Breast Reduction Surgery – Explaining the Procedure

Hello. My name’s Adrian Richards, and today I’m going to be talking about breast reduction surgery. Now this is a very fulfilling type of surgery because people with very large breasts often have a number of problems due to the weight of the breasts. These can vary from poor posture, difficulty in getting clothes, neck ache, often they have very heavy grooves where the bra digs in. They can also get skin inflammation, called impetigo, in the fold underneath the breast where the two skin sides are running together.

So, breast reduction, very satisfying. Patients feel a lot better after the operation. Many patients I see do consider it probably the best thing they ever because they don’t realise they are carrying almost two bags of sugar around the front of their chest all the time. They can’t believe the increased movement and the improvement in posture following the operation.

So, breast reduction surgery, very satisfying. There are different approaches to it. Basically, the approaches are to do with the pattern of skin excision and the way the nipple is kept connected. So the old fashioned way of maintaining blood supply to the nipple was actually to remove the nipple and replace it as a skin graft, and that is a technique known as free nipple grafting. Mow, that isn’t done very often nowadays, and the reason for that the nipple doesn’t look very aesthetic afterwards and you lose sensation and the ability to breast feed following the operation. So free nipple grafting now is an older, historical technique nowadays is only really used for people with very, very big breasts, say a reduction of over 2 kilograms per side.

Nowadays we tend to preserve the nipple blood supply and when we can nipple sensation. We do this by keeping the nipple attached by a bridge of tissue to the underlying chest wall. Essentially the bridge of tissue can have a lot of different patterns, but is usually either inferior based, that means it is a bridge running from the bottom, or my preferred technique is a superior medial pedicle, which is based this way facing inwards. The reason for that is you maintain volume in the upper part of the breast, give a better shape, and also preserve sensation better to the nipple.

So it is worthwhile talking to your surgeon about the type of nipple pedicle. The bridge of breast tissue preserving the blood supply and nerves is called the pedicle, and it is worthwhile having a little bit of information, a little bit of knowledge about the different types of pedicle.

The second thing you need to think about is the pattern of skin excision, and breast reduction surgery always involves a scar around the nipple, at the junction of the brown area, the areola of the nipple, and the surrounding skin. Often, patients with big breasts will have big areolas, and the areola is usually reduced during surgery. So there will always be a scar around the junction of the areola. There will always be a scar downwards to the inframammary fold, and if you are having a vertical pattern breast reduction, that’s the limit of the scarring.

Some surgeons will do a more traditional anchor type breast reduction where you have the lollipop incision around the nipple, downwards, and then along the fold. That’s normally used for people with bigger busts and a bigger reduction.

So essentially, how do you choose the surgery? Know a little bit about the pedicle. Probably veer away from anyone who suggests a free nipple graft unless you are really very large busted. Ask about the pedicle. Ask about the likelihood of nipple sensation being maintained. Ask about the scarring. Ask to see some photographs of patients who the surgeon has treated previously for breast reduction. Where possible, ask the surgeon if you can talk to some of his previous patients. The other important thing to say is if you are having the surgery if you are over 40, it is probably best to have a mammogram prior to surgery, certainly over the age of 50, because this will show any abnormalities which can be dealt with at the time of surgery.

So breast reduction, very good operation to have. Very satisfying for the patient and surgeon, but there are a few basics that you need to know. I hope this has helped.