Breast reduction surgery. Name, contraindications, consequences

Reduction mammoplasty is a plastic surgery consisting in reducing the size of the mammary glands and mastopexy to give a beautiful breast shape. The procedure is carried out for medical reasons to eliminate problems caused by curvature of the spine, circulatory disorders, as well as to solve psychological problems that appear when a woman doubts the attractiveness of the mammary glands.

Indications for surgery

An operation to reduce the mammary glands is performed at the request of the patient or medical indications.

It is prescribed in cases if:

• Large breast size puts additional strain on the cervical and thoracic spine, provoking scoliosis, problems with posture.
• Disturbed blood circulation, reduced oxygen supply to the brain and spinal cord, headaches, fainting appear.
• Breast size does not match body proportions.
• A woman experiences psychological and physiological discomfort associated with the large size of the mammary glands.
• There is a pronounced asymmetry of the mammary glands.
• There is ptosis (prolapse) of the breast caused by pregnancy, the effects of lactation, and aging of the skin.
• There is a pathological increase in the volume of the bust under the influence of:
• hormonal disorders;
• a strong increase in body size;
• pregnancy, oxytocin production;
• genetic predisposition to glandular tissue growth.
• Gigantomastia (rapid breast growth) occurs, provoked by a malfunction in the pituitary gland. In this case, surgical treatment is combined with hormonal therapy.
• The patient shows nodular, fibrotic mastopathy. A benign tumor of the mammary glands causes breast enlargement with the growth of connective tissue.
• An allergic rash and diaper rash often appear under the breast.
• Gynecomastia develops in men – an increase in the size of the mammary glands with strong physical exertion and abuse of sports nutrition.

Breast volume

An operation to reduce the mammary glands is performed when normal breast volumes ( 9 – 9’8 foot) Are exceeded by 2 or more times:

• minor hypertrophy – 13’1 – 19’7 foot;
• severe macromastia – 19’7 – 26’2 foot;
• a high degree of breast enlargement – 315 – 393’7 inch;
• gigantomastia – more than 1 16’4 foot.

The basis for the appointment of the operation is:

• the size of one breast is more than 500-3000 g;
• sagging bust, which appeared due to the mismatch of the chest to the proportions of the body 2 times or more;
• detection of hypertrophy (one mammary gland is 300-400 g heavier than the other);

Before the procedure, the doctor takes into account:

• height;
• weight;
• patient age;
• individual physiological features.

During the operation, excess connective (fat) tissue is cut out of the mammary glands and axillary hollows, the size of the halo is reduced if necessary. The nipple moves up, the unnecessary skin is excised, the remaining tissues are tightened, giving the breast elasticity.

Mastopathy

Mastopathy is a pathological process of proliferation of connective tissue, accompanied by the appearance of nodules, cysts, is an indication for the appointment of reduction mammoplasty. During the operation, the amount of adipose tissue decreases, benign tumors and nodes exceeding more than 0’4 inch in volume are removed.

With fibrocystic mastopathy, the procedure is carried out with extreme caution.

This neoplasm causes the skin tissues to lose their initial elasticity, which can be complicated by severe scarring in the postoperative period. After the operation, the symptoms of mastalgia disappear, the breast takes on its original form. The withdrawn neoplasms are necessarily sent for histological examination.

Upon completion of surgical treatment, the woman is under control by a surgeon and a mammologist, hormone replacement therapy is used to eliminate pituitary dysfunction in order to prevent recurrence of the pathology.

Limitations and contraindications

Surgery to reduce breasts is not performed if the patient has:

• chronic diseases in the acute stage;
• severe thyroid dysfunctions that are not amenable to therapeutic treatment;
• diabetes mellitus;
• cardiovascular pathologies;
• bleeding disorders;
• pregnancy
• hypertension
• emphysema
• oncology.

A temporary refusal in the procedure of reduction mammoplasty is given:

• nursing mothers, until the lactation process is completed;
  
• girls under the age of 18;
• in the absence of a woman’s children (surgery is prescribed strictly after childbirth and lactation);
• in the presence of viral infections in the body;
• patients suffering from obesity (the procedure is delayed until the normalization of body weight).

Features of reduction mammoplasty

Special instructions for assigning an operation:

• Reduction mammoplasty (like any surgical intervention) is not performed during menstrual bleeding.
• After breast restoration is completed, pregnancy can be planned no earlier than in 10 – 11 months.
• A woman who has undergone reduction mammoplasty is better to refrain from breastfeeding. Postpartum lactation should be suppressed with hormonal drugs.
• It is advisable to correct the shape of the breast after 1 year from the date of completion of breastfeeding.

An operative reduction in the volume of the mammary glands is preceded by a complete comprehensive examination.

During which a plastic surgeon studies:

• physiological characteristics of the patient (height, weight, age);
• health status;
• medical history, including data on a genetic predisposition to gigantomastia.

The doctor determines the size of the necessary intervention, projects the planned result, features of the recovery period, possible complications. If necessary, the removal of excess adipose tissue is combined with liposuction and mastopexy to give the bust a beautiful shape.

The possibilities of reduction mammoplasty

Breast reduction surgery allows you to:

• eliminate the pronounced asymmetry of the chest;
• reduce ptosis;
• reduce the volume of the mammary glands to the desired size;
• to restore the breast to its previous shape,
• maintain the natural appearance of nipples and halos;
• eliminate mastopathy, gigantomastia;
• assist the patient in solving psychological problems associated with doubts about female attractiveness.

Preparation for surgery

Preparatory phase of the operation:

• Consultation of a plastic surgeon. The specialist examines and interviews the patient. It reveals a medical history, interviews a woman about the presence of endocr
  inological, gynecological, hereditary pathologies. Estimates the size of the mammary gland, the ratio of adipose and glandular tissues. Correlates the proportions of the patient’s body and breast, stretch marks, possible consequences are evaluated.
• Clinical diagnostic studies, including:
• OJSC, OAM;
• study of the hormonal background;
• blood biochemistry;
• determination of blood coagulation quality;
• establishment of the group and Rh factor;
• analysis of tumor markers;
• determination of antibodies to HIV, syphilis, Australian antigen, hepatitis virus.
• Oncologist consultation.

  

• ECG.
• Fluorography.
• Ultrasound examination of the mammary glands, mammography.

The operation is carried out only in a planned manner. After the final decision on the need for surgical intervention, passing all the tests, a woman visits a plastic surgeon for the 2nd time.

For determining:

• operation techniques;
• planned results of surgical intervention;
• places and dates of the procedure;
• the duration of the recovery period;
• necessary medications used for anesthesia.

During the 2-3 weeks prior to surgery, a woman is prohibited:

• Take any medications, dietary supplements, vitamins, except those specially prescribed by your doctor. Hormonal contraceptives, medicines that prevent blood coagulation are unacceptable (Aspirin, Analgin).
• Smoke and drink alcohol.
• Visit a solarium, sunbathe under direct UV rays.

Hospitalization is carried out the day before the operation or in the morning on the day of the procedure. Before surgery, the patient is visited by an anesthesiologist, explains the type of drugs planned to be used for anesthesia, the possible risks of using general anesthesia.

The last meal is allowed no later than 8-9 hours before the introduction of drugs. An early (around 20: 00-21: 00 h) light diet dinner is recommended.

What happens during surgery

Breast restoration is carried out by special techniques. The choice of equipment is carried out by the doctor depending on the amount of fat tissue to be removed, ptosis, and the patient’s age.

Name of operation method	Execution technique
Liposuction	The simplest plastic procedure is to remove excess fat with a catheter inserted into a puncture between the tissues. Least traumatic, but causes additional sagging breasts. Combined with skin tightening.
Periareolar incision	It consists of 2 cuts: the first is carried out in a circular motion around the areola; the second repeats the first at a short distance. The skin between the cuts is removed, the edge of the second cut is sutured to the nipple
Vertical section (keyhole)	Most popular with plastic surgeons. During the operation, the skin framing the areola is cut, then the movement of the scalpel is directed down to the base of the chest
T-shaped method (anchor)	It is used in cases where the volume of one mammary gland is more than 500 g. The doctor holds a scalpel around the areola of the nipple, goes down to the chest fold, and then cuts the skin horizontally.

The sequence of actions of the surgeon:

1. A preliminary marking is made on the woman’s chest with a medical marker. Hatching is carried out in a sitting position, since lying glandular tissue is spreading.
2. A scalpel surgeon cuts the skin according to the markings. Removes excess fat, glandular tissue, excess skin.
3. If necessary, the size of the areola decreases. The nipple and areola move up. The vessels, milk ducts, nerve endings remain intact to preserve breast sensitivity (the exception is the reduction in the size of the breast with gigantomastia).
4. At the end of the operation, the edges of the skin incisions are connected. The deep layers are sewn together with self-absorbable threads, a cosmetic suture is made on the nipple outside, on the lower slope of the chest. A drainage is installed in the mammary gland for outflow of the uterus, lymphatic drainage fluid.
5. A sterile compression (pressure) dressing is applied over the seams.
6. The duration of the operation is 2-4 hours. The procedure is performed under general anesthesia.

Technique with a large bust

In cases where the total volume of one mammary gland is more than 700 g, a T-shaped operation (anchor method) is performed. The duration of the procedure is about 3-4 hours. The doctor makes an incision around the halo of the nipple, then vertically goes down to the location of the total fold, then moves with a scalpel horizontally across the entire base of the chest.

During the operation, adipose tissue, part of the glandular, excess skin is removed.

Subcutaneous fat located in the armpit is also eliminated. The nipple and halo separate, decrease in size, rise upwards by 5’9 inch or more. The specialist tries to maintain the integrity of the milk ducts, blood vessels, nerve endings. With gigantomastia (the volume of tissue removed is more than 1000 g), this becomes impossible.

The operation performed by the “anchor method” is mandatory combined with liposuction and mastopexy. “T-method” is traumatic, requires a long recovery period. After the procedure, a partial or complete loss of breast sensitivity is possible. Breastfeeding after treatment of gigantomastia is almost impossible.

Technique with a small and medium bust volume

Vertical reduction mammoplasty (vertical short stitch technique) is prescribed when correcting a bust of a small, medium size (up to 500 g). The duration of the procedure is about 2 hours. Adipose tissue is removed from the incisions made around the halo, stretched vertically down to the total fold.

The operation is less traumatic compared to the classical (T-shaped) technique. With minor ptosis, a breast lift is not required. The operating technique preserves blood vessels, mammary ducts, and breast sensitivity.

In addition to the above method, to reduce a small breast, it is used:

• Liposuction – elimination of excess fat with a catheter inser
  ted into a puncture between the tissues of the mammary gland.
• The method of periareolar incision – consisting in two circular cuts along the nipple-areolar, carried out at a distance from each other.

Recovery process

Within 2 days after the operation, the woman should be in a hospital hospital. The patient spends the first 12 hours in intensive care. Antibacterial drugs, analgesics, decongestants are prescribed to prevent infection, relieve pain symptoms, edema.

On the 3rd day, the woman is discharged from the hospital. Over the next 2 weeks, the patient must be on an outpatient basis, come for medical supervision, dressing, and wound treatment. Sutures are removed on the 8-15th day. Swelling and bruising disappear after 3 weeks.

In the postoperative period, a woman should:

• constantly wear compression (supporting) underwear (at least 3-4 months);
• put a roll-shaped pillow under your back for the duration of sleep to relieve stress and reduce edema (14 days);
• lie only on your back (before removing the stitches);
• refuse to take a bath (shower is allowed on the 5th day after the operation);
• to abstain from sexual activity (until removal of sutures);
• remove salty and spicy foods from the diet, reduce daily water consumption (no more than 4 glasses);
• refuse cigarettes, alcohol, vasoconstrictor drugs;
• gently wash the chest with running water, the use of washcloths is excluded (at least 1.5 months);
• refrain from visiting the sauna, pool, solarium, fitness club, jacuzzi (up to 3 months after surgery);
• reduce any physical activity (up to 6 months);
• exclude diets (weight loss may return the preoperative form of the breast);
• protect themselves from possible conception (at least 7 months).

After the operation, you need to rest as much as possible, be sure to follow the doctor’s recommendations. If you experience any discomfort in the chest area, you should immediately contact the clinic. The final results of the operation can be assessed only after a year.

Possible complications

Surgery to reduce the size of the mammary glands may be accompanied by complications that occur after the completion of the procedure. Separate early and late undesirable effects. The first appear within the first 12 hours from the completion of surgery.

These include:

• Hematoma – a large number of blood clots collected in one place, caused by injury to blood vessels. Without the necessary treatment, it can be complicated by suppuration, tissue necrosis.
• Seroma is an accumulation of fluid caused by an injury to the lymph nodes during surgery. To prevent pathology, a drainage is necessarily inserted.
• The discrepancy of postoperative sutures occurs with strong tissue tension or surgeon errors.
• Infection and suppuration of the suture . Occurs with hematoma, seroma, pathogenic bacteria. Eliminated by antibiotic therapy.
• Soft tissue necrosis occurs after removal of a large number of fat cells, circulatory disorders.

Later consequences appear a few days or months after the end of the operation:

• Violation of the sensitivity of the nipples. It happens full or partial. It develops on the 3rd day after treatment. During the operation performed by the “vertical incision method”, it is restored independently after 3-6 months.
• Rough scarring of the tissue occurs with a large volume of the removed cavity.
• Secondary increase in the size of the mammary glands (hypertrophy). Occurs in cases:

1. if macromastia was caused by hormonal disorders not resolved before surgical treatment;
2. pregnancy and lactation;
3. changes in the volume of the mammary glands in a girl under the age of 18;
4. weight loss of the patient.

• Nipple retraction occurs when scar tissue is reduced.
• Migration of the nipple and halos. Appears after eliminating gigantomastia, may be caused by a surgeon’s error.
• Deformation of the nipple-areolar complex.
• Thrombophlebitis, thromboembolism.

To avoid unpleasant consequences, you need to responsibly choose the clinic and plastic surgeon, strictly follow the instructions of your doctor.

results

The recovery period after reduction mammoplasty takes at least 6 months. This time is necessary for the restoration of the body, tissue regeneration, scar healing. The first results can be seen 2 weeks after the disappearance of edema, bruising, removal of sutures.

Within 6 months, it is necessary to wear compression underwear, use special ointments, creams. After 7-12 months, the breast will take its final shape.

Will the scars remain

Suturing the incision, the plastic surgeon places small cosmetic sutures in inconspicuous places (around the halo, on the lower slope of the chest). The mammary gland takes on a new form. After 6 months, the scars fade, becoming almost invisible. A woman can easily be on the beach, including topless.

In the case of the operation by the classical method (if necessary, remove a large amount of adipose tissue), the formation of large scars is possible. After 1 year (as well as in the case of detecting a large amount of scar tissue) it is possible to use hardware removal of scars.

Can I breastfeed after surgery

The possibility of breastfeeding after breast reduction is completely dependent on the method of surgery. The technique of “vertical incision”, “liposuction”, “periareolar incision method” implies the complete preservation of the milk ducts, blood vessels and nerve endings.

The classical method (T-shaped operation), used when excising a large amount of adipose tissue, can injure the ducts, making lactation difficult to recover (impossible with gigantomastia).

Despite the possibility of breastfeeding after a gentle operation, plastic surgeons do not recommend prolonged lactation.

The fears of doctors are invoked by the mandatory process of breast augmentation that occurs during pregnancy and lactation (with increased production of the hormone prolactin). Long stretching of the tissue can return the preoperative form to the mammary glands, nullifying the previously performed surgical treatment.

How to choose a clinic

Breast reduction surgery must be performed only by a qualified plastic surgeon in a state (municipal) hospital or in an accredited medical clinic.

When choosing the location of the procedure and the doctor should refer to the resources of the global network to study:

• reviews of patients who underwent breast restoration;
• photos taken before and after breast reduction.

When considering commercial offers from various clinics, you need to pay attention to:

• the organization has medical accreditation for plastic surgery services;
• cost of operation;
• reviews of patients who visited the hospital;
• qualification of working staff.

Of great importance is the choice of the surgeon for the operation. After examining the online reviews, scores assigned to the specialist by clients on the websites of clinics, you should choose at least 3 doctors who have the best practice. Each candidate must make an appointment or an online consultation.

Before the conversation, it is recommended to prepare a list of questions to clarify:

• the qualifications of the doctor, the number of similar operations per day;
• the cost of the procedure, including postoperative care;
• operation techniques;
• guaranteed result;
• drugs that are planned to be used in the postoperative period;
• duration of the recovery process;
• possible risks of the operation;
• location of the procedure;
• personnel responsible for postoperative care.

It is imperative to inquire about actions in case of late postoperative complications. Clinic staff and the attending physician should be available to the patient 24 hours a day / 7 days a week.

It must be remembered that each person is individual, unforeseen situations and reactions of the body are possible. Reduction mammoplasty should be carried out only in a trusted medical institution under the guidance of an experienced doctor.

How much is in public and private clinics

Bust size can be reduced in European clinics, medical centers in Israel, American plastic surgery centers.

State	Procedure cost	Services included
Switzerland	from $ 136 – $ 204 euros	transfer services; conversation with a doctor; accompaniment of a translator; accommodation in a medical facility with meals; operation, consultations and support in the operational period (7-14 days); drugs, anesthesia
Germany	from 7000 euros
Israel	from $ 3808
USA		surgeon consultation; preparation for surgery; stay in the ward with meals; full postoperative service; anesthesia
SM-PLASTIK ( New York)	from $ 2040.
Frau Klinik ( New York)	from $ 4080.
Reform Medical Center ( New York)	from $ 2448.
Avromed ( New York)	from $ 3400.
Brazil ( Atlanta)	from $ 2040.
Center for Plastic Surgery JK ( Los Angeles, New York)	from $ 2720.
Clinic of Doctor Prikhodko ( Los Angeles)	from $ 2312.

The largest number of clinics providing reduction mammoplasty services are located in New York and the New York. Operations are carried out by private clinics. The cost of treatment varies from $ 2040 – $ 5440. depending on the qualifications of the doctor, hospital staff, location of the procedure.

Plastic surgery aimed at reducing the mammary glands helps prevent spinal curvature, impaired posture, and headaches. In addition to practical benefits for the body, reduction mammoplasty helps to cope with psychological problems, returning a woman confidence in her own attractiveness.

Breast Reduction Surgery Video

Breast reduction or breast reduction surgery: