance of sloughing it postoperatively. Typical
candidates would include diabetics, smokers, longer breasts approaching
20 cm from the IMF to the nipple, and breasts with significantly larger
than normal resection requirements. 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 also eliminates the ability for lactation. The
technique is sometimes used during surgery or postoperatively if the
NAC viability is questionable. By eliminating the requirement for a
pedical, this procedure allows larger amounts of tissue to be removed
safely.
Reduction mammoplasty gives the
patient smaller, lighter, and firmer breasts. The surgeon
might also alter the size and/or shape of the areola or nipples.
Patients often have restored confidence.
Possible problems after
surgery include difficulty breast feeding, scarring, asymmetry, delayed
wound healing, altered nipple sensation, fluid retention in the
breasts, changed erogenous function, and late changes in shape and
recurrent ptosis (drooping).
It might impair the
likelihood of breast feeding due to disruption of the lactiferous duct
system.
Scarring from this procedure
might be extensive and permanent. At first, the scars will be lumpy and
red, but they gradually subside into their final thin lines, possibly
lightly discolored. It is possible that the cosmetic surgeon will be
able to make the scars inconspicuous to the point that low-cut tops
might be worn without visible scars.
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BREAST REDUCTION SURGERY
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