Breast reduction

Indications for reduction mammoplasty

As a rule, women think about breast reduction surgery for psychological and aesthetic reasons. Among the indications for surgical intervention:

• dissatisfaction with the large weight and size of the mammary glands;

• unpleasant sensations (back and shoulder pain, headaches, skin irritation, etc.);

• breast asymmetry;

• marked ptosis (omission) of the mammary glands;

• uneven load on the spine, causing its curvature;

• difficulty breathing, especially during sleep;

• difficulties in exercising or playing sports.

Contraindications

There are no special contraindications for breast reduction surgery. The following are considered standard contraindications, as well as for other types of surgical intervention:

• decompensated somatic diseases (diabetes mellitus, arterial hypertension, etc.);

• acute infectious diseases or inflammatory processes;

• varicose veins;

• blood clotting disorders;

• pregnancy and breast-feeding;

• oncological diseases;

• severe psychiatric pathologies.

Preparing for the operation

The first stage of preparation for breast reduction surgery is a consultation with a plastic surgeon. The patient and the doctor discuss the goals of reduction mammoplasty, the technique of surgery, and the expected results. To reduce the risk of complications, standard blood tests (general clinical, biochemical, coagulogram, infectious diseases), ECG, ultrasound of the breast, and specialist consultations on indications are prescribed. Patients planning surgery over the age of 40 are recommended to undergo a mammogram and consult a mammologist.

Two weeks before surgery, it is advisable to stop smoking. It may also be recommended to discontinue certain medications for continuous use[1].

How the operation works

Reduction mammoplasty is performed under general anesthesia. The duration of the surgical intervention depends on its volume and type. The surgeon chooses the preferred technique of plastic surgery based on several parameters:

• the desired size of the mammary glands and, accordingly, the estimated volume of tissue to be removed;

• breast shape, anthropometric parameters of the patient;

• the patient's wishes regarding the location of postoperative scars;

• the need for additional manipulations (braces, removal of asymmetry, etc.).

Breast reduction surgery is most often performed using a T-shaped or "anchor" incision. It allows you to correct significant breast hypertrophy and remove excess breast tissue[3]. The surgeon makes an incision around the areola, a vertical incision from the areola to the breast fold and a second horizontal incision along the submammary fold (the place of the bend under the breast). After removing the excess tissue, cosmetic sutures are applied. At the same time, excess skin is excised. The stitches will be visible immediately after the operation, but they will lighten over time, and after the rehabilitation period, the cosmetologists at the EMC clinic will help make them completely invisible on the skin. The advantages of the method include the possibility of better preoperative planning, as well as the most reliable and predictable result for any breast shape and size.

In some cases, the following may be used:

• Vertical incision method.It is used for moderate breast hypertrophy, as well as for operations for true breast ptosis. During the operation, V-shaped incisions are made on the lower slope of the breast, excess tissue is excised in the central and lower parts of the breast, and liposuction is performed if necessary. The nipple-areolar complex shifts upward, the surgeon forms more beautiful outlines of the areola. The formed mammary gland is covered with a skin "cover", stitches are applied. During the healing process, the skin contracts and the normal shape of the breast is formed. Advantages of the method: no horizontal scar under the breast. Minus: the final result can be assessed only after 1-2 months due to hypercorrection (excessive compression of the lower slope), which is specially performed for a more aesthetic appearance of the mammary glands after resorption of the sutures.

• Periareolar mammoplasty.In this case, the incision is performed around the nipple-areolar complex. The glandular tissue is removed from the lower quadrant of the breast. The operation is usually performed only if there are contraindications to surgery with vertical or T-shaped access. The advantages of the method include less visible scars. However, the disadvantages of the method include loss of nipple sensitivity, loss of lactation ability, hypopigmentation of the nipple—areolar complex, and the inability to remove large amounts of tissue.