Breast Reduction A common procedure for men and women Breast reduction A real aesthetic and physical issue for women is the disproportion of the volume of the breasts which results from the abnormal development of the mammary gland. Congenital or hormonal in origin, the overly large breasts can result in the relaxation of the skin tissue, back and muscle pain and poor posture of the back and shoulders. The breast reduction surgery is the intervention that aims to reshape the breasts that are too big. This procedure gives them an aesthetic curve andbetter position which is more elevated on the chest. Mammary hypertrophy may appear at the end of the pubertal period or may be secondary to pregnancy and significant weight fluctuations. The natural process of aging also induces a progressive accumulation of fatin the breast tissue. This will be more noticeable in women as they age. The breast reduction is also a procedure commonly requested by men. The overly large and female looking breasts in men are called gynecomastia and in most cases, it can only be corrected with the help of plastic surgery. Indications for breast reduction The breast reduction surgery is considered a cosmetic procedure as its purpose is to make the breasts more aesthetically pleasing. However, in most cases, it is also performed as a result of a medical recommendation as it provides significant relief of back pain by reducing the excessive volume of the breasts that puts a lot of pressure on the spine. The surgical correction of breast hypertrophy can be considered when the breast development is completed; the patient is required to be at least 18 years old. When considering male patients, the procedure is usually performed later on in life as the gynecomastia can disappear on its own if it has hormonal causes. These are the cases where breast reduction should be considered: • Mammary hypertrophy, the breasts are too heavy compared to the anatomy of the patient. • An associated breast ptosis, overly large breasts often cause the sagginess of the breasts at a much younger age. • Back, shoulder or neck pain that is constant and difficult to alleviate without medication. • Associated mammary asymmetry (unilateral hypertrophy which may be mild and go unnoticed, moderate or severe). • An off-centered mammary gland. • A skin distension and the presence of stretch marks, the weight of the breast being maintained not by muscles, but by the breasts skin envelope. • An emotional complex, the disabling aspect of the hypertrophy sometimes causing difficulties in finding suitable clothing. The patient might struggle to show his or her body on the beach or in intimate situations. Before breast reduction surgery The plastic surgeon conducts a clinical assessment to develop a strategy of intervention on a case by case basis: the fat and glandular components of the breast are evaluated, as well as the skin condition. There are a few health conditions that can deem the patient as not eligible for surgery such as severe blood coagulation issues. A preoperative medical evaluation is performed and tests are recommended. A radiographic exam (mammography) is usually prescribed for patients over 35 years of age or with risk factors for breast cancer to rule out any malign or benign tumors that a clinical examination could not detect. In cases where there is a significant weight excess, it is advisable to first try to lose weight and get as close as possible to the ideal weight before scheduling the procedure. It is strongly advised to stop smoking at least one or two weeks before surgery date and also avoid aspirin, anti-inflammatory drugs and oral anticoagulants during the two weeks before the intervention. How is the breast reduction procedure performed The intervention is carried out under general anesthesia and the duration of hospitalization differs from one to three days depending on the complexity of the case and the amount of tissue to be removed. The surgical technique used will depend on the anatomy of each patient: condition of the skin (elasticity of the skin, presence of stretch marks), degree of breast ptosis andhypertrophy. The operative time consists of several stages: • The breast is first marked by the cosmetic surgeon before entering the operative room, to point out the incision spots and the repositioning of the areola, if needed. • The removal of excess breast tissue is then performed: the removed gland is usually sent for pathological examination. • The remaining mammary gland is recentered and reshaped in order to obtain a round and aesthetic curve of the breasts. • Excess skin is removed. • The areola and nipple complex is repositioned. • The incisions are sutured on the redraped breasts. • A compressive bandage is placed over the breasts. Scars after breast reduction Different incisions will be performed during this procedure so scars will be left behind. The scars’ appearance will depend on the complexity of the breast hypertrophy that was treated. In all cases, a scar on the areola area is present and it can be associated with a second incision scar that will depend on the surgical method used: • A vertical scar going from the lower pole of the areola towards the inframammary fold: the plastic surgeon can opt for this incision as long as the anatomy of the patient allows it and the patient has good skin elasticity. • An inverted “T” scar when the incision in the inframammary fold is added to the vertical scar described above. The scar on the areolar zone will be completely camouflaged and almost invisible dueto the naturally darker pigmentation of this area. The vertical or inverted “T” scar will diminish with time but will never completely disappear. Its final appearance can only be assessed one year after surgery, as scarring is a long and progressive process. Your plastic surgeon will advise you to completely avoid sun exposure on the areas treated for at least six months to one year after the surgery to make sure your scars heal beautifully. Follow-up on the breast reduction procedure The day after the procedure, the bandage dressing is replaced with a specific bra and adapted to the new morphology of the patient. The discharge from the medical facility is done within the next couple of days, depending on the complexity of each case. In most cases, there is little pain following the breast reduction surgery. When it occurs, moderate pain is easily alleviated by the use of simple analgesics. The scars remain sensitive for a few days following the intervention, but this is a classic and normal occurrence. The bruises will start to fade within the first month from the surgery. The edema (swelling) will persist for one to two weeks. Most often, there is a decrease in the sensitivity of the nipples, but this phenomenon is just temporary and disappears after a month. A holiday of 2 to 3 weeks from work is recommended. The patient should avoid any intense physical effort the month following the procedure. Complications and risks of the breast reduction procedure Nowadays, post-operative complications and risks are rare. Preoperative examinations and consultations with the plastic surgeon and the anesthesiologist aim to avoid any risk or complication. Nevertheless, the patient must always be informed of the thromboembolic risks (phlebitis, pulmonary embolism), fat tissue necrosis (especially in the case of smoking), infection, hematoma, andalso complications requiring additional surgical interventions: unsatisfactory results, asymmetry, insufficient correction or on the contrary hyper-correction, andscar issues. Fortunately, the recovery process after the breast reduction surgery is fast and usually uneventful thanks to the current advanced surgical techniques. It is advisable to perform the breast reduction surgery once the patient decides she no longer wants to get pregnant again in the future, so as not to hinder the aesthetic result of the intervention. However, a pregnancy is physiologically possible, but a delay of at least one year is recommended between breast surgery and pregnancy for two reasons: relaxation and rest of the breast tissue, and a possible regeneration of the milk ducts. Due to the reposition of the nipple and areola complex, the milk ducts can be sectioned or injured. This can result in difficulties with breastfeeding. The patient should be aware of this before scheduling the procedure. As a general rule of thumb, the more severe the hypertrophy is, the more chances there are for breastfeeding to be affected. Conclusion The breast reduction surgery is a procedure performed on both men and women for similar purposes. Women want to get rid of the excessive volume of the breasts to have an improved body posture, eliminate back pain and find clothes that fit more easily. Men usually want to achieve a more masculine looking chest by getting rid of the excess tissue that makes their breasts look too feminine. The results of breast reduction can be evaluated 2 to 3 months after the procedure, which is the amount of time it takes for the swelling to disappear and all the breast tissues to soften and adapt to the new volume.