BREAST REDUCTION (REDUCTION MAMMOPLASTY)
Breast reduction is indicated in patients who have excessively large and heavy breasts. In addition to the aesthetic issues of size and a saggy appearance, the weight of the breasts often causes symptoms of backache and shoulder pain.
A breast reduction is basically a breast lift with the additional step of removing excess breast tissue in order to reduce the size of the breasts. Overly large breasts invariably need a lift in addition to a reduction in size because the large breasts are heavy and gravity makes them sag. It is a bigger operation than a lift, but is still safely completed as a day surgery procedure without the need for hospitalization.
In common with a breast lift, a breast reduction involves reducing the size of the areola, relocating the nipple areolar complex to a higher position, and removing excess skin. In addition, excess glandular breast is removed so that the breasts will become lifted and reduced in size.
A breast reduction results in a smaller, youthful and pert breast. The scars associated with the procedure are similar to the scars of a breast lift, i.e. one that encircles the newly relocated areola, a vertical scar that runs from the lower margin of the areola down the middle of the breast, and which joins a horizontal scar along the crease at the bottom of the breast (the inframammary fold). The horizontal scar along the inframammary fold tends to be longer in the case of a breast reduction because of the need to remove more skin in that area. These scars tend to fade well and become inconspicuous with time. Most patients who undergo a breast reduction have a high level of satisfaction because in addition to their breasts looking better, they also feel better from the relief of having the weight of their breasts reduced. These benefits are therefore well worth the resulting scars.
This operation is carried out under general anesthesia as a day surgery procedure and takes four to five hours to complete. Incisions are made around the new location of the nipple areolar complex, extended downwards on each side of the areola and angled inwards until they meet close to the bottom of the breast. The skin and breast tissue below the areola and within these boundaries is removed. If necessary, further removal of breast tissue beyond the lateral boundaries is performed. The areola is reduced in size by excising a rim of excess areola and is then moved up to its new, higher location. The defect left from the skin and breast tissue removal below the areola is closed by bringing the wound edges together with strong sutures. Excess skin at the bottom of the breast is then excised. Bleeding is carefully controlled. A surgical drain is inserted into each breast. The skin wounds are meticulously closed with stitches.
Postoperative pain is minimal and easily controlled with oral pain medication. There is moderate swelling and bruising. The drains are usually removed after several days. The stitches are removed after two weeks. A supportive surgical bra is worn for the first one month to two months. Daily activities may be resumed after the first two days and exercise is allowed after one month to two months.
A breast reduction is generally a very safe procedure. Although blood loss is greater compared to a breast lift, it is still not significant or dangerous. The risk of infection is low. As with a breast lift, good planning and execution ensures that the blood supply of the nipple areolar complex is safely preserved, ensuring its viability and optimal wound healing. Nipple sensation is usually not compromised. The scars need at least one year to fade completely but with good scar management they tend to fade well and complications such as keloid scars are uncommon.