Procedures - BREAST REDUCTION

Introduction:
Breast reduction, also called reduction mammoplasty, is designed to relieve the physical discomfort often associated with very large breasts and to enhance the overall appearance of the breasts. Women undergoing this procedure may experience significant improvement of symptoms including:

• Breast discomfort
• Neck ache
• Backache
• Shoulder pain
• Skin irritations underneath the breast fold
• Difficulty with ill-fitting clothes
• Indented bra-straps
• Discomfort during exercise

The Best Candidates For Breast Reduction:
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Candidates should be in good general health, non-obese and non-smokers. Breast reduction is not recommended for women who intend to breast-feed.

The Procedure:
During a breast reduction procedure, the surgeon removes excess breast tissue and skin, resulting in smaller, lighter and firmer breasts. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. Most breast reduction surgery begins with the nipple, which is lifted into a new position and kept alive on a pedicle (tube) of tissue. Excess skin and breast tissue is then removed, and the remaining breast tissue reshaped to create a smaller and more elevated breast. The methods of reduction and reshaping vary and depend upon the patient’s breast size, wishes and individual needs. While the principle of all breast reductions remains the same, different techniques do result in different types of scarring.

Traditional ‘Anchor’ Technique
The most common and traditional type of breast reduction uses an anchor-type incision, also known as an inverted-T. This technique results in an anchor-shaped scar, starting around the areola, travelling vertically down and then horizontally across the breast crease. After the excess breast tissue, fat and skin is removed, the nipple and areola are shifted to a higher position. The areola, which in large breasts has usually been stretched, is also reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm. Usually, the nipples and areolae remain attached to underlying mounds of tissue, and this allows for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed.

Circumvertical Technique
Another common type of reduction procedure is the circumvertical pattern breast reduction. With this technique, patients end up with a scar around the areola that travels vertically down, but with no scarring underneath the breast. This reduced scarring is a distinct advantage to this procedure; however, the vertical pattern is less effective for particularly large breasts. Furthermore, because there is no horizontal excision of skin under the breast, the skin around the vertical scar can appear gathered or puckered in the early days after the operation. The appearance of this puckering will improve as the incision heals and the breasts settle into their new position, however, the final result may not be visible for up to one year following the procedure.

Circumareolar Technique
In a circumareolar breast reduction the only scar is from a circular incision around the areola. This technique is suitable when only a small amount of tissue needs to be removed or when only one breast needs to be reduced to match the other breast, as in the case of breast asymmetry. Benefits:

• Breast reduction often makes a dramatic change in appearance as well as physical comfort.
• Many patients experience increased confidence and greater choice when selecting clothing, particularly swimwear and underwear.
• The level of patient satisfaction from breast reduction is among the highest of any plastic surgery procedure.
• Significant complications from breast reduction are infrequent.
• It is often possible to return to work within 10 days to two weeks, depending on the level of activity required in the patient’s job.
• Resumption of most normal activities, including some form of mild exercise, is often possible after several weeks. Return to full activities is usual after approximately 6 weeks.

Risks and Considerations:

• Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. The procedure usually takes between 2,5 and 4 hours and is performed under general anaesthesia.
• Every surgery carries some uncertainty and risk. Potential complications include reaction to anaesthesia, bleeding, infection and poor healing.
• Pregnancy and breast-feeding affects the size and shape of a woman’s breasts so it is recommended that patients undergoing a breast reduction procedure do so after completing their family.
• Patients may be instructed to wear a postoperative compression garment/support bra for a few weeks, until the swelling and discolouration of the breasts diminish.
• Diminished sensation in the nipple and areola areas usually is temporary; however, it may take weeks, months or even more than a year before sensation returns to normal. Permanent loss of sensation in the nipples or breasts may occur rarely.
• Incisions will initially be red or pink in colour, and will remain that way for a number of months following surgery before fading to white.
• Incision lines will be permanently visible, more so in certain individuals than others. The incisions for breast reduction are generally quite long but are in locations easily concealed by clothing.
• Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time, but patients should remember that natural breasts usually show some variation.
• Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body or tattooed.)
• Revisionary surgery is sometimes helpful in certain instances whereincisions may have healed poorly.