Breast reduction surgery is one of the most preferred surgeries in our country, at least as much as breast enlargement surgery. As well as being an organ of self, the breast has also played a status determining role in societies for centuries. In old historical artifacts and painting motifs, women's breasts are depicted as large, symbolizing fertility.
However, the weight of the breast becomes more disturbing over time and patients want to get rid of the size of their breasts.
Breast reduction surgery may leave visible scars on the breast, but patients demand that the burden be reduced in addition to having fewer scars.
Although breast size is mainly affected by genetic (family characteristics) factors, in some women, the decrease in breast volume after the breastfeeding period is much lower than expected. and therefore large breasts start to bother after a while.
Large breast weight and volume negatively affects spine and shoulder health. There is no clear defining characteristic of the upper limit of breast size because inter-racial and inter-individual sizes can vary significantly. The definition of large breasts in a tall woman with a narrow rib cage is different from the definition in a short woman with a wide rib cage. In my personal opinion, breast size that affects shoulder and spine biomechanics and causes pain in these areas can be considered large. The most obvious effect of the trauma caused by the breast on the shoulder is the scar and hump left by the bra strap.
Breast reduction surgery can be performed from the age of 15, when the breast has completed its development in adolescence (2). Dimensions that negatively affect the social life and daily activities of the patient under the age of 18 should be evaluated together with the family in terms of surgery.
Breast reduction surgery is actually the most important for a possible diagnosis of breast cancer, as it involves the removal of tissue from the breast. can be considered as a diagnostic method. The parts taken from breast reduction surgery are marked during the surgery and sent for pathological examination, and if any cancer focus is detected, relevant treatments and breast reconstruction surgery can be applied.
The critical point in choosing the surgical technique in breast reduction surgery is It is the location of the normal location of the nipple and areola relative to the location available in the patient.
Breast reduction surgery requires moving the areola and nipple to their normal location in the breast.
For this purpose, various measurements must be made on the breast. The most important of these is the distance of the nipple to the collarbone and the breastbone notch (jugulum).
This distance is around 21-22 cm on average. However, each patient is evaluated on his or her own merits.
The main goal in breast reduction surgery is to move the areola and nipple slightly above the level of the submammary fold, as in breast lift surgery.
In breast reduction surgery, tissue bridges called pedicles are used to transport the nipple and areola. While these bridges are connected to the body at one end, the other ends are free and carry the nipple and areola.
The basic stage in breast reduction surgery is the transportation of the nipple and areola. The remaining tissue is shaped within the framework of this transport. As I mentioned, when the nipple-sternum notch distance exceeds 21-22 cm, it is necessary to move it with tissue bridges in a way that does not disrupt the blood circulation and sensation of the nipple and areola in order to reduce it to these dimensions.
These bridges, called pedicles, are made of plastic. It is prepared with critical width and length ratios in surgery. When these rates are exceeded, the blood supply to the nipple and areola may be impaired and lost. Various pedicle types have been defined according to the point at which the pedicle tissue sits at the base. Depending on the area where they attach to the breast, external (lateral), internal (medial), superior, inferior and central (central) pedicle techniques and their variants are the main pedicle creation techniques used.
The determining factor here is are possible pedicle sizes. In breast reduction surgery, the possibility of blood circulation deterioration increases with pedicle sizes exceeding 34-35 cm, and in this case, breast shaping will become difficult. In these patients, the nipple and areola are taken like a button at the beginning of the surgery and kept in a serum-soaked gauze, and at the end of the surgery, the ideal location is determined and adapted again.It is defined as free nipple graft technique (free nipple graft technology). In this method, it is not possible to feel the nipple and areola in the future. Again, it is not possible to give milk with this technique. On the other hand, in the later period, there may be discolouration in the adapted nipple and areola tissues.
Also in patients whose breast length (nipple-chest notch distance) is above critical values but who want to be able to breastfeed and feel the nipple in the future. There are techniques that can be tried. However, adequate reduction may not be achieved in these patients.
Especially in young women who have not had children, the choice of technique to protect the nipple and milk ducts is essential. However, exceeding the critical length in these techniques may still lead to nipple and areola loss. I talk about this in detail with my patients. Another situation is that the breast tissue will not shrink sufficiently. In these patients, the prepared pedicle will create volume in the breast on its own.
The scars that will remain after breast reduction surgery are related to the volume of the breast and excess skin.
Breast reduction surgery is performed under general anesthesia, that is, with the patient asleep, and lasts between 2-4 hours. Although the average wound healing process is 15 days, it is recommended that patients avoid activities that strain the rib cage (tennis, swimming, using a broom, etc.) before the end of the first month. Sometimes it may take much longer for the breast to heal, especially in patients with a fibrocystic breast identified on breast ultrasound. In these patients, dissolving breast tissue may be discharged from the suture lines in the form of a transparent discharge. These complaints will regress with regular dressing. Very rarely, it may be necessary to repair it with stitches a second time.
After breast reduction surgery, tubes called drains are placed, which are used to take out dirty blood that may accumulate inside. These will be removed on the third day of the surgery at the latest.
Depending on the reduction rates of the breast after the surgery, the scar that will remain may remain in the shape of a lollipop (breast reduction with vertical scars) or its extended J-shaped form.
In larger breasts, it may be necessary to leave a scar in the shape of an inverted letter T by extending the scar along the sub-breast fold in order to tighten the skin in the horizontal axis.
In breast reductions with vertical scars, the scar is a A tissue bump may remain at the lower end.
This bump may be necessary to prevent the scar from turning into an inverted T, and it usually disappears within 1-3 months. I have patients who apply to have their breasts reduced using the liposuction technique. In breast reduction surgery, liposuction technique is used to eliminate surface irregularities that may remain on the surface of the breast.
Breast reduction surgery can be performed in combination with liposuction (fat removal) technique.
Unlike the liposuction technique in breast reduction surgeries, fat injection is one of the techniques used to shape the breast surface, although less frequently. Here, some volume can be provided by fat injection, especially in patients with insufficient upper pole fullness. However, when the injected volume is above a certain amount, fatty cysts or calcium precipitates into the injected fat and calcification may occur. In this last case, the resulting mass may need to be removed.
Breast reduction surgeries are the largest aesthetic surgeries performed on the breast. Various problems may arise in the early and late periods after the surgery, and some of these are unforeseen problems before the surgery.
Problems that may arise in the early period of breast reduction surgery, related to the breast itself, can be listed as follows;
Most of these problems can be solved in cooperation with your surgeon. Some problems may require taking you back to the operating room.
Late breast problems that may occur during breast reduction surgery are as follows; In some people, it is associated with the body's excessive response to wound healing and is alleviated with some injections and silicone layer applications. With weight gain in some patients There may also be widening of the scars.
In general, they do not negatively affect lactation functions. However, this possibility is not excluded. Although it is unlikely, lactation function may be negatively affected in patients. However, there are also broad-based publications stating that the lactation function is not affected.
The idea that breast reduction surgery disrupts the monitoring of the breast for cancer is erroneous and is not based on scientific evidence.
Breast reduction surgeries, auxiliary techniques used in breast cancer surgeries. has also entered the ranks. Especially after the removal of cancerous tissue with limited surgery (such as lumpectomy), the breast can be shaped with breast reduction techniques by choosing a pedicle according to the area where the loss occurs, in order to provide a repair without creating deformity in the breast. This is called oncloplastic breast surgery. Again, for limited cancer foci, the removal of the cancer can be performed like a breast reduction procedure, allowing the breast to remain in a more anatomical shape. On the other hand, the tissue pieces obtained during breast reduction surgery can be subjected to direct pathological examination and a diagnosis of breast cancer can be made without leaving any room for doubt.
Breast reduction surgery is a unilateral breast surgery.
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