Breast Reduction Dallas
Breasts undergo changes secondary to hormonal stimulation of puberty, pregnancy and lactation. In some women, breast attain very large sizes and this can cause self-image concerns, interference with daily activities by causing upper back pain and postural changes to the upper torso. Besides with a large breast, the nipple and areola occupy a lower position on the breast mound which is not aesthetically pleasing. A breast reduction removes the excess breast tissue and skin along with reshaping of the breast. Besides, the nipple and areola are now shifted to a more aesthetic position over the central portion of the breast mound. This gives an elevated appearance with a breast size that is more in proportion to the individual. Stretched out areolas can also be reduced to smaller size during a breast reduction.
Although breast reduction can restore a youthful look, it is impossible to predict the exact post-operative cup size. Bra cup sizes have no standardization and vary between manufacturers. I ask my patients if they want to be small, moderate or moderate to large for their body frame after reduction. Although, I discuss a potential cup size, this can vary slightly.
A breast reduction removes and rearranges residual breast tissue. It also repositions the nipple at a higher location. Some patients especially with increasing age may be happy with their breast volume, but may have relatively less fullness over the upper part of the breast.
There are several different techniques described for breast reduction; but all types will leave visible scars on the breast surface that typically fade with time, but can be prominent in some women.
Although results are stable over several years, aging and weight loss can cause progressive loss of breast fullness and skin excess that may require revisions in the future.
Modern techniques do not completely remove and reposition the nipple; instead the nipple is left attached to underlying breast tissue and is moved together as one block of tissue. In spite of this, although most women can successfully breast feed, some may have difficulty doing so.
Breast reduction will not decrease your chance of getting breast cancer. Regular screening mammograms are still required.
Mammograms are routinely performed preoperatively in all patients undergoing breast reduction over age forty and in younger patients with a family history of breast cancer. Even with such screening, very rarely it is possible for the removed breast tissue to show breast cancer. In such circumstances, a breast oncologic surgeon will decide if a mastectomy is required.
Smoking causes decreased blood flow and can cause significant complications related to wound healing and tissue loss. For this reason, most surgeons will not operate till patients stop smoking at least 4 to 6 weeks immediately before surgery.
Types of breast reduction
Breast reduction surgery is described based on the pedicle used to preserve blood flow to the nipple and areola. The pedicle is a portion of breast tissue in direct continuity to the nipple and areola. Tissue outside of the pedicle is removed while the pedicle preserves blood flow to the nipple. Pedicles can be superior, medial, inferior or lateral. The commonest technique used in North America is an inferior pedicle technique.
The traditional scars from a breast reduction have a circular component around the areola, a vertical line from the areola to the base of the breast and a horizontal scar in the fold under the breast. Newer short scar vertical reductions eliminate the horizontal scar and produce a breast with better contours and projection. However, not all patients are suitable for this technique.
Patients usually go home the same day after recovery from anesthesia. Sometimes an overnight stay is required. Strenuous activity needs to be restricted for 4 to 6 weeks afterwards. A support bra can help with post-operative discomfort. Pain is usually moderate and well tolerated by most patients. Although by three months the breast has mostly settled, it can take much longer for final results.
Who is a good candidate?
Women who have back pain, activity restrictions or self-image concerns secondary to large breasts are good candidates for the procedure. In very overweight patients, it is ideal to lose weight before proceeding with the operation as weight loss can decrease breast size and provide symptomatic relief.
My approach to breast reduction
My preferred technique is a short scar vertical breast reduction. This is done utilizing a medial/superomedial pedicle and provides better shape and projection compared to the traditional inferior pedicle technique. Besides, there is no horizontal scar. Patients with very large or droopy breasts however will need a horizontal scar, but I still perform the procedure using the medial/superomedial pedicle technique for better shape.