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Large, heavy breasts can cause a number of problems including neck pain, back pain, bra strap grooving, upper extremity nerve compression, rashes, or yeast infections, as well as considerable embarrassment, especially to younger women and teenagers. Women experiencing any of these problems may be candidates for a breast reduction. A breast reduction removes excess tissue and returns the descended nipple/areola to a more normal size and position, producing more comfortable, proportional, and aesthetic breasts.
Excessively large breasts (macromastia) are often the result of increased sensitivity to estrogen and may occur due to genetics, weight gain, or endocrine disorders. Teenagers may develop macromastia with hormonal changes known as virginal hypertrophy and observation is recommended as it may improve or recur if a reduction is performed in teenagers, but if significantly traumatic to the psyche, a reduction mammoplasty can be helpful.
Prior to the consultation, a recent mammogram should be obtained and weight loss should be attempted. During the consultation, measurements of the breast, nipple position, body, height, and weight help determine if a reduction is an option and what technique will be chosen. Insurance companies require these measurements, photographs, a history of problems and previous treatment, and the planned reduction volume in order to determine potential coverage. Dr. Park will determine if there is a possibility for insurance coverage and assist with authorization in those cases. If insurance denies or the breast characteristics do not make breast reduction medically indicated, a reduction mammoplasty can be performed with self payment.
The biggest drawback to a breast reduction is scarring, although most patients are happy with the trade off. Most breast will require an inferior pedicle wise pattern reduction which leaves scars that extend around the areola, down along to the inframammary fold, and across the inframammary fold in the shape of an anchor. Certain smaller breast can be reduced without the transverse scar below the breast, using a vertical breast reduction technique either medially or superiorly based pedicle. This method often leaves some excess skin at the bottom of the breast that dissipates in time, but may require a minor excision later. Projection is often greater with this technique, but 6 – 12 weeks of settling is necessary before the final result is appreciated. The nipple is left attached to blood and nerve supply and rotated up before adjusting the skin envelope for closure. Sensation, nipple survival, and nipple function should remain normal. Patients with extremely large breasts (gigantomastia) may require a technique where the lower breast is removed and the nipple is transferred as a free graft, disrupting the sensation and functional ducts.
The operation and recovery process
The operation is usually performed as an outpatient but observation overnight may be desired. Extensive markings that may be awkward or embarrassing will be completed preoperatively to minimize the surgical time. Postoperatively, the breasts will be tender and swollen for a several days. A support garment that is not too tight is helpful for healing and pain control. Dressings are used to collect minor oozing. Drains are occasionally necessary. Swelling and bruising will subside over the ensuing weeks. Stitches are removed between 7 and 14 days. Physical activity should be significantly limited for two weeks and strenuous activity can resume at six weeks. A baseline mammogram should be obtained after 1 year and routine screening thereafter.
The risks of breast reduction include scarring, skin loss, fat necrosis, wound problems, nipple changes, bleeding, infection, asymmetry or an unexpected diagnosis of breast cancer that would need further treatment.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
