Breast Reduction Surgery

Breast reduction surgery is a cosmetic procedure which removes excess glandular tissues, breast fat and skin to allow women to attain a proportional breast size relative to the body. Also known as mammoplasty, the procedure is aimed alleviating the physical, mental and psychological anguish and discomfort associated with breast hypertrophy. Mammoplasty has demonstrated the highest level of patient satisfaction rates of any invasive and non-invasive treatments of breast hypertrophy.

 

What is macromastia?

 

Macromastia, or breast hypertrophy, is a medical condition which causes medium to severe persistent pain in the neck, back and shoulders. It also triggers intertrigo (rashes) caused by ill-fitting undergarments, a common situation involving women suffering from breast hypertrophy as off the rack clothing rarely fit their disproportionate upper body shape and size.

 

Sexual objectification caused by large breasts, as well as taunting and disparaging remarks from the onset of puberty, could also lead to life-long psychological damage and low self-body image. Additionally, breast hypertrophy will also restrict physical activity, participation in sports, and career prospects. This combination of factors will ultimately impair and reduce the quality of life of those afflicted with the condition.

 

Non-operative management of macromastia rarely yield satisfactory results. Weight reduction, customised undergarments, painkilling medication, and physical therapy can slightly alleviate the physical and emotional issues associated with the condition. However, the only permanent solution to breast hypertrophy is breast reduction surgery.

 

 

Overview of Breast Reduction Surgery

 

Mammoplasty is performed by making incisions on strategic locations on and around the breast to remove glandular and fat tissues, as well as excess skin. In some instances, fat tissues are removed using liposuction, a popular vacuum-suction method, particularly if breast hypertrophy is caused by a high level of fat deposit.

 

Even though local anaesthetic is sufficient for the procedure, patients are sedated using general anaesthesia administered intravenously during the surgery as they might become alarmed at the sight.

 

After the incision has been made, surgeons will need to reposition the nipple as it is the nexus of the region’s nerve and blood supply. Depending on the extent of the procedure and size of the breast, the areola may also need to reduced and transplanted together with the nipple – using a technique called free nipple graft.

 

Once the desired amount of tissues has been excised, the breasts are then reshaped and held in place using a combination of sutures, surgical tapes and skin adhesives.

Keyhole incision plan for breast reduction surgery

Surgical Outcome of Mammoplasty

 

While mammoplasty is generally deemed a low-risk procedure, negative surgical outcomes, ranging from mild to serious, can occur. Complication rates for the five types of techniques widely used for the mammoplasty averages at 11.2%.

 

Technique

Complication Rate

Pitanguy

6.5%

Skoog

17.7%

McKissock

18%

Mandrekas

11.4%

Bolger

13.6%

 

 

The ten most common post-surgical complications are:

 

Infection

 

Owing to the fact that breast ducts naturally harbour the Propionibacterium and staphylococcus aureus bacteria, breast reductions are subjected to a higher rate of infection compared to other forms of cosmetic surgery. Patients can also be infected from open incision wounds. However, they can be easily remedied by an oral treatment of antibiotics while maintaining good wound hygiene.

 

Hematoma

 

Hematoma is condition defined as excessive bleeding. This occurs primarily to patients with higher than average rate of blood pressure.

 

Seroma

 

The accumulation of blood plasma and inflammatory fluid from damaged blood vessels and cells below the surface of the incision.

 

• Glandular, Fat and Areola Necrosis

 

Define as tissue and cell deaths caused by the separation of healthy tissues from dermal or cutaneous blood supply. The condition somtimes leads to dehiscence, where healed wounds open up again, which can place the wound under a high risk of infection.

 

• Asymmetry

 

After a certain period of time (anywhere from weeks to months and even years), the breasts start to become asymmetrical, usually in the form of uneven sag, direction, shape and lift between two breasts. A corrective surgery is required to address the issue.

 

Hypertrophic scarring

 

Incision lines will be visible post-surgery. For the majority of patients, the scarring will fade over time.

 

Cancer

 

Tumours have been discovered in up to 1.5% of patients after surgery. Studies have shown no causal relationship between reduction mammoplasty and cancer, but the statistical anomaly remains. To be safe, patients should consider a mammogram exam six months after the procedure and periodically thereafter.

 

Inability to Breastfeed and Nerve Damage

 

Over half of mammoplasty patients have issues relating to breastfeeding after surgery. The sensitivity and lactating ability of the nipples may be temporarily and permanently damaged by breast reduction surgery, which typically causes massive trauma in the nerve-rich region near the areola.