BREAST REDUCTION
(Reduction Mammaplasty)

 

The enlarged female breast called Mammary Hypertrophy or Gigantomastia is a frequent reason given for Plastic Surgical Consultation.

Historically, rapid breast enlargement is an expected occurrence during puberty. Once the young woman approaches the late teens or early twenties, breast growth ceases.

In women with mammary hypertrophy, the breast growth is more intense, may begin at an earlier age and be prolonged. The cause for this condition is unknown but may be related to the patient's heredity or intense reaction of the breasts to the hormonal changes of puberty.

In this circumstance, the breasts are abnormally enlarged and may become quite painful due to their rapid growth and distended nature. The weight of these breasts are significant and lead to abnormal posture, heavy bra strap creases in the shoulder areas and increasing neck and back pain. If the condition is allowed to persist, the woman may develop early arthritic changes in her neck and upper spinal column. Occasionally there is nerve trauma and degeneration in the shoulder and arm areas. Some women note the occurrence of rashes under the breast folds due to persistent moisture which accumulates there. For these reasons, there may be significant medical indications for the procedure of breast reduction. In these circumstances, some insurance policies will cover this surgery.

Reduction Mammaplasty is the operation of choice for mammary hypertrophy. The goals of this procedure are to reduce the amount of breast tissue, move the nipple and areolar complex (pigmented area around the nipple) to a higher cosmetically satisfactory level, and to reduce the skin brassiere or envelope of the breast. The nourishing bridge of tissue (pedicle) containing the nerves, blood vessels and milk ducts to the nipple is left intact in the majority of cases. This surgical technique does not require the nipple to be detached and the woman may be able to experience sensation and breast feeding after surgery. In many instances, liposuction is utilized to reduce the fullness in the axillary (armpit) and lateral areas of the breast during surgery. By using liposuction, the overall contour is improved, more weight can be removed and occasionally the scars can be reduced.

TA a middle age female sought reduction of enlarged, heavy, painful breasts.

Following reduction mammaplasty during which over
two pounds of tissue was removed from each breast.

 

 

 

 

THE BREAST LIFT (Mastopexy)

The woman who has been previously satisfied with her breast contour may, in later years after breast feeding, weight loss, or reduced tone, experience a dropping or sagging of her breasts. This condition is referred to as breast ptosis. In this situation, there may be a satisfactory amount of breast tissue, but the skin brassiere or envelope of the breast is too large. In addition, retaining internal ligaments (Cooper's) of the breasts become stretched and lose their elasticity.

The breast lift also called mastopexy is a procedure designed to restore the breast contour by reducing the skin brassiere and lifting the nipple-areolar complex to a normal position. As in the reduction mammaplasty, the nipple is generally not detached during the procedure. In certain situations, where there has been a significant loss of breast tissue, an implant may be required to replace this tissue and enhance the postoperative result. (Please visit the Breast Implant-Mammary Augmentation Link)

The incisions utilized in both the reduction mammaplasty and the mastopexy are similar. They are made in the most inconspicuous and hidden areas as possible around and below the areolar as well as the fold beneath the breasts. The resulting scars, then, are in the lower hemisphere of the breast and will not be seen in the usual low cut gowns or bathing attire. However, although the scars will fade during the first year, they will always be visible. Most patients have remarked that these scars are considered a very satisfactory trade off for their new mammary contour.

BL in her 60's desired a breast lift operation to restore her breast contour and reduce some of the weight creating slouching, shoulder and neck pain.

The breasts and nipples are in a better position, symmetry has been restored and approximately a pound of tissue has been removed from each breast. This is an early postoperative results at 6 weeks. The scars will continue to fade and at one year be hardly noticeable.

JM 60 yo with mammary involutionary ptosis (Breast sag), desired a mastopexy,
ie. lifting without reduction.

 

Preparation.

Any patient over forty may be asked to see her internist for medical clearance. Special tests will be requested of all patients, to ensure that they are healthy and that there will be satisfactory healing. Smoking and aspirin ingestion is prohibited for two weeks before and two weeks after surgery. Aspirin will cause more bruising and bleeding, thus prolonging the recovery period. It has been found that smoking may lead to delayed healing and more noticeable scars. Occasionally, a hyperbaric oxygen treatment is recommended for smokers to prevent postoperative complications.

You will be given prescription for homeopathic and pharmaceutical preparations to prepare your system for surgery.

 

Anesthesia

General Anesthesia is the anesthetic method of choice for the reduction mammaplasty. With this approach, there is complete rest, safety, and no discomfort during the procedure. In addition, because the operation can take up to four hours, your vital signs are monitored for fluid, medication and inhalation anesthetic needs. This is better accomplished with this type of anesthesia. Although blood loss can occur during reductions of very large breasts, it is rare that a transfusion is required with the modern approach utilized. However, some patients feel more secure if they have donated a unit or two of their own blood for possible intraoperative needs. If you wish to take this precaution, these arrangements will be made for you. You will have an opportunity to discuss these options and choices with Dr. Sokol and our Anesthesia staff.

 

Procedure

You will enter the Nova Surgicenter through a private and discreet entrance. After routine charting is accomplished, you will meet with Dr. Sokol. He will review your photos with you and with a mirror explanation and your input, will point out the operative plan for reducing or lifting your breasts. He will then mark your breasts with a special indelible ink. These marks will indicate the plan of your anticipated surgical procedure. The anesthesiologist will then prepare you for surgery with the application of special monitors, medicines and equipment to ensure the procedure is not only safe for you, but comfortable as well.

 

Postoperative Period.

Following the procedure you will be taken into our recovery room. A special bed will be available that is electrically positioned for comfort. In addition you will be wrapped in a special heating blanket of circulating warm air to maintain your body temperature and improve your comfort. A bladder catheter may be utilized to allow the nursing staff to monitor your urinary output so as to gauge your fluid requirements. This catheter may be left in over night to allow you a restful night's sleep without having to get up during the night to urinate. Occasionally, small silastic tubes called tissue drains are utilized to monitor the operated area for any bleeding. If used, drains are removed after there is minimal drainage.

You will be attended by our recovery staff and monitored for approximately 2 hours. Thereafter you will have your operative area examined and be checked by our anesthesia staff. After the recovery room staff is satisfied that you are safely recovered from surgery, you will be permitted to go to your after care facility.

 

After Care

After Care Facilities - Many patients elect to use an aftercare facility in a nearby hotel. These are fully staffed with 24 hour expert nursing care. All patients in these facilities have had cosmetic surgical procedures. Thus the nurses are experienced with your specific needs as well as what to be aware of with this particular type of surgery. In addition the entire after care staff are highly attuned to your privacy and comfort. Meals and transportation to your postoperative office visits are provided. You will be seen by the nursing staff the next day to inspect your operative site, redress your breasts and arrange for your next visit.

If you live less than one hour away from the office, you may wish to go home with a family member or friend that can devote the time to you. If you prefer, a nurse will be arranged for you. Nearby hotels can be utilized if you prefer to stay there with a nurse or friend. This is especially recommended if you live more than one hour away from the office. The next day, our staff will see you, redress your surgical area before you make the trip to your home. You will be given an appointment for your next visit, generally on day 3 or 4. Showers are permissable at that time after any drains have been removed.

 

Pain

Many patients experience little or no pain following breast surgery. Everyone is different and you may feel some discomfiture. You will be provided with a prescription for pain pills that will assist you during the first 48 hours. This is the period that some patients experience pain. Sutures are removed by the tenth day and replaced with special supportive tapes called steristrips. These are left on for an additional 7-10days. Thereafter they may be removed by the patient. It is normal for the patient to experience numbness in the breast envelope and nipple-areolar area for the first 6 weeks to 6 months after surgery. Some patients experience lightning shocks or crawling sensations in the numb areas. These are signs that sensation is returning and a welcome phenomenon.

 

Activity

It is recommended that for the first 3-4 days that you sleep on your back with the head elevated on one or two pillows. This will reduce the swelling and lead to a more comfortable and shorter postoperative period. No bending over, keep your head above your heart at all times. No lifting, sudden movements or exercising is permitted for the first seven to 10 days. You may take short walks by day 5-7 if your are comfortable. By day #10 you may use a stationary bicycle. set at low resistance for 10 minutes. Future use can be doubled every other day until you have reached your preoperative level. You may return to aerobic exercise classes in 3-4 weeks wearing a good supportive athletic bra.

No intimacy, caressing your breasts, emotionally charged situations, or alcohol is permitted for the first 7-10 days. No smoking is permitted for 14 days. This will insure a safer, shorter postoperative period, without increased bruising or delayed healing.

A return to your employment or social schedule can occur as soon as you are comfortable and pain free. We generally recommend that the patient take off at least 7 to 10 days.

 

Complications.

Complications are rare after breast surgery. Some of the more well known are infection and bleeding (hematoma), or fluid accumulation requiring drainage. Rarely, irregularity of healing, permanent numbness, nipple retraction, and inability to breast feed can occur. These are more severe and may require further operative and/or non operative treatment. These include but are not limited to hypertrophied and/or Keloid scars, skin loss including nipple loss or irregularity, permanent numbness and finally inability to breast feed. These complications may lead to permanent unfavorable results or require further operative and or non operative treatment. Although these complications are quite rare, scar treatment and revisions have been performed if indicated.

 

Results

The goals and of reduction mammaplasty are to provide the patient with a lighter, more attractive breast and relief of the weight and pressure symptoms and signs of this deformity. The goals of mastopexy are to lift the breast and provide a more aesthetically pleasing breast contour. Many times breast reduction is performed in the overweight woman. This has been shown to be a wonderful first stage for a conscientious weight reduction and exercise program. These women are thrilled with their new profile and will go to great lengths to preserve and improve their body contour. Similarly, with mastopexy, a more pleasing breast contour is achieved which has allowed our patients more confidence.