Breast reduction

The main requirements of a breast reduction, in addition to reducing breast volume, are to ensure the viability of the areola-nipple complex, a discrete soft tissue scar, and a harmonious and stable shape of the breast in keeping with the patient’s morphotype.

A wide range of factors come into play when choosing the type of mammoplasty. These include the tonicity and elasticity of the soft tissue envelope, the contents of the envelope, whether fatty, glandular or fibrocystic, the blood supply to the areola-nipple complex which will be provided either from deep in the gland or from the skin around its circumference, the surgeon’s mode of operating, and patient-related parameters such as the sensitivity of the areola-nipple, breast-feeding, and the shape of the breasts.

Many surgical procedures with widely varying designs are available. All can meet one parameter, but to the detriment of another.

The current trend among plastic surgeons is to limit the horizontal scar, and event the vertical scar as far as possible. However, these methods can compromise the shape of the breast or lengthen the infra-areolar vertical scar and even widen the diameter of the areola and/or the peri-areolar scar or, again, cause the sub-mammary fold to move upwards and, above all, result in insufficient breast reduction.

The technique should be judiciously chosen and be supported by the patient’s fully-informed consent.

The volume, the scar

The situation could be summed up as follows: the larger the volume to be removed and the greater the surface area of skin to be corrected, the longer will be the scar needed to achieve a pretty breast which will remain stable over time.

The extent of the reduction will depend upon the structure of the breast, which can be either predominantly glandular or predominantly fatty.

But, like you, I prefer scars to be as small and inconspicuous as possible and to permit long-term stability. Hence, the importance of finding a good compromise together.

Very often, breast reduction is combined with lipoaspiration in order to reduce the extent of the scar by inducing retraction of the elastic cutaneous tissue.

In conclusion: when studying a request for breast reduction, it will be necessary, at the very first consultation, to evaluate the breast contents i.e. to determine whether it is predominantly glandular or fatty. The amount of tissue to be resected will vary from one patient to another if a lasting result is to be obtained.

See published article by Richard Casey

 

*The surgical results shown in these photographs cannot be reproduced identically, nor even approximately. Results are dependent on the initial anatomy of each individual patient.