Reduction Mammoplasty

Large, pendulous breasts are often unattractive because gravity causes them to lose their shape and the nipples are lowered. It is also difficult to find clothes and bras that fit and to enjoy physical activity. Beyond these physical problems, psychological stress may be there, due to the attention large breasts attract.

The Procedure
A variety of techniques are available to reduce breast size. The

Specific technique varies from surgeon to surgeon and depends on breast size and shape, the patient’s age and associated medical problems, and the results desired. The essential steps are as follows:

• A keyhole incision is made around the nipple and down to the inframammary fold. With most techniques the incision extends along the inframammary fold to leave an inverted " T " shaped scar pattern. The nipple areolar complex and its underlying breast tissue with the accompanying blood supply and nerves are preserved in order to maintain sensation and circulation to the nipple.
  
  
• Excess breast tissue and skin within the incision is then removed and in some cases fat is sucked out using a liposuction technique. The nipple areolar complex is raised to the planned height, and the incisions are closed.
  
  
• Drainage tubes are usually inserted into both breasts. This enables any accumulated fluid or blood to drain into the bag. The drainage tubes are removed and the dressings changed 48 hours after surgery. Normally, the incisions heal within two weeks, and no further dressings are necessary. Women who smoke, however, tend top heal more slowly, particularly at the juncture of the inverted "T". This is due to the constriction of the small blood vessels within the skin caused by the nicotine, as well as a reduced blood supply caused by the incision and the tension exerted upon the breast skin at the point of closure. Women are cautioned not to smoke for ideally 5 months but minimally 2 days prior to surgery and a week or two following surgery.

Anesthesia:
All cases of Breast reductions are performed under general anesthesia and are to be hospitalised for 2-3 nights.

Possible Complications
The following are the potential problems that, may occur after breast reduction.

• Scarring: Troublesome scars are not very common and can very with the race and the color of the skin. They can be cosmetically improved by injecting cortisone into the scar to flatten it, using the vascular lasers to remove residual redness, the pigment removal lasers to treat hyper-pigmentation and the carbon-dioxide laser to resurface uneven lumps and bumps. If the scar is dramatically white or the nipple has abnormal appearance color can be implanted into the tissue using medical tattooing techniques.
  
  
• Hematoma: A hematoma is a collection of blood. A sudden increase in swelling, pain, and tightness in one or both breasts is an indication that there is hematoma within the breast. The drainage tubes put in place after surgery remove small amounts of blood and serum but do not prevent hematomas; they must be surgically drained. It is important to realize that hematomas are a potential complication of most types of surgery and are not a reflection of the quality of the surgery. Rather, the early recognition and appropriate treatment of the hematoma is an indication of a surgeon’s skill.
  
  
• Nipple Complication : Loss of sensation in the nipple is rare and unpredictable. Women with large breasts often have poor sensation in the nipple area than do women with smaller breasts. Therefore, the potential sensory loss in women requesting a reduction mammoplasty does not seem to be as critical as for women requesting breast augmentation.
  
  The inability to breast-feed is a potential problem as well, and occurs in approximately 50% of cases. There is also a risk, although rare, that the nipple and areolar complex will die due to insufficient blood adjacent breast tissue. This occurs more often in older women, smokers, and women who have diseases such as diabetes or high blood pressure than in other people. This condition is usually recognized at the time of surgery because the nipple and areolar complex turns white or dark blue indicating circulation problems. When this occurs during the operation, the nipple and areolar complex is usually removed and placed on as a graft. If the problem arises after surgery is complete, the nipple and areolar complex, along with the underlying tissue, will die, and the healing process will be prolonged. Over a period of 3 months the dead tissue is removed by the surgeon, while the breast slowly heals. When the site has completely healed, a nipple reconstruction may be considered. Permanent coloration (medical tattooing) of the areola can be helpful in creating a natural appearance of the nipple, in these cases.
  
  
• Fat Necrosis: An area of fat that has died as a result of poor blood supply is called fat necrosis. It is characterized by a firm, hard lump in the breast and often some redness of the overlying skin. The body temperature usually increases for a few days mimicking an infection. If the necrosis is small, it usually resolves spontaneously over a period of weeks. If the affected area is larger it may require surgical removal of the dead fat, which could result in size asymmetry when healing is complete.
  
  
• Infection: Infection rarely occurs in breast reductions and, therefore, antibiotics are not usually prescribed as a precautionary measure after surgery.
  
  

FAQs:

• Will there be a scar?
  
  Any surgical procedure that involves the cutting of tissue leaves a scar. The way the incision heals and the scar forms is genetically determined. Therefore, some women end up with fine, barely visible white lines, whereas others have more obvious scars. Normally, however, the scars fade to white lines which look similar to stretch marks within 12 to 18 months.
  
  
• Does it hurt?
  Breasts do not have many nerves, so most discomfort is experienced at the incisions. Moderate discomfort for the first few days after surgery is normal, and painkillers are provided. The discomfort gradually subsides as bruising and swelling decrease.
  
  
• How soon after surgery can normal activity be resumed?
  A normal level of activity can be resumed within one week, depending on the discomfort. Normally, a return to work is possible after 1 to 2 weeks. Heavy lifting or any activity that causes discomfort should be avoided for 6 weeks. As the discomfort subsides, the level of activity may be increased.
  
  
• At what age should a breast reduction be performed?
  Breast reduction can be performed in girls as young as 12 (who may have a condition known as massive gigantomastia). Women in their sixties and seventies also are candidates.
  
  
• What about breast cancer or fibrocystic disease?
  The risk of developing breast cancer is the same after a breast reduction as before the surgery. But breast reduction surgery changes the appearance of the breast on mammography. Therefore, if the fibrocystic disease is being followed by serial mammography, a repeat mammogram will be required 6 months after a reduction to establish a new baseline.
  
  
• Will breast reduction get rid of stretch marks?
  Stretch marks on the skin that was surgically removed will be gone. The remaining stretch marks are flattened out because the skin over the breasts has been tightened. This makes them less obvious but does not eliminate them.
  
  
• Will the breasts become smaller with weight loss?
  If breast of normal size become quire large with weight gain, weight loss significantly reduces their volume. As a general rule, though most women with marked breast enlargement due to weight gain report that their breasts were always large even when they were slim, yet weight reduction has a minimal effect on the overall breast size.