INTRODUCTION

Breast reduction is a surgical procedure to remove certain parts of the glandular and fatty breast tissue, as well as the skin, in order to have smaller, lighter, elevated and generally better shaped breasts.

Women with large, heavy and sagging breasts can have a variety of health issues such as as neck and back pain, spine deformities, respiratory problems, skin irritations and rashes in the section underneath the breast, ulcerations, etc.Extremely large breast can also cause problems when buying underwear and clothes and, in general, they can cause discomfort, insecurity and even real complexes for women. Taking all of these factors into consideration, there is a notion that this procedure isn’t simply aesthetical one.

For breasts which are inadequately large in comparison to one’s body frame, the term Hypertrophic Breast, is used, and sometimes also Macromastia, or Gigantomastia, for most severe cases. If 250 to 350g per breast is considered an ideal mass, then 400-600 g of mass is considered moderate hypertrophy, 600-1000g hypertrophy, and masses over 1.5kg are considered Gigantomastia ((although some authors use the term Macromastia for masses over 1.5kg, and the term Gigantomastia for masses over 2.5kg).

Hypertrophy is different in younger and older people (it is more common in younger). Three different entities could be in question when it comes to younger people:

  1. juvenile (pubertal) hypertrophy
  2. developmental hypertrophy associated with general obesity
  3. gestational (gravid) hypertrophy, while in older women it is the so called adult hypertrophy which is associated with menstrual disorders or menopause, and sometimes the cause is completely unknown.

PREPARATION


In addition to standard preoperative preparation, ultrasound examination of breasts or mammography are recommended.

OPERATION


It is performed with general anaesthesia and it lasts 2-4 hours.

There is a large number of different surgical techniques, but the following three are the basic:

  1. “Anchor” incision technique (reverse T), where the final scar will have three components: the circular section around the areola, the vertical section on the lower half of the breast of 5-8cm in length and the horizontal section in the inframammary fold of 5-10cm in length
  2. The so called Vertical technique, as well as Circumvertical, where the final scar will have only the first two components: the circular section around the areola and the vertical section on the lower half of the breast
  3. Periareolar technique, where the final scar will only be the circle around the areola

None of these techniques can, nor should be used for each individual case, it is up to the surgeon to assess each individual case and use the appropriate technique which will have the most optimal result. The primary consideration should be the quality and quantity of the breast tissue, both glandular and fatty, the quality and the condition of the skin, as well as the nipple position. During the operation, certain segments of the skin, as well as the glandular and fatty tissue are removed, and the nipples are elevated to the desired position. If need be, the procedure will include liposuction and liposculpture techniques.


RECOVERY, COMPLICATIONS

The patient stays in the hospital for 1-2 days. It is recommended to wear a special brassiere for the next 4 weeks. The stitches are removed after two weeks. The pain and the tightening sensation are present for the first several days and they are regulated with analgesics. The breasts are more or less swollen, taut and hard, and bruising may occur. Sometimes, the appearance of a breast is unnatural at first, but in time it gets the desired shape. The skin around the incisions may be wrinkled (the so called “folds”), but they will get smoother in time. Physical activities, heavy lifting and sports are prohibited for a month, sometimes longer.

In some patients, the recovery is quicker, while in some it is slower, and this can’t always be predicted. Possible complications are: widening and thickening of scars, temporary loss of sensitivity, necrosis, asymmetry, infection etc. Usually, the breastfeeding capabilities are preserved, but cannot be guaranteed. The scars fade and soften gradually and can be considered aesthetically acceptable, but if it is necessary, they could be corrected later on for an even better result.