About the Breast Reduction Procedure
Breast Reduction is a procedure designed to relieve the discomforts caused by large, heavy breasts including: Back, neck, and shoulder pain, shoulder discomfort and indentations from bra straps and potential skin irritation beneath the breasts. Enlarged breasts can cause those various discomforts as well as limiting the patient’s potential for physical activity. In severe cases it can even affect nerves that go to the arms. Excess breast tissue, skin, and fat are removed to make the breasts smaller and to improve the associated conditions that are associated with large breasts.
Breast Reduction Surgical Options
Several operations have been described for breast reduction over the years. Operations can be classified in several ways. Some are defined by the external scars that are left in the breast while others may be classified by various technical parts of the operation such as the way the blood supply is left or returned to the nipple.
This can also be called the anchor-shaped incisions. These are the current standard incisions for breast reduction in the United States. They involve incisions that go around the nipple-areolar complex(colored area) continuing vertically down the breast, and then horizontally along the crease underneath the breast. The excess breast tissue and skin is removed, the nipple is repositioned, and the breast is lifted and shaped.
In some cases, the reduction can be done without the horizontal component beneath the breast. This is called a vertical reduction mammaplasty. This operation is most popular in Europe and South America. It does limit the scars but is typically only applicable to smaller and medium breast reductions.
Apron Technique (elimination of the vertical portion)
The Apron technique was actually published in the late 1980’s by Dr Yousif, It was a variation of another technique previously described which eliminates the vertical portion of the anchor incisions. In Dr. Yousif’s variation, the breast must be low or “ptotic” to make it suitable for this operation. This technique is well suited for very large breasts or very low breasts.
Blood Supply Circulation
In the early days of breast reduction surgery, one major way of reducing the breast was to take the nipple-areolar complex completely off the breast, reduce the breast size and place the nipple back on as a skin graft. This is called nipple amputation. This operation is done very infrequently now and in most instances, the nipple can be left on the breast and never leaves the body. In any surgery to the breast, the blood supply to the nipple-areolar complex must be maintained or regained. Currently, this is done by retaining a connection of the nipple to the body where the blood vessels are located. If this does not happen, the nipple will not survive. The connection of the nipple to the body is called the pedicle. The connection or the pedicle can be located beneath the nipple and this is called an inferior pedicle. The connection can be upward from the nipple and this is called a superior pedicle. These the most frequent but there is also a central pedicle and lateral pedicles. The pedicle is only important to the patient in a technical sense to maintain the connection and therefore the blood supply and nerve sensation to the nipple.
What to Expect
In many instances, insurance coverage can be obtained if the patient has significant symptoms from enlarged breasts. Prior approval for insurance coverage is required. That is usually done after the first office consultation. Symptoms are documented by the plastic surgeon, as well as the estimated amount of breast tissue to be removed in grams. That consultation note, as well as photographs are sent to the insurance for approval. Many insurance companies have a formula with which they determine that the size of the breasts, in relations to the patient’s habitus meets their requirement for medial indication for breast reduction. That number, or the amount of estimated breast removal, is variable for each insurance company. If the insurance company denies coverage the breast reduction can still be done as a cosmetic procedure, in which the patient pays for the surgery. Most breast reductions however, are done with insurance coverage.
Breast reduction surgery is done in the hospital usually under general anesthesia. The procedure usually takes 3-4 hours and the patient can either stay in the hospital for or go home the same day as an outpatient procedure. Most surgeons place a drain in each breast that needs to be emptied twice a day by the patient. Those drains are typically removed on day 5-7 after surgery. It is important to know that breast reduction is not typically painful procedure. Most patients have significant improvement in their symptoms.
Recovery & Risks
Early recovery take 4-6 weeks. Complications can include bleeding after surgery called a hematoma. 5-15% of patients can lose sensation to the nipple. Loss of circulation to the nipple is very rare but that result in loss of the nipple areolar complex. Very rarely, wound healing can be a problem. This can be due to circulation issues. All circulation issues are worsened by smoking! So the patient must stop all smoking 3 weeks prior to surgery and 3 weeks after. That includes reduction of circulation to the nipple and skin resulting in potential loss of the nipple and poor wound healing,