Breast Procedures | Breast Reduction







Reduction Mammaplasty

Breast Reduction


The breast reduction operation has aesthetic, physiological and psychological benefits.  In today's society, where women of all ages are more active, massive breast size can be a deterrent to exercise, posture and physical fitness.  The breast reduction operation reduces the volume of the breast, lifts the breast, and moves the nipple to an aesthetically more desirable position.  Most frequently the lollipop or vertical scar technique is used with moderate to large reductions avoiding the horizontal scar beneath the breast.  The traditional approach, using an anchor shaped incision which goes around the nipple straight down and then underneath the breast, is employed less frequently.  In most cases, the nipple is not detached, but simply moved up still attached to the ducts, blood supply, and nerve supply.  The nipple, rarely, needs to be removed and repositioned as a graft.  This may be necessary with extremely large breasts or for older patients with other medical problems.  More frequently, the scar is lollipop in shape, going around the nipple and straight down, avoiding the incision beneath the breast.  Nipple sensation is normally preserved but there is a 15% chance of nerve injury.  The ability to breast feed may be lost after large volume breast reduction.


The expected results and possible complications are detailed during the consultations.  In my experience, 85% of the scars are acceptable, which means they are visible, but accepted by the patients.  Approximately 5% of the scars would be considered perfect and approximately 10% of the post-surgical scars may require management.  This can include pressure dressing with silastic or silicone rubber, injections of steroids or revision of the scars themselves.


Another approach to breast reduction includes the round block technique of Bonelli, which uses an incision around the nipple.  This is utilized with small reductions and results in breasts which are slightly less perky and more globular.  Finally, for patients whose breast tissue is mainly fat and less glandular, liposuction alone through a small incision can provide the desired volume of reduction.  This is advantageous for young women whose breasts have a large fat component and who need only a small reduction of half a cup to a cup size.  No significant scarring and an early return to full activities are benefits of this approach.  Older patients with fatty breasts also find this procedure advantageous.


The benefits of liposuction as the sole procedure are that there is minimal scarring, less bruising, and a rapid return to activities.  The disadvantage is that in patients with combination of fatty and fibrocystic breasts, the cysts become more palpable and are more easily felt beneath the skin.  The breast lift operation (or mastopexy) is much less invasive and uses the same incisions, resulting in scars either simply around the nipple or the lollipo shaped or the anchor-shaped configuration.  Obviously, the volume of the breasts is unchanged in this procedure but the breast configuration is rejuvenated. 


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