Breast reduction

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is a procedure to reduce the volume and bulk of the breast tissues as well as rearrange the overlying skin to create a "perkier" breast mound. It usually involves repositioning the nipple/areola in a better position on the breast mound. This web page also addresses suction only breast reduction which does not manipulate or sculpt the breast mound or reposition the nipple/areola on the existing breast mound. Breast reduction surgery can be performed by a variety of methods and there is no one method which is best for all patients. In most practices, the patient will make the decisions regarding breast reduction based upon their goals and expectations as well as their anatomy and tissue turgor. Like everything in life, there are advantages and disadvantages for each option and every patient has different opinions and desires, so you are encouraged to discuss the various options with your plastic surgeon at length to find out which option is best for you. Here are a few common options with advantages and disadvantages of each option. The is the most common type of breast reduction performed in our practice and involves a scar around the areola and in a vertical direction beneath the areola down to the crease under the breast.

This "lollipop" shaped scar allows exposure to the underlying breast gland to adequately shape and sculpt the breast mound. Additionally, closure of this vertical incision allows the breast "pillars" to be sutured together in the midline which creates additional projection and support to the breast mound independent of the overlying skin. The vertical breast reduction most commonly utilizes a superior or medial-based pedicle which means that the blood supply comes from the upper portion of the breast or from the portion closest to the sternum. The advantages to the vertical breast reduction include excellent breast shape, projection and long-term results. The disadvantages of the vertical breast reduction include significant breast projection (some people do not desire this) and the fact that the surgical result on the operating table does not look like the final result which will be seen in 3-4 months. Another potential disadvantage to the vertical mastopexy is the fact that skin is not removed in the horizontal plane and tightening of these tissues may take 4-6 months. The other advantage to the vertical mastopexy is that it avoids the transverse or "anchor" shaped scar. The is the traditional breast reduction performed most commonly 20 years ago and it is still popular in certain circumstances today. The "inverted T" or "anchor" shaped scar is utilized to cone the breast up into a conical shape and allows removal of excess skin in both a vertical and horizontal direction. The classic Wise pattern breast reduction utilizes an inferior-based pedicle which means that the blood supply comes from beneath the breast gland from the chest wall. This type of breast reduction is very advantageous in patients who had massive weight loss and have significant excess skin. A potential disadvantage of this procedure is that the skin will lose its elasticity over time and the breast mound tends to "bottom out". This type of breast reduction has a very pleasing shape on the operating table and allows plastic surgeons to sculpt the breast mound and achieve a very nice shape. Both the vertical and Wise pattern breast reduction procedures involve separating the skin envelope from the underlying breast gland and then sculpting and repositioning the underlying breast gland separate from the skin envelope. Once the excess breast tissue is removed and the breast gland is shaped, the skin is closed over the newly sculpted breast mound to create the final shape.

Because of the extensive undermining of tissues with both of these procedures the blood supply of the skin flaps as well as the nipple/areola can be compromised. For this reason, these procedures are not performed in smokers. There are probably several dozen modifications of the above mentioned breast reduction techniques and these oftentimes carry specific names or acronyms. Some of the modifications include variations of the incision and may have an incision or a incision. Other modifications may involve the blood supply to the nipple and areola referred to as the pedicle. The pedicle is the mass of breast tissue which is not removed and left behind to constitute the remaining breast mound and is left attached to the chest wall. This mass of breast tissue contains the blood supply, nerve supply and the nipple and areola complex. The pedicle can be left attached to the chest wall from above (superior), below (inferior), from the armpit side (lateral) or the sternum

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side (medial). There are advantages and disadvantages to each of these pedicles and variations amongst the pedicles and incision types create the multitude of different breast reduction techniques that plastic surgeons perform. It is important for you to discuss what options may be most beneficial to you with your plastic surgeon based upon your anatomy as well as your goals and expectations.

Another type of breast reduction is . This type of breast reduction involves several small puncture sites but no other lengthy incisions. Through these small puncture sites the breast and fatty tissues of the breast are suctioned and removed. A significant volume of breast gland is comprised of fatty tissue and a large proportion of this can be removed in this manner. Because there are no skin incisions, this type of surgery does not involve surgical skin tightening and does not allow for precise control of the shape and form of the breast. Oftentimes, there is significant skin retraction following this type of surgery but this is not always predictable and is solely up to "mother nature". The amount of skin retraction is usually insufficient to create a pleasing breast mound shape. This type of breast reduction works best in patients who have an excellent breast shape already and desire a very small amount of volume reduction such as removal of a small amount of additional volume following previous breast reduction. This type of reduction also is acceptable for patients who simply want relief of their symptoms and do not care about the appearance of the breasts following breast reduction. The biggest advantage of this type of procedure is the lack of large scars in the relatively short recovery from several small puncture-type incisions.

The plastic surgeon will perform specific measurements using the notch at the apex of the patient's sternum as a fixed reference point to determine the amount of breast tissue, amount of breast skin, laxity of skin and sagginess (or ptosis) of the breasts. The ideal candidate for breast reduction surgery is a patient who has excess breast tissue, ptosis or droopiness of their breasts and desires a "perkier" breast mound with an improved shape. Oftentimes, patients may come into the office requesting breast reduction surgery when in reality a major component of their breast appearance is droopiness or ptosis and they really don't desire smaller breasts. These patients would benefit from a breast lift or mastopexy procedure. The scars for a breast reduction surgery can be a considerable deterrent for patients who want to improve the plastic appearance of their breasts and allowing considerable time for discussion with your surgeon is extremely important. This is one reason you should never rush into surgery without meeting with your plastic surgeon several times before your surgery. Discussing how a misshapen breast is not aesthetically pleasing even if there are minimal scars and the trade off of an aesthetically pleasing shape to the breast with scars is still a difficult decision for some patients.

The immediate recovery will depend upon what type of anesthesia is employed for the surgery. A total intravenous anesthesia (TIVA) technique which wears off relatively quickly has minimal side effects such as nausea. Various anesthetic agents affect patients differently and will dictate the patient's recovery. The other main determinant of recovery from breast reduction surgery is a surgical drain that most likely will be placed at the time of surgery. Most plastic surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in 3-4 hours and most patients will experience mild to moderate discomfort at this stage. Surprisingly, most patients state that the pain from breast reduction surgery is not as much is the anticipated. Most patients will have discomfort with raising their arms overhead for 3-4 weeks. There are no specific restrictions following breast reduction surgery aside from no soaking for a week. Patients may shower the following day; but no Jacuzzi, swimming or soaking in the tub for a week. Most plastic surgeons want to see their patients back in the office 5-7 days after their surgery to remove the drains which are placed at the time of surgery. For most plastic surgeons, there are no sutures to remove. It is most common to use absorbable sutures which melt on their own within a few months and the outer skin is often times sealed with skin glue which flakes off in a few weeks. One of the potential risks of surgery is infection and this usually manifests itself around 5-7 days after surgery and is usually effectively treated with oral antibiotics. Other risks of breast reduction include anesthesia problems or adverse reactions, scars, bleeding, hematoma (blood collection), delayed wound healing, contour irregularities and recurrent ptosis (drooping). Your plastic surgeon will go over all of the potential risks and complications with you prior to surgery so that you can make an informed decision regarding the risk to benefit ratio for their proposed surgery. The actual “full� recovery period from breast reduction is at least a year and this involves a gradual softening and settling of the tissues its natural position. A significant amount of the recovery occurs within 2-3 months but it will take the external scar a year to soften/mature and the internal tissues undergo similar softening. Immediately following breast reduction especially following vertical type breast reduction, the breast will have a very protuberant appearance with a very rounded upper pole.

Over the course of a year, this appearance will soften and the upper pole of the breast will develop a more natural slope with the breast mound assuming a more natural appearance as well. Other long term potential complications are related to each patient's own tissues and the loss of elasticity in those tissues. The amount of sagging which can occur in these tissues is mostly dependent on that particular patient's genetic makeup. You may also be interested in the following procedures Breast Augmentation, Liposuction or Tummy Tuck.