Breast reduction

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The common inferior pedicle breast reduction procedure with final result (red indicates incision lines).
The common inferior pedicle breast reduction procedure with final result (red indicates incision lines).

Breast reduction or reduction mammoplasty is an outpatient surgical procedure[1] which involves the reduction in the size of breasts by excising fat, skin, and glandular tissue; it may also involve a procedure to counteract drooping of the breasts. As with breast augmentation, this procedure is performed most often on women, but may also be performed on men afflicted by gynecomastia.

The surgery, which the Food and Drug Administration has called "good medicine", is quickly gaining popularity. In 2005, over 113,000 women had breast reductions, an increase of 11 percent from 2004.[2]

Contents

[edit] Candidates

Breast reduction surgery is oriented toward women with large, pendulous breasts, especially gigantomastia, since the weight of their breasts may cause chronic pain of the head, neck, back, and shoulders, plus circulation and breathing problems. The weight may also cause discomfort as a result of brassiere straps abrading or irritating the skin.[2] For these reasons, the surgery is usually covered by insurance.[3] Even if physical discomfort is not a problem, some women feel awkward with the enormity of their breasts in proportion to the rest of their relatively smaller bodies. Except in unusual cases, this procedure is performed on individuals with fully-developed breasts, and it is not typically recommended for women who desire to breastfeed.

Males with common condition of gynecomastia may feel embarrassed and upset with their condition, usually developed during adolescence. They may get the surgery for restored confidence.[4]

A few celebrities are known for receiving breast reductions, such as Drew Barrymore,[5] Queen Latifah,[6] and Sharon Osbourne.[7]

[edit] Procedure

Doctors almost always perform breast reductions while the patient is under general anesthesia. During pre-operative visits, the doctor and patient may decide on new, usually higher, positions for the areolas and nipples.

For males, excess tissue may simply be removed through a tiny incision in each breast. This leaves minimal scarring.[4]

Patients may take a few weeks for initial recovery, however it may take from six months to a year for the body to completely adjust to the new breast size. Some women may experience discomfort during their initial menstruation following the surgery due to the breasts swelling.

[edit] Techniques

The two most popular techniques in North America are the inferior pedicle and vertical scar techniques.[8] Both of which are more likely to leave both nipple sensitivity and capability to lactate for the patient as compared to other techniques of the past.[9] It is now being studied and debated as to which of the two techniques results in a better quality of life for the patient in the long run.[8] Liposuction has been used along with the other breast reduction procedures for quite some time, but the newer liposuction only technique is now gaining popularity. All of the breast reduction techniques include a breast lift besides the liposuction only method.

A comparison of post-surgery incision lines from the two most popular techniques
A comparison of post-surgery incision lines from the two most popular techniques

[edit] Inferior pedicle technique

The inferior pedicle technique, sometimes also known as a keyhole or Weiss pattern reduction, involves an anchor-shaped incision which circles the areola. The incision extends downward, following the natural curve of the breast. Excess glandular tissue, fat, and skin is removed. Next, the nipple and areola are moved into their new higher position.[10] A drawback of this technique is sometimes "square" looking breasts, but this is a common option for women with the largest, droopiest breasts.

[edit] Vertical scar technique

The vertical scar technique, also known as the SPAIR or short scar breast reduction, is now widely gaining popularity due its minimal scarring and round shape post-surgery. To perform this, a doctor performs what is also known as a "lolipop incision" to the breast, resulting in the least amount of scarring. There are no horizontal incisions, and the scars are less likely to broaden with time, as with the Anchor-shaped technique. This technique keeps its results the best in the long term.[11] The breast is reduced through removal of the lateral and inferior tissues, leaving the upper pole mostly untouched.[12]

[edit] Liposuction only technique

The liposuction only technique is used for women with breasts that are not quite as large as with the other procedures. For the best outcomes, women who choose this procedure have perkier breasts without a drooping nipple, as the skin itself never moves, but, rather, fat is simply removed from inside of the breast. The result is not as drastic as the other techniques, but it involves a much quicker healing time, less pain, and less money.[13] This is the technique typically used for men.

[edit] Free nipple graft technique

The free nipple graft technique, a less common procedure, is now typically used only in the most extreme cases of drooping. In this procedure, the areola and nipple are completely removed for relocation and replaced as a skin graft higher on the breast. In these cases, sensation from the areola area will be lost and it is most likely to impair lactation as compared to the two most popular procedures, although some women have been known to successfully produce some amounts of milk.

[edit] Results

Reduction mammoplasty affords the recipient smaller, lighter, and firmer breasts. The surgeon may also reduce the size of and change the shape of the areola or nipples. Both men and women typically have restored confidence, as well.[4] It is often mentioned that patients who have received breast reductions are the happiest and most satisfied of all plastic surgery recipients.[3][2]

[edit] Risks

Possible issues include difficulty breast feeding, scarring, asymmetry, delayed wound healing, altered nipple sensation, fluid retention in the breast, altered erogenous function, and late changes in shape and recurrent ptosis (drooping.)

It may impair the likelihood of breastfeeding success due to the surgical disruption to the lactiferous duct system.[14][15] However, a number of studies have demonstrated a similar ability to breast feed when breast reduction patients are compared to control groups.[16][17][18]

Scarring from this procedure may be extensive and permanent. Initially, the scars are lumpy and red, but they gradually subside into their final smaller sizes as thin lines, slightly discolored. Though permanent, the surgeon can make the scars inconspicuous to the point that even low-cut tops may be worn without visible scars.

[edit] Cancer-prevention

Although not advocated as a cancer risk reducing procedure, a woman's risk of subsequently developing breast cancer will be reduced proportionately to the amount of breast tissue left.[citation needed]

The surgery can also make mammograms easier, since it may be difficult to get a decent mammogram reading with a great deal of excess breast tissue. Therefore, with less tissue, it can be easier for a doctors to get and interpret the results of a mammogram.[2] However, it is still typically recommended that patients receive new baseline mammograms 6 to 8 months after breast reduction to accommodate expected radiographic changes and give a new basis to which future imaging studies can be compared.

[edit] References

  1. ^ Breast Implants 411 [http://breastimplants411.com/dbii/articles.asp~Article_ID=265 "The Minimal Incision Breast Reduction or Lift "
  2. ^ a b c d Breast Implants 411: "Breast Reductions on the Rise as More Women Choose to Reduce in Order to Increase Their Quality of Life"
  3. ^ a b Breast Implants 411: "Downsizing"
  4. ^ a b c Breast Implants 411: "Helping Boys Overcome Self-Consciousness"
  5. ^ The Drew Barrymore Collective -> Articles -> GQ UK (Apr 95)
  6. ^ Queen Latifah: changes her figure and her tune | Ebony | Find Articles at BNET.com
  7. ^ Sharon Osbourne to Get A Breast Reduction - Surgery again for Mrs. Osbourne - Softpedia
  8. ^ a b Vertical Scar Versus Inferior Pedicle Reduction Mammoplasty - Full Text View - ClinicalTrials.gov
  9. ^ KakagiaD, Tripsiannis G, Tsoutsos D.(2005) Breastfeeding after reduction mammaplasty: a comparison of 3 techniques Ann Plast Surg. 2005 Oct;55(4):343-5 [PMID 16186694]
  10. ^ Breast lift / reduction techniques
  11. ^ Breast Reduction Information
  12. ^ The Center for Short Scar Breast Surgery
  13. ^ eMedicine - Breast Reduction, Liposuction Only : Article by Francesca Romana Grippaudo, MD
  14. ^ D.T. Ramsay et al (2005) Anatomy of the lactating human breast redefined with ultrasound imaging. J. Anat. 206:525-534
  15. ^ Souto, GC et al. (2003) The impact of breast reduction surgery on brestfeeding. J Hum Lact. 19(1):43-49
  16. ^ Cruz-Korchin N, Korchin L. (2004) Breast-feeding after vertical mammaplasty with medial pedicle. Plast Reconstr Surg. 15(114):890-4 PMID 15468394
  17. ^ Brzozowski D, Niessen M, Evans HB, Hurst LN.(2000) Breast-feeding after inferior pedicle reduction mammaplasty. Plast Reconstr Surg. 2000 Feb;105(2):530-4 [PMID 10697157]
  18. ^ Witte PM, van der Lei B, van der Biezen JJ, Spronk CA. Successful breastfeeding after reduction mammaplasty. Ned Tijdschr Geneeskd. 2004 Jun 26;148(26):1291-3 [PMID 15279213]

[edit] See also

[edit] External links