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BREAST REDUCTION

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Breast Reduction
Breast Reduction

Breast Reduction Procedure

A breast reduction procedure or a boob job involves the removal of breast tissue and skin. The reduction in breast volume will result in smaller, lighter breasts and may lead to improvement in posture and relief of back, neck and shoulder strap pain. The procedure can also reduce the risk of rashes which form under the breasts (intertrigo).

The breast reduction surgery achieves a functional bust that is proportionate to the woman’s body, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC) to ensure the functional sensitivity and lactational capability of the breasts.

The indications for breast reduction surgery are three-fold physical, aesthetic and psychological. It involves restoration of the bust, of the woman’s self-image and of her mental health.

The reduction in breast size and weight result in a new lease of life allowing greater unrestricted activity. The procedure also produces an uplift of the breasts so correcting any downward pointing of the nipples. Thus, this procedure accomplishes both, a breast reduction and lift.

All of these help to increase self-confidence and self-esteem of the person. A breast reduction also leads to an improvement in the shape of the breasts, particularly with restoration of fullness to the upper pole and improving some of the loss of volume associated with ageing, weight loss and breast feeding.

A reduction mammoplasty aims to re-size enlarged breasts and to correct breast ptosis (hang / sag). It resects (cuts and removes) excess tissues (glandular, adipose, skin), overstretched suspensory ligaments and transposes the nipple-areola complex (NAC) higher upon the breast hemisphere. The specific reduction mammoplasty procedure is determined by the volume of breast tissues (glandular, adipose, skin) to be resected (cut and removed) from each breast and the degree of breast ptosis present.

Pseudoptosis(sagging of the inferior pole of the breast, the nipple is at or above the infra-mammary fold).

Grade I: Mild ptosis (the nipple is below the IMF, but above the lower pole of the breast)

Grade II: Moderate ptosis (the nipple is below the IMF; yet some lower-pole breast tissue hangs lower than the nipple)

Grade III: Severe ptosis (the nipple is far below the IMF; no breast tissue is below the nipple)

Breast Reduction

Skin Pattern and Final Scar

Circumareolar/Periareolar

This surgery can be performed simply with a circular scar running around the nipple areolar complex at the interface with the normal skin (Circumareolar or Peri areolar scar). This scar usually fades and is relatively inconspicuous.

Circum-vertical (lollypop)

A second option is to have a circular scar running around the nipple and a short vertical scar running below the nipple to the crease under the breast (circum-vertical or ‘lollypop’ scar).

Wise Pattern (Anchor)

The third and more extensive skin excision results in a keyhole pattern (Wise pattern). This produces an ‘anchor’ pattern whereby the scar runs around the nipple in a circular fashion and is connected with a vertical scar running from the nipple to the fold underneath the breast and small scar running in the groove underneath the breasts, which is hidden in the fold below the breasts.

BREAST EXCISION PATTERN

There are two common procedures employed.

  1. Inferior Pedicle

    The inferior pedicle technique preserves the nipple areolar complex on a pedicle of the breast tissue (parenchyma) based in the lower part of the breast. This technique has the advantage of potentially keeping breast sensation. It does however produce a more ‘boxy’ shape. There is also the possibility of “bottoming out” with time.

  2. Supero-medial Pedicle

    The second option uses a supero-medial pedicle. The pedicle preserving the nipple and gland is based on the upper, inner part of the breast. This technique permits a ‘coning’ of the breast and results in a better breast shape. The shape also is maintained more with time and does not ‘bottom out’.

    Some studies have shown that there is no difference between these techniques with respect to nipple sensation after a period of approximately two years, but there is usually more sensory loss initially with the supero-medial technique.

    In some patients a breast reduction can also be performed using a combination of liposuction and skin excision (or mastopexy). This is a procedure usually reserved for older patients in whom the breast tissue (parenchyma) becomes replaced with fatty tissue (adipose tissue). It is also a safe procedure to use in patients who require a second breast reduction in whom the original technique is unknown. An ultrasound scan is usually performed prior to the surgery to calculate the percentage of the breast which is adipose tissue.

    The full, corrective outcome of the surgical re-establishment of a bodily-proportionate bust becomes evident at 6-months to 1-year post-operative, during which period the reduced and lifted breast tissues settle upon and into the chest.

    The team at the ‘The Plastic Surgeons’ with their extensive work and exposure internationally in this area of breast surgery are acknowledged as the best breast reduction surgeons.

    They are called in from various parts of India as well as internationally, to teach the art of breast reshaping surgery to fellows and residents in Plastic surgery. Dr. Rajesh Gawai and Dr. Vinay Jacob achieve excellent breast reduction results.

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