Breast reduction or reduction mammoplasty
is an outpatient 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 typically performed on women, but may also be performed on men afflicted by gynecomastia.
Breast Reduction is advised for women who have heavy and large breasts. Due to this fact many of them suffer from physical pain and embarrassment before surgery. The surgery can be performed from the late teens into the 70s. Usually plastic surgeons advise to undergo breast reduction in case when a client doesn’t plan any more pregnancies in the future. Breast Reduction is performed under general anaesthetic and the surgery takes 2–3 hours.

The surgery, which the Food and Drug Administration has called "good medicine", is quickly gaining popularity. In 2005, over 113,000 women had breast reductions, an increase of 11 percent from 2004.

Candidates

Breast reduction surgery is oriented toward women with large, pendulous breasts, especially gigantomastia, since the weight of their breasts may cause chronic pain of the head, neck, back, and shoulders, plus circulation and breathing problems. The weight may also cause discomfort as a result of brassiere straps abrading or irritating the skin. For these reasons, the surgery is usually covered by insurance. 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. Except in unusual cases, this procedure is performed on individuals with fully-developed breasts, and it is not typically recommended for women who desire to breastfeed.

Males with common condition of gynecomastia may feel embarrassed and upset with their condition, usually developed during adolescence. They may get the surgery for restored confidence. The surgical methods employed may vary depending on whether the breasts in the male patient are caused by adipose (fatty) or glandular tissue, and the degree to which any glandular tissue extends laterally along the sides of the torso.

A few celebrities are known for receiving breast reductions, such as Drew Barrymore, Soleil Moon Frye, Queen Latifah,, Sharon Osbourne, and Kerry Katona.

Procedure

Breast reduction surgery is performed in an operating theatre under general anaesthetic, and lasts 2–4 hours. Plastic surgeons use classical stitches, which need to be removed in 10days after breast reduction surgery.

The plastic surgeon removes excess fat, glandular tissue and skin that contribute to large, pendulous breasts. In order to achieve the desired shape, the surgeon makes anchor-like incisions, creating a vertical line downwards from the areola (the coloured area around the nipple) and the horizontal line beneath breast. The areola, its blood vessels and nerves are repositioned together in most cases. The vertical incisions are brought together to reshape the now smaller breasts. Occasionally, in significant reductions, it might be necessary to separate the areola totally and relocate it. The size of the areola can also be reduced, if needed. The plastic surgeon will make the decision as to the most appropriate technique to use.
The scars will not be visible in clothing or most swimwear. Immediately after the surgery the scars will be red, firm and raised. The scars will mature, fade, and soften within 3–12 months. Many scars fade and become nearly invisible, but other scars may become wide and raised. Final scar appearance cannot be predicted prior to surgery. Post-operative course
The patient will usually stay at the cosmetic surgery clinic for about 2nights and will wear a compression bandage and a special surgical support bra. This bra should be worn at all times (even at night) for 14days to 3weeks. If a drain is introduced during the surgery, it is removed within 24hours. The stitches are removed in 10days after the surgery.
It is not possible to sleep on the abdomen for a period of 5weeks. Within a few days you can shower. When you will be released from the clinic you will be given instructions from the plastic surgeons how to exchange the dressings. Every 2–3 days we will take you for a free check up to the clinic, so your plastic surgeon can keep an eye on your recovery.
You will be able to resume everyday activities after a few days, but must avoid lifting objects over the head or making fast movements during the first 4–6 weeks. If you have small children who require a lot of lifting, you need to plan an additional help during the initial recovery period. The individual post-operative process is very important and client can participate on that by following the instructions given by the plastic surgeon and the healthy diet.
After 2weeks, the patient can return to everyday activities, avoiding strong physical efforts. Any bruising and swelling will usually dissipate within 1–2 months.

For males, excess tissue may simply be removed through a tiny incision in each breast. This leaves minimal scarring.

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

Techniques

The two most popular techniques in North America are the inferior pedicle and vertical scar techniques. Both of which are more likely to leave both nipple sensitivity and capability to lactate for the patient as compared to other techniques of the past. It is now being studied and debated as to which of the two techniques results in a better quality of life for the patient in the long run. Liposuction has been used along with the other breast reduction procedures for quite some time, but the newer liposuction only technique is now gaining popularity. All of the breast reduction techniques include a breast lift besides the liposuction only method.

Inferior pedicle technique




The inferior pedicle technique, sometimes also known as a keyhole or Weiss pattern reduction, involves an anchor-shaped incision which circles the areola. 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. A drawback of this technique is sometimes "square" looking breasts, but this is a common option for women with the largest, droopiest breasts.

Vertical scar technique


Conventional vs. 'short-scar' incision Vertical short-scar technique: before and after
The vertical scar technique, also known as the SPAIR or short scar breast reduction, is now widely gaining popularity due its minimal scarring and round shape post-surgery. To perform this, a doctor performs what is also known as a "lollipop incision" to the breast, resulting in the least amount of scarring. There are no horizontal incisions, and the scars are less likely to broaden with time, as with the Anchor-shaped technique. This technique keeps its results the best in the long term.The breast is reduced through removal of the lateral and inferior tissues, leaving the upper pole mostly untouched.

Liposuction only technique

The liposuction only technique is used for women with breasts that are not quite as large as with the other procedures. For the best outcomes, women who choose this procedure have perkier breasts without a drooping nipple, as the skin itself never moves, but, rather, fat is simply removed from inside of the breast. The result is not as drastic as the other techniques, but it involves a much quicker healing time, less pain, and less money.This is the technique typically used for men.

Free nipple graft technique

The free nipple graft technique, a less common procedure, is now typically used only in the most extreme cases of drooping. In this procedure, the areola and nipple are completely removed for relocation and replaced as a skin graft higher on the breast. In these cases, sensation from the areola area will be lost and it is most likely to impair lactation as compared to the two most popular procedures, although some women have been known to successfully produce some amounts of milk.









Crescent Lift for Minor Ptosis
The plastic surgeon removes a crescent-shaped piece of excess skin above the areola and repositions the nipple-areola complex superiorly by closing this gap. This results in a minor lift of up to one inch for patients who have minor ptosis. Its advantage is that the scar is located at the periphery of the areola and thus is not noticeable. If needed, an implant can also be inserted through the same incision. The disadvantages of this technique are that first, it can only achieve a minor lift, and second that by pulling the edge of the areola upwards there can be some temporary distortion of the shape of the areola depending on the degree of pull or lift.








Concentric, Peri-areolar, or Benelli Mastopexy for Moderate Ptosis
In this procedure, two circular or concentric incisions are made around the areola. A doughnut-shaped area of excess skin between the two incisions is then removed. By positioning the center of the outer ring of the doughnut higher than of the inner circle, the closure of this wound will result in superior repositioning of the areola-nipple complex. The main advantage of this technique is that rather moderate amount of ptosis can be addressed without leaving a noticeable scar on the breast. It disadvantage is that it tends to stretch our and enlarge the diameter of the areola and flatten the nipple areola complex. Therefore, the breast looses it cone like projection. More importantly, this procedure carries a higher rate of recurrent ptosis as compared to the Inverted-T mastopexy. Women who have poor skin elasticity and more that mild to moderate ptosis can experience some recurrent sagging; usually requiring a second minor procedure when more excess skin removed and the size of the areola is further reduced. In terms of the scar appearance, although this scar is limited to the periphery of the areola, early on it may wrinkle or show some purse-stringing effect which usually resolves within weeks. This technique works best for women with smaller breasts, and minor to moderate ptosis.

The Benelli-Lollipop Mastopexy
This technique is similar to the concentric lift, but with an extension of vertical scar extending to the mammary folds. It differs that the Inverted–T Mastopexy by eliminating the horizontal scar in the infra-mammary fold. This procedure is considered appropriate for those with medium ptosis that can’t be corrected with the Benelli Mastopexy, but who aren’t sagging enough to need a full Anchor or Inverted–T lift (see below). Vertical Mastopexy- LeJour Mammoplasty Madam LeJour, a plastic surgeon from Belgium, popularized Vertical Mastopexy in the 1980. This technique offered to lift the breast only with a vertical scar and without the additional horizontal scar, thus also being called a "short-Scar Mammoplasty." In this technique the excess horizontal skin in the breast fold area is "bunched-up" into the vertical component of the scar. This "bunched-up" scar although being unsightly at first, would stretch out and flatten over several months after surgery. Because there is limit to how much skin could be gathered-up at the bottom of the breast, this technique is not ideal for women with large breasts or those with severe ptosis. Furthermore, I have found that in the today's environment where women demand immediate results, many are not willing to wait five to twelve months until the unsightly gathered-up scar under the breast resolves.

Inverted-T or Anchor-Shaped Mastopexy
Inverted–T Mastopexy can achieve the tightest and most dramatic lift and is usually reserved for those with moderate to sever breast ptosis. It can eliminate excess breast skin, in both the vertical and horizontal dimensions. Because of this, it can create a breast that has excellent projection and a very "perky" look. It also carries a much lower incidence of recurrent ptosis as compared to the Benelli Peri-areolar Mastopexy. This technique involves creating an opening in the shape of an anchor or inverted–T where the nipple is moved superiorly to the apex of the vertical incision and the base of the anchor is positioned in the Inframammary fold. Reshaping the breasts by this method involves extensive dissection of the breasts. This enables the surgeon to also remove excess breast volume from one breast in order to achieve size symmetry. With respect to the resulting scar, the anchor or inverted-T scar tends to heal very well in the vertical limb. At times the horizontal limb of the scar can become hypertrophic and more noticeable, but fortunately this part of the scar is hidden in the Inframammary breast fold. Like Benelli Mastopexy, with this technique an implant can be inserted under the breast or chest muscle through the same incision. The combination of a breast lift and augmentation is called an Augmentopexy.

How to decide which type of breast lift is more appropriate for you.
For women with moderate breast ptosis, the decision of which type of breast lift is a most difficult one, both the patient and the plastic surgeon. Obviously, everyone wants to have minimal scar, with the maximum breast projection, along with a natural looking breasts. Removal of excess skin results in a tighter breast but carries more scars. Sometimes, adding a breast implant to increase the volume of the breast relative to the breast skin envelope will help to reduce the excess skin to breast volume discrepancy. But note that placement of a larger implant will only help to some extend. Ultimately, the decision comes to choosing between a Benelli Peri-areolar Mastopexy and an Inverted–T Mastopexy. To make your decision you have to look more at the cons than the pros of each technique. If you absolutely object to having the more extensive Inverted–T scar, and are willing to possibly undergo a second breast tightening revision, you might then consider a Benelli Peri-areolar Mastopexy. One the other hand, if you have to have the perkiest and most youthful breasts, and don't mind having a bit more scars, then the Inverted–T Mastopexy is for you. What is involved with Mastopexy Surgery? A mastopexy is a procedure that is usually performed under general anesthesia. An exception to this is a minor crescent lift that can be performed under local anesthesia with sedation. A Benelli Peri-areolar and an Inverted–T Mastopexy involves extensive measurements and marking by your plastic surgeon before the surgery, especially with you in a standing or upright position. At that time the approximate final location of the nipple is marked along with the incision lines. Then once you are taken to the operating room and put under general anesthesia, your entire chest and abdomen is cleaned with antiseptic solutions and the areas of skin incision are further anesthetized with local anesthetics. Previously marked incisions are made, the nipple is elevated to its final position and the remaining breast skin envelope is tailored to accompany the nipple in its new position. Usually before closing these incisions the other breast is lifted and then the two are compared. At this time most surgeons usually have the patient raised into a sitting position on the operating room table so that they can better evaluate the extent of the lift and symmetry. It is not uncommon to then make additional changes to further lift the breasts and also to make them more symmetrical. At times drains are also placed into the depth of the breasts to remove excess fluid. Finally, the incisions are meticulously closed to minimize scarring. The incisions are dressed in protective gauze dressings and the patient is placed in a surgical bra that supports the breasts.




Results

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. Both men and women typically have restored confidence, as well. It is often mentioned that patients who have received breast reductions are the happiest and most satisfied of all plastic surgery recipients.

Risks

Possible issues include difficulty breast feeding, scarring, asymmetry, delayed wound healing, altered nipple sensation, fluid retention in the breast, altered erogenous function, and late changes in shape and recurrent ptosis (drooping.)

It may impair the likelihood of breastfeeding success due to the surgical disruption to the lactiferous duct system. However, a number of studies have demonstrated a similar ability to breast feed when breast reduction patients are compared to control groups.

Scarring from this procedure may be extensive and permanent. Initially, the scars are lumpy and red, but they gradually subside into their final smaller sizes as thin lines, slightly discolored. Though permanent, the surgeon can make the scars inconspicuous to the point that even low-cut tops may be worn without visible scars.

Cancer-prevention

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.[citation needed]

The surgery can also make mammograms easier, since it may be difficult to get a decent mammogram reading with a great deal of excess breast tissue. Therefore, with less tissue, it can be easier for a doctors to get and interpret the results of a mammogram. However, it is still typically recommended that patients receive new baseline mammograms 6 to 8 months after breast reduction to accommodate expected radiographic changes and give a new basis to which future imaging studies can be compared.

Breast Reduction Before and After Photos