Breast Reduction

Megalomastia or gigantomastia is a major aesthetic and functional problem for women. Some of the more serious problems often faced by patients with large breast size include fibrocystic mastopathy, ailments of the vertebra, annoying skin irritations in the inframammary fold, as well as breast cancer. However, even from an aesthetic point of view, the grooves on the shoulders from the bra straps are quite inelegant on a woman’s body, while the choice of clothes is a permanently harrowing experience.

The same technique is performed both for breast reduction and breast lift (mastopexy). In breast reduction, part of the breast is removed peripherally along the nipple. There are many techniques available for breast lift and reduction. Others support perfusion of the operated breast from below (inferior pedicle), others from above (anterior pedicle, Pitanguy’s technique), and others both from below and above (bipedicle) or vertically (vertical pedicle). All the techniques, though, leave the same scar, known as the anchor-type scar. Depending on the technique, the procedure may last from 1.5 to 3.5 hours. Patients usually do not have to be hospitalized overnight, unless the procedure exceeds 2 hours of surgical time.

A new technique has been developed in the last four years and over 300 women have undergone successful surgery. This technique is based on perfusing the operated breast internally and below. The surgery can be planned very easily by new doctors, with the possibility of being customized during the procedure, depending on the needs of the patient. The scar is much smaller that the typical ones and consists of a sidelong scar going outwards and down. The technique is very short (50 minutes to 1.5 hours) and the breast has a better shape, is functional and above all, there is no scar on the inside of the breast, allowing patients to wear clothes with low cleavage. Patients are discharged on the same day. The surgery is painless and the postoperative course does not exceed 6 days, which is when the sutures are removed. This technique has been acknowledged by the world-renowned Plastic and Reconstructive Surgery Journal of the American Society of Plastic Surgeons, which published the related article in its March 2009 issue.

The surgery is performed with general anesthesia. The preoperative checkup (CBC, blood sugar and serum urea, sodium, potassium, chest X-ray, EKG) for the purposes of anaesthesia may be performed prior to or on the same day as the surgery. Patients over 40 are also advised to have a mammography performed. Patients have to arrive at the hospital on an empty stomach and without having drunk any water at least 6 hours prior to surgery. They should be prepared for a simple surgery with an easy postoperative course. Usually, patients are discharged two-three hours after the surgery, as soon as the anaesthesia has worn off. The first redress takes place on the 2nd postoperative day, while patients should also bring along the right bra, which will be worn on the same day. On the following day, patients may remove the gauzes under the bra for a quick shower. They must then dry themselves with an ironed towel and place the gauzes at the exact same place as before, so that the bra does not rub on the incisions. This should be repeated thereafter. The sutures are removed on the 5th or 6th postoperative day.

Patients rarely experience any pain, which can be treated with painkillers. They may return to work or their normal activities on the 2nd or 3rd postoperative day, and start exercising as of the 10th postoperative day. Although immediate pregnancy is not forbidden, it is also not recommended, as it may affect the incisions. Falling pregnant a year after the surgery will not affect the scars. However, it may cause laxity or ptosis of the breasts, which could have happened even if the breasts had never been operated on. There are rarely any complications to this surgery, but even if there are, these just concern a small split of the surgical incision, which may delay the removal of the gauzes for 10-20 days, or even more. Patients may also experience numbness of the breast skin, but not the nipple, for a few months. In extremely large breasts, there is the rare possibility of reduced sensation in one of the nipples due to the compulsory removal of the mammary gland, through which certain nerve branches reach the nipple. Nipple necrosis is an unlikely event.

Breast lift and mainly breast reduction procedures are completely safe, while in many cases they have proven life-saving. In quite a few cases, a breast tumor has been discovered accidentally, either during preoperative tests (mammography, ultrasound) or during the operation, when the parts that have been removed from the breast are sent for biopsy.