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The
breast reduction operation has aesthetic,
physiological and psychological benefits. In
today's society, where women of all ages are more
active, massive breast size can be a deterrent to
exercise, posture and physical fitness. The breast
reduction operation reduces the volume of the
breast, lifts the breast, and moves the nipple to an
aesthetically more desirable position. Most
frequently the lollipop or vertical scar technique
is used with moderate to large reductions avoiding
the horizontal scar beneath the breast. The
traditional approach, using an anchor shaped
incision which goes around the nipple straight down
and then underneath the breast, is employed less
frequently. In most cases, the nipple is not
detached, but simply moved up still attached to the
ducts, blood supply, and nerve supply. The nipple,
rarely, needs to be removed and repositioned as a
graft. This may be necessary with extremely large
breasts or for older patients with other medical
problems. More frequently, the scar is lollipop in
shape, going around the nipple and straight down,
avoiding the incision beneath the breast. Nipple
sensation is normally preserved but there is a 15%
chance of nerve injury. The ability to breast feed
may be lost after large volume breast reduction.
The
expected results and possible complications are
detailed during the consultations. In my
experience, 85% of the scars are acceptable, which
means they are visible, but accepted by the
patients. Approximately 5% of the scars would be
considered perfect and approximately 10% of the
post-surgical scars may require management. This
can include pressure dressing with silastic or
silicone rubber, injections of steroids or revision
of the scars themselves.
Another
approach to breast reduction includes the round
block technique of Bonelli, which uses an incision
around the nipple. This is utilized with small
reductions and results in breasts which are slightly
less perky and more globular. Finally, for patients
whose breast tissue is mainly fat and less
glandular, liposuction alone through a small
incision can provide the desired volume of
reduction. This is advantageous for young women
whose breasts have a large fat component and who
need only a small reduction of half a cup to a cup
size. No significant scarring and an early return
to full activities are benefits of this approach.
Older patients with fatty breasts also find this
procedure advantageous.
The
benefits of liposuction as the sole procedure are
that there is minimal scarring, less bruising, and a
rapid return to activities. The disadvantage is
that in patients with combination of fatty and
fibrocystic breasts, the cysts become more palpable
and are more easily felt beneath the skin. The
breast lift operation (or mastopexy) is much less
invasive and uses the same incisions, resulting in
scars either simply around the nipple or the lollipo
shaped or the anchor-shaped configuration.
Obviously, the volume of the breasts is unchanged in
this procedure but the breast configuration is
rejuvenated.
For
additional information on breast reduction visit:
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