For women, breast is the symbol of femininity, motherhood and eroticism.
Above all, it is a part of their body that in some cases, such as large and sagging breasts, may create problems. Megalomastia, or breast hypertrophy, has its onset in puberty and typically remains even after menopause. It seems that a combination of hormones, such as estrogens, progesterone, prolactin, insulin, etc, play an important role. This breast enlargement relates to the gland and its surrounding fat tissue.
When is a plastic surgery indicated?
A surgery may be performed on a woman as soon as she finishes high-school (18 years of age) and until after menopause. 18 is considered the minimum age for a young girl because it is the time her breast forms. Most women visit a plastic surgeon because they want to relieve their back and shoulder pains. Nevertheless, they do stress the fact that they want an aesthetically balanced result, i.e. a smaller and firm breast.
Chronic breast pain, especially during menstruation, manifests as fibrocystic breast disease, which is another common reason for women to consult a plastic surgeon.
Bra strap grooves, eczema and fungal infections, especially in the summer, are not uncommon discomforts.
A lot of young girls with large, sagging breasts cannot work out or engage in sports. Their physical activity is limited, they cannot wear clothes they fancy and they fell uncomfortably with their breast image.
Concluding, a significant surgical indication is the difficulty experienced by both the surgeon-breast oncologist during the examination and the woman during her breast self-exam (periodic breast screening test) for the detection of small tumors or masses.
Procedure – Techniques
Breast reduction surgery is carried out under general anesthesia. During consultation, the plastic surgeon thoroughly explains the procedure and the patient sees photos of cases similar to her. All women undergo the preoperative tests. Breast reduction is performed in well-organized medical establishments (private hospitals). Though many techniques are available, they all share the reduction and lifting of large, sagging breasts.
Prior to the surgery, the plastic surgeon marks on the patient’s breast those points he must strictly respect during the procedure. This is one of the key stages of the procedure in order to obtain an excellent result, as it determines what should be removed or retained for the formation of the new breast. The procedure lasts 3-3.5 hours.
The traditional technique performed in North America and the rest of the world with some variations is based on the retention of a part of the breast which includes the nipple and the areola and is vascularized by the thoracic wall (inferior pedicle technique). Compared to older techniques, a good understanding of the anatomy and flap nerves leaves the sensitivity of the nipple unaffected and allows women to breastfeed. Liposuction may be complementary used, but it is no longer used alone. All techniques achieve a breast lift to a certain degree.
Inferior pedicle technique.
The technique, also known as inverted-T technique, includes an anchor-like pattern incision around the nipple and the areola. The pattern extends downwards, following the natural creases of the breast. The surgeon removes skin, fat tissue and mammary gland, and the nipples and areolas are translocated to a higher point. The technique is applied on large as well as on small breasts, but with fewer incisions.
Vertical scar technique
The vertical scar technique has gained great popularity in the USA and the rest of the world due to the smaller incisions required and the nice breast profile delivered after the procedure. It entails the use of an upper, internal or external flap, including the nipple and the areola. This kind of reduction procedures are used in small breasts with little excess skin and require restricted incisions. The surgery removes the lateral and lower breast pole and leaves the upper pole intact.
Free nipple graft technique
Free nipple graft technique refers to breast reduction with free translocation of the nipple and areola. It is commonly used in excessively large breasts and gigantomastia patients, when the survival of the nipple and the areola is at risk. Good candidates are diabetics, heavy smokers, gigantomastia patients, and in general all women whose distance between the nipple-areola and the submammary crease measures more than 20 cm and thus large incisions are required. In these cases, the nipple and the areola are resected en-bloc, and placed anew at a higher level on the new breast as a free graft. Nipple sensitivity and ability to breastfeed are lost with this procedure. Of course, the technique delivers large reductions.
After the surgery
Immediately after the surgery, the woman is admitted to a patient room. She feels no pain and wears a special bra for 3 weeks. The next morning, after the first dressing change, the patient is discharged and can go home. She enjoys immediate mobilization and may resume professional activities within a week (of course this depends on the nature of her profession). 7 to 10 days after the procedure, we remove the stitches around the areola.
Watch the procedure on video.