Breast reduction, also known as reduction mammoplasty, is a surgical procedure employed to remove excess fat, tissue and skin from the breasts. It is indicated to reduce the size and volume of large, heavy and drooping breasts for those suffering from the pain and discomfort of heavy breasts. It is also done to correct breasts that are of two different sizes. Bilateral breast reduction refers to the reduction of both breasts, while unilateral breast reduction refers to the reduction of only one breast.
Men can also have breast reduction, and while they do not typically suffer from the pain and discomfort associated with the need for breast reduction in women, they do suffer from the visual appearance and embarrassment of this condition. One in three men suffer from gynecomastia, which is most often caused by a subtle imbalance of hormone metabolism.
This is the most common method of breast reduction. The pedicle method refers to the location of the blood and nerve supply - not where the incisions are placed.
Types of pedicle:
- Inferior pedicle- the blood and nerve supply from the bottom of the breast.
- Superior pedicle - from the top of the breast.
- Central pedicle - from the center of the breast.
- Lateral pedicle - from the side of the breast.
- Bi-pedicle - from two locations, mainly used in cancer surgery.
In the pedicle methods of breast reduction, nipple-areola sensation and milk production are typically preserved. In the case of very large breasts, however, women are sometimes faced with the Free Nipple Graft procedure (FNG). The pedicle, along with its blood and nerve supply, must be severed, and the nipple-areola complex is detached and grafted back on after the reduction is completed. Function and sensation are lost with this method.
Skin incision types include:
- Vertical scar: This is a breast reduction procedure where your surgeon makes an incision around your areola and vertically down to the crease, in the shape of a lollipop. This is indicated in those who require only moderate reduction in size. It results in less scarring than the traditional technique (that requires an additional incision along the breast crease) and fewer complications. However, the technique may not be suitable for larger breasts as it does not allow removal of large amounts of tissue and skin, and may leave a small fold of skin at the bottom of the vertical scar.
- Wise Pattern Scar (Anchor Incision Pattern): This is the most common incision pattern for breast reduction done today. The incision allows more skin to be used and more tissue to be removed. It is the incision of choice for large breast reductions or very floppy breasts.
Benelli technique: This refers to both the incision and reduction type. For this surgery, your doctor makes an incision around the outer margin of the areola and another incision in the breast skin surrounding the first incision. The second incision may be symmetrical to the first or wider on top to allow more skin to be removed from the upper breast. The advantage of the Benelli technique is that it results in minor scarring. The resultant scar is only around the areola. This technique can only be used for specific cases such as small breast reductions which do not require much skin removal.
Your surgeon will mark the incision lines and other relevant measurements on your breasts. When you lie down, the landmarks change as the breast assumes a different shape to what is observed when you are standing. The diagram demonstrates the "landmarks" your surgeon will use to achieve the result. Your surgeon measures the height of the nipple and estimates the volume of breast to be removed.
Breast reduction surgery is performed under general anesthesia. The incision is made
and excess breast tissue is removed from the inner and outer areas of the breast. Skin edges will be approximated after the excess breast tissue is removed and the nipple is elevated into a new position.
At the end of the operation, a firm dressing or brassiere is placed around your chest. Drainage tubes may be placed to drain any blood that may accumulate, and are removed within 2-3 days of the surgery.
As with any surgery, breast reduction may involve certain risks and potential complications such as infection, scarring, breast asymmetry, temporary or permanent loss of sensation in the nipples or breasts, inability to breastfeed, hematoma (bleeding inside the breast tissue) and poor wound healing.
Your surgeon will help you decide on the right technique that will give you the best results for your specific condition.