Breast Reduction
Women choose breast reduction surgery because their oversized breasts may cause them both serious medical issues and emotional turmoil. Breast reduction, which has origins dating back 100 years or even further, is one of the most commonly performed surgeries. Initially performed as reduction mammoplasty, this procedure allows relief from macromastia. Investigations show that the satisfaction rate is very high with the reduced weight of their breasts. A filtration of the enormous amount of scientific research shows that in academic institutions, breast reduction is a common subject: these papers are written mostly by plastic surgeons, but are also written by radiologists, internal medicine practitioners, or certain gynecologists. A positive body image is the entryway to the limitless world of self-confidence and well-being; therefore, patient choice is mainly associated with substantial distress from hypertrophy of the breasts.
Breast reduction is a treatment designed with two objectives: functional and aesthetic, allowing female patients to meet their desire to reduce their high body mass index, which may contribute to a condition called lipodystrophy or gynoid lipodystrophy, more commonly referred to as cellulitis or cellulite. Basic forms of breast reduction procedures are classified as three-step applications, free-nipple graft procedures, wise-pattern techniques, and vertical ‘short scar’ options. Any of the developed surgical techniques are used to decrease the overall volume of the breasts. The horizontal reduction mammoplasty, submammary reduction mammoplasty, or the wise-pattern procedure was the first procedure designed and explained to reduce the size of the female breast. More recently, the importance of the pedicled reduction mammoplasty technique has been remarked upon. Different needs may match various surgical procedures.
Medical Indications for Breast Reduction
The breast is made up of breast tissue and fatty tissue. The average size is 350 grams for medium-sized breasts, but it can be much more for larger breasts. When breasts become excessively large, they may cause a number of medical problems, such as tumor-related symptoms, irritant dermatitis, neck strain, back pain, skeletal deformity with hump formation, hunched posture, symptomatic shoulder grooving, and thoracic outlet syndrome. Women with macromastia should be carefully evaluated to diagnose these conditions, and a systematic multidisciplinary work-up is proposed for cancer. The social and psychological aspects of this condition are described, and the potential indications for breast reduction are explained. The new technologies allow the possibility of reducing breast tissue and fine-tuning final results. A comprehensive evaluation is necessary to determine who may benefit from this procedure.
Patients submitted not only a reduction mammoplasty problem-oriented specific clinical practice such as neck strain, back pain, and shoulder grooving but also reflected improvement from local shoulder bra strap syndrome up to rare ipsilateral painful motor and reversible restricted sensory impairments post-photos and alcohol screening exam. The initial evaluation of patients with macromastia includes clinical history, complete physical examination, and a focused review of medicine regarding recent presentations and melanoma risk factors such as nevi.
Cosmetic Considerations and Patient Expectations
Most women who choose breast reduction report that they do so for comfort, but there is a very clear aesthetic element to their choice as well. Breast reduction can significantly improve physical health and alleviate symptoms associated with the condition of having larger breasts, but the psychological impact often drives patient feelings and decisions on its timing. Cosmetic breast reduction is generally anticipated by both the patient and the surgeon, yet messaging in consultations and direct-to-consumer marketing is usually focused on the medical improvements the patients can expect post-surgery. Many patients describe psychological impacts from the consultation process that include helping to realize how poorly they actually feel as well as recognizing the availability of a fix for that general sense that is impinging on one’s quality of life.
Women seek a smaller breast size for many reasons. They may feel too big and conspicuous or become frustrated with the limits on their activities that their body puts into place. They may simply prefer the look of the smaller breast on their figure and wish they could experience a different body size and shape just as their small-breasted sisters do. It is critical to determine the breast size and shape that feels right for them before proposing any reduction mammaplasty. This is a long consultative discussion and may reveal important clues to the patient’s basic body type and attitudes about how she would like to present to the world. Body type is determined by frame size and bone structure but also by the distribution of fat and muscle on the frame. Most women under about age 35 do not have extensive rolls of flesh, but rather much more of an hourglass shape, and acceptable, even if very problematic breasts. So, while the focus on rolls of fat is one basic way of sizing up the situation for breast reduction, it may not match what is actually happening with many younger patients with concerns about breast size. Patients need to be encouraged to be in the bathroom with their bras off looking into the mirror and desiring the projected and somewhat high-riding shape. After the choices for resultant shape and positioning have been made appropriate to the patient’s muscle and rib width and the existing breast form, further attention can be placed on the cosmetic appearance of a more natural or gland-free upper pole, as preferred, thereby rounding out the list of breast characteristics as gleaned from a brief psychiatric interview. They then must be open to the idea that not all of the projectable pain will be resolved by a breast reduction even if that is all they kind of feel.
Surgical Techniques and Recovery Process
There are several methods for performing breast reduction, but the following characteristics should be applicable for all styles. The breast tissue is transposed and the nipple/areola complex is mobilized in some shape and form. The skin is then tailored around it instead of taking away excess skin as in a skin resection. The nipple/areola complex gets elevated to a higher position on the chest and rotated to the appropriate level that best suits the final breast shape. The surgeon takes into account the anatomy and individual characteristics of the patient’s breasts to determine the most appropriate surgical plan. The breast reduction usually makes a woman a natural D or DD cup. The larger cup sizes are reduced using breast reduction techniques, while the smaller cup sizes are augmented using breast implants.
There are several techniques for breast reduction, the most common of which is the “anchor” or “keyhole” incision technique. This technique uses a combination of one line of scars around the areola, a vertical line scar from the 6 o’clock position of the areola down to the breast fold, and a horizontal line scar at the breast fold. It is also possible to use a simplified version of the vertical technique where the scar at the breast fold is omitted, and then it is termed the “vertical” scar technique. An experienced surgeon is very important in breast reduction. It is important to consider the patient’s anatomy and the desired result. In general, heavier patients may require more aggressive reduction techniques. For more petite patients, the breasts are commonly reduced to a full C cup. The average amount of tissue removed ranges from 250 grams to 750 grams per breast. Ideally, this should be determined at the time of surgery. Drawing on the skin allows the surgeon to determine the amount of tension that will be exerted on the skin. Too much tension could result in a thick and angry scar. Normally, the skin is drawn tight enough to eliminate any fine lines or wrinkles, but the tissue is not pulled too hard. Patients will place anti-embolism socks on their lower legs to help prevent blood clots. Surgery is performed under general anesthesia, usually in the hospital. Often, these surgeries require a two-night stay in a hospital. A plastic tube with a little suction will be attached to the skin to help drain away any fluid that starts to collect. They also require some post-operative pain management. No big splints are used, but the patients need to wear a surgical support bra for at least 2 weeks after surgery. The sutures on the nipple will be absorbed by the body and don’t need to be removed. The sutures on the rest of the incision are absorbed by the body. It should be noted that the rest of the skin differs from the nipple or areola in that it may need to be shaved or trimmed 3-4 weeks after surgery. This will allow the fresh, raw edges of the skin to lie together again to allow faster healing. Full healing takes 1 year after breast reduction. A breast reduction has a long recovery process. Post-operative care will include bandages and dressings over the incision. After the procedure, you will need to wear a support bra. Pain, bruising, and swelling are also common after surgery. Pain medications are often prescribed to manage any discomfort. During your consultation, your doctor will explain the recovery process in more detail and answer any questions you may have. Within two weeks after the breast reduction process, you can return to work. Moderate activities can be resumed in three to four weeks. Following a breast reduction, exercise or heavy lifting is not recommended. Finding a qualified surgeon in your area will provide you with help dealing with breasts that are too large, heavy, and painful. They usually allow their patients to contact them in their practice directly. Plan a post-operation follow-up appointment to check on your progress. Regular check-ups are important to monitor your healthy breasts.
Potential Risks and Complications
Breast reduction is increasingly recognized as an effective medical intervention for symptomatic breast hypertrophy. In addition to carefully chosen aesthetic operations, the surgery may give rise to various complications that can be short- or long-term in nature. Hence, all patients must be aware of the potential risks, costs, and implications of an intervention.
The decision for surgery should be well-informed, planned, and based on an individual’s needs and expectations. Surgical outcomes affect mental health. Consequently, the process of plastic surgery includes psychoeducation, a detailed preoperative interview, and written informed consent in which all the risks, results, and expected outcomes are shared with the patient.
Patients should obtain detailed preoperative instructions from the surgeon, including the need for preoperative laboratory tests, specialist consultation, and electrocardiography, as well as when and how to stop their current medication before surgery. Postoperative care instructions, including immediate hygiene and activity-related implications, use of the tetanus vaccine, and medication for the relief of intraoperative or postoperative pain, should also be obtained. In particular, patients should be instructed to look for numerous red flags, including sudden hematoma, increasing pain, shortness of breath, and acute general malaise, as well as perspiration, and to immediately call emergency services when these occur day or night, including weekends.
The most common general complications of surgery are infections and hematomas. Disruptions of wound healing are possible, characterized by the formation of hypertrophic or keloidal scarring. Proper wound-related postoperative care can help to reduce this type of complication.
Postoperative complications also include reoperations, position- or wound-related healing disorders, the formation of seromas, scar hyperproliferation, and epidermal inclusion cysts. Rare postoperative complications include inversion or flat nipple, temporary or permanent loss of normal nipple and skin sensation, temporary or permanent arterial or venous occlusion, paresthesia, hypertrophic scarring, keloids, implant rupture, fistula, severe recurrent ptosis, loss of the areola, and death. Anesthesiological complications are also rare, including awareness, aspiration into the lungs, myocardial infarction, cerebral infarction, a severe allergic reaction to the medication, and unexplained death of the patient under anesthesia. Such risks can be minimized by the anesthesiologist’s preoperative assessment and careful premedication to tailor anesthesia.