Breast Reduction

In breast reduction, the size of the breast is reduced. Candidates for the reduction may include men as well as women. The process is also known as reduction mammoplasty. Men who have gynecomastia and women who do not breast feed, but have much of breast tissue may experience overly large breasts, giving them a sense of disproportion. Breast reduction alleviates breathing trouble and backache.

Who is a good candidate for a breast reduction?

Exceptionally large breasts can cause more than just feelings of embarrassment for some women, they can cause physical discomfort and medical problems as well. Breast reduction removes fat, tissue, and skin from the breasts, making them proportionate with the rest of the body. The goal of breast reduction is to make the breasts smaller, lighter, and more firm. Breast reduction can also reduce the size of the areola (the dark-pigmented region surrounding the nipple). In many cases, this procedure is covered by insurance depending on the patient’s symptoms and an estimated size of reduction. many patients experience significant medical difficulties from their larger breasts including back pain, neck pain, chronic headaches, bra strap related complications, and chronic irritation of the skin underlying the breasts. In these patients a breast reduction can dramatically improve their quality of life.

 

 

Vertical incision vs Classic “anchor” approach:

Breast Reduction

There are a large number of techniques that are utilized in breast reduction. The classical approach which is still used by many plastic surgeons involves a classic “Anchor incision.” A more modern approach championed By many of the world’s top breast surgeons is the vertical incision mammoplasty, or vertical incision breast reduction. These two procedures are outlined below.

Classic approach:

The classic approach involves a circular incision around the areola, followed by a vertical incision down to the point where the breast meets the chest wall, and then finishes with an incision extending across the base of the breast horizontally. This approach allows the reduction of the breast tissue as well as skin, and at the end of the procedure at the breast appears fairly similar to its postoperative outcome. There is some flattening of the inferior portion of the breast which tends to improve with time. The advantage of this procedure is that the breasts appear more like their final postoperative state in the immediate postoperative recovery period. The disadvantage is that there is a large horizontal scar at the base of the breast, and there is also a tendency for this particular procedure to weaken more quickly and allow the breasts to sag after the surgery. In addition the intersection of the two incisions is a notorious weak point, and is prone to wound separation. However, there are certain women to which this procedure is more aptly suited.

Vertical incision:

The vertical incision breast reduction involves the same circular incision around the areola, followed by the vertical incision, but no horizontal incision. Through these incisions the same skin reduction in breast reduction can be accomplished, but with significantly less external scar. The advantage is the obvious decrease in external scarring, but perhaps more importantly is the natural curve of the base of the breast which is afforded through this technique. initially the breast is positioned very high on the chest wall with the knowledge that in the near future the breast tissue will settle out into a normal feminine curve of the base of the breast. The disadvantage of this incision is that immediately after the surgery the breast appears to be more high on the chest wall than is desirable. The breast typically assumes a more natural position within a week to 10 days. The advantages of the surgery far outweigh the disadvantages, and this is the principal procedure that Dr. Smith performs.

What do the procedures generally entail for a breast reduction?

Breast Reduction Procedures

Breast reduction is performed as an inpatient or outpatient surgery under general anesthesia. Typically the length of the surgery is two to four hours. The breast reduction begins with an incision around the areola that extends below the natural curve of the breast. Excess skin, fat, and glandular tissue are removed through this incision. The nipple and areola are then placed in their new position. The remaining skin is tightened to form the new shape of the breast. The incisions are closed with all absorbable sutures, and no drains are used. A fluffy dressing then cushions the breasts and a very lightweight wrap is placed around the patient. The patient then recovers and may stay for the night or go home depending on the particular needs of that patient.

 

How is the recovery after a breast reduction?

Approximately 50% of the patients go home the same day and 50% of the patients stay one night in the hospital. This is dependent on the patient’s individual care plan. We ask that our patients leave the dressings in place and they follow-up in the next several days in the office. There is a small amount of discomfort for the first 48 to 96 hours, but this is easily controlled with pain medication. Most women however state that the discomfort from the surgery is insignificant compared with the decrease in pain that they feel from having less weight on their chest wall. We typically send the patient home with a five day course of antibiotics. The sutures dissolve on their own, and the only wound care is to replace the small band aides when they fall off. There is typically a modicum of bruising at the operative site which begins to resolve after 48 hours. The patient may shower after the dressing is removed (typically in 48 hours), and they resume normal activity slowly after one week as their clinical course dictates. Dr. Smith asks that patients not use a underwire bra or any other supportive bra that places an excessive amount of pressure on the underside of the breast for approximately 6 weeks after the surgery.

What are the typical results from a breast reduction?

Women asked about breast reductions are universally emphatic about how pleased they are with the surgery. The results are immediately apparent, and the patients who received the surgery are extremely happy with the results in the vast majority of cases. After the swelling subsides from the initial surgery and the breast tissue has settled into it’s normal anatomical, feminine position, a woman can begin to have her breasts resized for bra fitting. The results of the surgery are very durable on the order of many years, but we have still not stopped the process of time and gravity. Eventually the breasts may sag, but the breast tissue should not increase over time. Sometimes in the distant future this would require a second surgery to lift the breasts after the initial surgical procedure. Obviously however, this is a significantly less invasive and time-consuming operation than the initial. Almost all women who had the surgery state that they would definitely have it again if they were in the same circumstances.