Surgical
Procedures
Breast Surgery
Reduction
Concept
- Reduction mammoplasty is a procedure to reduce the size of the
breast and to lift it into a more aesthetic, anatomic position.
This procedure is frequently indicated because of the untoward
consequences of large breasts including shoulder notching, neck
pain, intertrigo (skin irritation beneath the breasts),
breast pain and difficulty in wearing clothing. Many times, insurance
will pay for this procedure because of the symptoms.
Surgery - Reduction
mammoplasty is usually performed in a surgicenter under general
anesthesia. In some situations, the patient will stay overnight
in a recuperative environment. The procedure takes proximally
2 hours to perform. Often, drains are placed, which are removed
several days later. The patient is instructed not to perform any
high reaching or lifting of heavy objects for approximately six
weeks following the surgery.
Reduction mammoplasty nay be performed by a variety of techniques,
depending on the need. For simple reduction in volume, suction
lipectomy alone may be utilized. There are none of the usual scars,
maintained nipple sensation, and the ability to nurse is preserved.
It is a good procedure for the very young patient or the patient
whose medical status makes them high risk.
The incision most frequently used is called a vertical incision.
This incision leaves a scar around the perimeter of the nipple
and then to the underside of the breast. There are potential alternative
incisions, but most reductions today are done through this approach.
Dr. Dabb frequently utilizes this approach popularized by Dr.
Hall-Findlay from Canada.
Other approaches may also be utilized. In the Strombeck incision,
there is an incision around the nipple, which then joins an inverted
T incision. The nipple may be left attached to a breast pedicle
and then brought upward or completely transected and replaced
as a free skin graft. The procedure selected must be individualized
based on the patient’s need.
Recovery - The
patient is to wear a bra and tape the incisions for several weeks.
There is no high reaching or lifting for 6 weeks.
Back to Work -
2 weeks for sedentary jobs.
Full Activity -
6 weeks
Complications -
Hypertrophic scars, loss of nipple sensation, nipple slough, loss
of nipple arousability, skin or breast slough, fat necrosis (a
painful mass in the breast tissue after surgery), bleeding,
infection, and asymmetry.
Examples
Free Nipple Graft Reduction
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