Breast reduction is a procedure to reduce the size and bulk of the breasts.
Large breasts apart from causing social problems, can cause medical problems like back pain, skeletal deformities and breathing problems. They can also cause personal hygiene problems like a rash or recurrent fungal infections. Such women are candidates for Breast Reduction Surgery or Reduction mammoplasty.
The procedure is similar to mastopexy, but also involves removal of fat and glandular tissue making the breasts smaller, lighter and firmer.
There are 3 age groups of women seeking breast reduction:
Young women aged 18 to 26 years who come because of social problems
Women aged 35-45 years who have finished having their families and want to regain normal body contours
Older women who gain weight after menopause.
There are different techniques which have evolved over a period of time. Some of the most commonly used ones are:
The Vertical Scar Technique: Also called the 'Short Scar Technique'. This is a variation of the traditional reduction techniques by restricting the scar to only the vertical limb and eliminating the need for the full anchor scar. In this technique and the variations to this technique, initially the lower pole of the breast is flat with more fullness in the upper part. This takes around 3 months to settle down. This method is good for moderate reductions.
Inferior Pedicle Technique: The classical method is one which gives an anchor shaped scar that goes around the areola and a vertical scar in the midline, inferiorly and extending on either side into the crease.
Liposuction: Also called "" Scarless Breast Reduction"" is done With the use of liposuction especially in young women, lot of fat is sucked out and only a skin reduction can be done thereby reducing the scarring. Good for minor to moderate reductions in fatty breasts. Though initially the breast sag more because they are now empty, over a period of time they shrink owing to the decreased weight and also decreased volume. hence is it of better value in younger patients with good skin quality.
Round Block : The procedure, which has been championed by South American surgeons in particular, is the “peri-areolar approach” or the “round block” technique. This procedure can only be used for breasts that require a mild to moderate reduction and where the nipple only needs to be raised approximately 6 cms. It is an excellent procedure, reducing the scarring to just around the nipple without the traditional anchor shaped scars which actually run vertical and horizontal in the crease underneath the breasts. So in the smaller breast reductions, the vertical and horizontal scars are completely discarded, leaving only the peri-areolar incision.
In a large breast, however, the vertical and horizontal scars still need to be used. The breasts are still functional by maintaining the duct tissue to the nipple, as only around 20 to 30 % of the ducts and gland is sacrificed even in a formal traditional reduction. The nipple is not cut off and women may still be breast feed after the procedure, though in some cases it might not be possible.
Breast Amputation: is a more extensive procedure done in cases of extremely large breasts. Here there is no function of the remaining breast tissue. The nipple is taken away as a free graft and sutured back on after completion of the reduction and hence no function is retained.
Scars are the most common problem after breast reduction. The scars are extensive and are visible, though proper care is taken to minimise them. If the procedure is done in younger individuals, after pregnancy and lactation, they might find that the procedure needs to be revised.
Breast feeding may be possible in most of the pedicled techniques but is some cases it may not be possible.
But overall, when done for the proper indications it is a very satisfying procedure providing a lot of freedom and improvement in the quality of life of patients.
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Dr. Surindher is a graduate from G.R.Medical College in Gwalior. He completed his Medical undergraduate studies and then his Post Graduation in Surgery. Visit Website »
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