Breast reduction

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Breast reduction, or reduction mammoplasty, is a surgical procedure which involves the reduction in the size of breasts by excising fat, skin, and glandular tissue; it may also involve a procedure to counteract drooping of the breasts. As with breast augmentation, this procedure is performed most often on women, but may also be performed on men afflicted by gynecomastia.

Breast reduction surgery is oriented toward women with large, pendulous breasts, since the weight of their breasts may cause neck, back, shoulder, circulation, or breathing problems. The weight may also cause discomfort as a result of brassiere straps abrading or irritating the skin. Even if physical discomfort is not a problem, some women feel awkward with the enormity of their breasts in proportion to the rest of their relatively smaller bodies. Reduction mammoplasty affords the recipient smaller, lighter, and firmer breasts. The surgeon may also reduce the size of and change the shape of the areola or nipples.

Although not advocated as a cancer risk reducing procedure, a woman's risk of subsequently developing breast cancer will be reduced proportionately to the amount of breast tissue left. It is recommended that patients receive new baseline mammograms 6-8 months after breast reduction to accommodate expected radiographic changes and give a new basis to which future imaging studies can be compared.

Except in unusual cases, this procedure is performed on individuals with fully-developed breasts. It is not recommended for women who desire to breastfeed, as it can impair the likelihood of breastfeeding success and significantly decrease the volume of breast milk produced because of the surgical disruption to the lactiferous duct system within the breast. ^[1] ^[2] ). Interestingly however, a number of studies have demonstrated a similar ability to breast feed when breast reduction patients are compared to control groups. ^[3] ^[4]^[4] The Inferior Pedicle technique is believed to preserve the lactation potential better than other techniques. ^[5] The Free Nipple Graft technique is most likely to impair lactation, although some women have been known to successfully produce some amounts of milk.

Doctors almost always perform breast reductions while the patient is under general anesthesia. During pre-operative visits, the doctor and patient may decide on new (usually higher) positions for the areolas and nipples.

The most common procedure involves an anchor-shaped incision which circles the areola (aka. "Wise-pattern" reduction). The incision extends downward, following the natural curve of the breast. Excess glandular tissue, fat, and skin is removed. Next, the nipple and areola are moved into their new higher position. Recently there has been increasing interest in limited scar techniques which leave only a vertical scar or a vertical scar with a shorter horizontal scar.

In some extreme cases of drooping, the areola and nipple may need to be completely removed for relocation and replaced as a skin graft (aka "free nipple graft"). In these cases, sensation from the areola area will be lost.

Patients may take a few weeks for initial recovery, however it may take from six months to a year for the body to completely adjust to the new breast size. Some women may experience discomfort during their initial menstruation following the surgery due to the breasts swelling.

Scarring from this procedure may be extensive and permanent. Initially, the scars are lumpy and red, but gradually subside into their final smaller sizes as thin lines. Though permanent, the surgeon can generally make the scars inconspicuous to the point that even low-cut tops may be worn without visible scars. Other common problems include: asymmetry, delayed wound healing, altered nipple sensation, fluid retention in the breast, altered erogenous function, and late changes in shape and recurrent ptosis (breasts) (drooping.)

[edit] References

^ D.T. Ramsay et al (2005) Anatomy of the lactating human breast redefined with ultrasound imaging. J. Anat. 206:525-534
^ Souto, GC et al. (2003) The impact of breast reduction surgery on brestfeeding. J Hum Lact. 19(1):43-49
^ Cruz-Korchin N, Korchin L. (2004) Breast-feeding after vertical mammaplasty with medial pedicle. Plast Reconstr Surg. 15(114):890-4 PMID 15468394
^ ^a ^b Brzozowski D, Niessen M, Evans HB, Hurst LN.(2000) Breast-feeding after inferior pedicle reduction mammaplasty. Plast Reconstr Surg. 2000 Feb;105(2):530-4 [PMID 10697157]
^ KakagiaD, Tripsiannis G, Tsoutsos D.(2005) Breastfeeding after reduction mammaplasty: a comparison of 3 techniques Ann Plast Surg. 2005 Oct;55(4):343-5 [PMID 16186694]