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There are many female breast reduction surgery techniques. Some have come and gone; others have become “gold standards”. These techniques are taught in plastic surgery residency training programs and most plastic surgeons are highly trained in these procedures.
Traditional or classic procedures are: inferior pedicle technique and free nipple breast reduction. Both of these time-tested procedures have the same inverted-T incision but the nipple-areola complex is treated differently. Most women are candidates for these procedures, especially if their breasts are of significant size.
INFERIOR PEDICLE BREAST REDUCTION
The inferior pedicle technique (also known as the inverted-T or “anchor” technique) is the work horse of breast reduction surgery. The nipple-areola complex remains attached to the bulk of the remaining breast tissue. This tissue is attached at the base of the breast near the bottom crease, therefore the name inferior pedicle breast reduction. Once the breast tissue is removed, the skin is trimmed and the skin envelope is tightened to maintain breast shape. In many cases the breast nipple sensation will be maintained. The resulting incision looks like an inverted “T” and the healing is usually excellent. The disadvantage of this procedure is that the shape of the breast is maintained by the skin envelope, and this can stretch out over time. This can result in “bottoming-out” of the inferior portion of the breast due to skin stretch.
FREE NIPPLE BREAST REDUCTION
The free nipple breast reduction is used for women whose breasts are very large. The main difference with free nipple breast reduction surgery is that the nipple-areola complex is removed completely from the surrounding connective tissue. Once the breast reduction is complete the nipple complex is reattached as a skin graft. This technique is used for women who require a large volume reduction. Similar to inferior pedicle, the incision is also an inverted-“T”. This procedure is chosen if the breast size is so large that the nipple complex would not live if compacted into the skin envelope of the inferior pedicle breast reduction. The disadvantage of the free nipple breast reduction is that nipple sensation is lost.
Breast Reduction Surgery: Incision plan for correcting breast enlargement via inferior pedicle technique, and the corrected breast. Free nipple technique is similar but the nipple is detached then re-attached as a skin graft.
Breast Reduction Surgery techniques: the vertical scar or short scar procedure and the inferior pedicle flap.
A personal consultation is the first step for every patient considering a breast reduction. This appointment can be scheduled at Dr. Delgado’s San Francisco or Marin County office.
During the appointment, Dr. Delgado will inquire as to the patient’s concerns about her appearance and the impact her breasts are having on her daily life. A detailed exam will be performed to determine the best breast reduction procedure. A complete history will be taken, and if the case is potentially covered by insurance, photos will be taken.
The patient is provided with a booklet that supplies detailed pre- and post-operative instructions, including the use of medications prior to surgery. For example, it is required that aspirin and aspirin-containing products be discontinued, including anti-inflammatory products, two weeks before and two weeks after surgery, as these products have a negative effect on the patient’s clotting ability. The pre-operative instructions include a complete list of medications that could pose hazards for the patient, and therefore should be avoided. However, the patient is reassured that Tylenol (acetaminophen) can be safely taken during this time. The booklet also provides a list of vitamins and homeopathic preparations that promote healing and limit bruising which a patient can opt to use before and after her surgery. Dr. Delgado will provide a surgical healing package which includes all the necessary vitamins and healing derivatives.
Breast reduction surgery is performed under general anesthesia. At Marin Cosmetic Surgery Center, anesthesia is administered only by a physician who is board-certified by the American Board of Anesthesia. Dr. Randy Gaynor has worked with Dr. Delgado since 2001 and they evaluate each case to optimize each patient’s care. The anesthesiologist also calls the patient the evening before surgery to review the medical history, confirm last-minute instructions, and answer any questions the patient has regarding anesthesia. Dr. Delgado realizes that anesthesia can be a frightening event and takes great care to comfort patients.
DAY OF SURGERY
Breast reduction surgery is typically performed in an outpatient surgery center or a hospital. Sometimes the patient is kept overnight as a 23-hour stay, for comfort.
Dr. Delgado offers breast reduction surgery at Marin Cosmetic Surgery Center, an accredited outpatient surgery center. Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, is located in his Marin County office on the Sutter Novato Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before anesthesia is given, Dr. Delgado answers all questions the patient or family might ask. At this time detailed drawings are made on the breast using a surgical marking pen. This architectural plan enables the doctor to make precise adjustments to accommodate the changes that occur as the body moves from a lying position to a sitting position. Regardless of the breast reduction technique, the nipple-areola complex will be moved upward and the skin tightened. Excess tissue is removed and the remaining tissue reshaped and contoured. Liposuction is often used to remove excess fat from around the side of the chest.
AFTER BREAST REDUCTION SURGERY
The first few hours after surgery are spent in the recovery room. When the patient is fully alert, she will be able to go home with the assistance of a friend or family member. In some cases, a patient is kept overnight in the recovery room to ensure her comfort during the early post-operative period. In order to reduce post-operative swelling, it is important that the patient sleep with her head and back elevated.
Drains are usually placed to remove body fluid that develops over a few days. They will be removed after three to five days and, at that time, the dressings will be removed and replaced. The patient can safely shower 24 hours after removal of the drains, as those tiny incisions will have closed and become waterproof. Prior to drain removal, only sponge bathing of other parts of the body is permitted, as the drain insertion sites are very susceptible to infection and must remain dry. Instructions are given in the preoperative booklet as to wound care. The sutures are removed approximately ten days after surgery.
Drain removal and suture removal can be done at Dr. Delgado’s San Francisco or Marin County offices, but all surgeries are performed at Marin Cosmetic Surgery Center.
The breasts will be uncomfortable for a day or two, but the pain should not be severe. If desired, a pain pump can be provided. Pain medications are prescribed for use the first few days, to make movement and sleeping more comfortable. By the third day, pain medications are uncommon. However, some patients have a low pain threshold and, therefore, might take pain medications up to five days.
The swelling and bruising will resolve after approximately one week, but a patient should allow two weeks for her recovery. Once the bruising and tenderness are gone, the patient can return to normal activity. Most patients can drive a car and return to work or social activities after one week. Sexual activity should also be postponed until a week after surgery, since this can also aggravate swelling and cause discomfort. Strenuous exercise should be avoided for three to four weeks following surgery as this can still cause swelling to recur.
RISKS AND COMPLICATIONS
A breast reduction carries the usual surgical risks of infection, bleeding, and complications of anesthesia. However, with Marin Cosmetic Surgery Center’s highly-trained surgical team, the risk of these complications is minimized. Breast reduction does leave incision scars around the nipple-areola complex down to the base of the breast, and along the bottom crease of the breast in the inferior pedicle and free nipple techniques. Occasionally, sensation in the nipple and breast area is reduced and this is especially true with a free nipple breast reduction. The feeling may not return for up to six months for the inferior pedicle technique. Most women having breast reductions are unable to successfully breastfeed. However, a small minority might be capable of nursing, but certainly not the patient who undergoes a free nipple breast reduction. On rare occasions, there may be a slight difference in size from one breast to the other, or the nipple-areola complex will have some differences.
BREAST REDUCTION RESULTS
Although a significant reduction in breast size can be enjoyed immediately after surgery, it takes a couple of months for the breasts to settle into their new shapes. A patient will experience better balance with her reduced breast size and she will also find that clothes fit better with trimmer proportions. As breast reduction reduces the weight of the breasts, the body adjusts to a lighter gravitational pull, reducing symptoms of back and neck pain and improving posture. The changes brought about by breast reductions are among the most helpful and dramatic of all plastic surgery procedures. Patients who undergo breast reduction surgery are among the most satisfied plastic surgery patients.