Reconstructive breast surgery
Breast Reduction / Mammary hypertrophy
When breast size is too large compared to the morphology of the patient, it is called mammary hypertrophy
Mammary hypertrophy is almost always accompanied by some degree of breast ptosis (breast sag). There are aesthetic, physical (sore back and / or neck, difficulties finding clothing that fits, discomfort during sporting activities) and psychological side effects.
The surgical procedure (treatment of mammary hypertrophy or breast reduction) reduces the glandular and fat volume of the breasts, repositions the nipple and areola to the correct height, lifts the remaining gland and removes the excess skin. The breast is raised, firmer, smaller and more beautiful.
To achieve this reshaping, the breast surgeon needs to cut the skin which causes scarring. The scars size is proportional to the breast volume and degree of breast sag :
- for mild hypertrophy (volume of each breast between 400 and 600 cubic centimetres), a periareolar scar around the areola, where the lighter skin meets the darker skin, may be sufficient ;
- for moderate hypertrophy (volume of each breast between 600 and 1000 cubic centimetres), an additional vertical scar is necessary, from the areola to the fold under the breast ;
- for major hypertrophy (volume greater than 1000 cubic centimetres for each breast) and gigantomastia (greater than 1500 cm3 volume), an inverted T scar or navy anchor is mandatory. It combines a periareolar scar, a vertical scar and a more or less horizontal scar located in the fold under the breast.
The procedure called "round-block" can treat some moderate hypertrophy and only produces a periareolar scar. Breast shape and appearance of the scar, however, can be less attractive than with a conventional technique. This method very often requires touchups several months after the initial procedure. This technique is preferred for patients who wish to limit at any cost the length of the scars, despite any drawbacks as mentioned.
In the vast majority of cases, the nipple-areola complex is raised higher by being "kept alive" by what is called a pedicle, a sort of "temporary bridge" for blood vessel supplyto the areola. In the case of major hypertrophy, this method may fail or be deemed impossible from the outset. It is then necessary to cut off the nipple and areola and reposition them higher by grafting (areola free graft or Thorek technique). Use of the Thorek technique is rare.
Principle of the procedure
The breast reduction is performed under general anesthesia and lasts from 1 and a half to 3 hours ;
Hospitalisation lasts usually 24 hours.
The after-effects are slightly painful requiring only simple analgesics;
Edema (swelling), ecchymosis (bruises) and a hindrance to elevate the arms are frequent in the early stages;
A compression bandage is applied when the patient leaves the operating room (type of elastic bustier made to measure). It will be replaced before the patient leaves the clinic or at the first appointment.
Rarely, a drain is inserted. It is removed before the patient leaves the clinic.
Complete healing is achieved within 2 to 3 weeks. The concealed stitches are dissolvable. Some small stitches may be removed between the first and third week.
The dressings are semi-permeable, showers are allowed.
Special adhesive dressings will be applied to the scars for 2-3 months in order to improve their appearance.
Wearing a support bra 24 hours a day for 1 month is recommended.
Returning to work is possible between 5-10 days after surgery depending on the job.
The patient can resume sporting activities after 1 or 2 months.
The aesthetic, functional, and psychological improvement is always very satisfactory. The shape of the breast will be permanent and the scars will be fully developed, that is, discreet, one year after the operation.
Risk of complications
As with any surgery, a number of complications can occur. But the likelihood of these complications is reduced in the hands of a qualified plastic surgeon and in the presence of a competent anesthetist. The patient’s compliance to instructions given by the surgeon is also essential and include :
- stopping smoking 1 month before and after the procedure (reduction of all risks) ;
- not taking aspirin for 10 days before and after the procedure (reduced risk of hematoma).
Fortunately, postoperative effects are generally manageable following a breast reduction that has been carried out properly, so serious complications are rare.
In spite of the fact that complications are so rare you must be aware of the following problems :
- Haematomas are quite rare but can occur. They can be evacuated.
- Infection : this is extremely rare when the procedure is carried out in sterile environment.
- Delay of healing process.
- Numbness of the nipples may be observed. It is usually transient and most patients recover normal nipple feeling after 6 to 18 months.
In case of a complications, your surgeon will treat them successfully if necessary.
In practice, the vast majority of cases take place without any problem and the patients are satisfied with the result.
Health Insurance coverage
Under certain conditions, the procedure may be partially covered by health insurance.
Frequently asked questions
Does the breast reduction prevent pregnancy or breastfeeding ?
No. Pregnancy and breast-feeding are possible but can alter the result. A period of 6 months is recommended before or after surgery.
In very rare cases of areola free graft (Thorek technique), breastfeeding is impossible.
Can mammary hypertrophy reoccur ?
In principle no, except in certain special and unusually severe hypertrophy during puberty (virginal hypertrophy) or in case of significant weight gain.
Can the procedure be repeated several times ?
Yes. The treatment of mammary hypertrophy can be carried out several times in a lifetime.
Mammary Hypertrophy and breast cancer
The risk of breast cancer is unchanged after a treatment for mammary hypertrophy. It may even be assumed that the decrease in the amount of mammary gland decreases the probability of developing breast cancer. In some cases,the treatment of mammary hypertrophy can lead to the discovery of breast cancer, either through systematic analysis of the gland that may be removed (anatomo-pathological exam) or through mammographic assessment conducted generally before the procedure.
Breast reduction by liposuction
In some cases well selected by the surgeon, breast reduction can be performed by liposuction with minimal scarring. This possibility must be evaluated during the consultation.
Author: Dr. Christophe Laveaux
Specialist in aesthetic surgery - Antibes
Reproductions, even partial, of the texts are allowed on the express condition cite the author (Dr. Christophe Laveaux) with a direct link to the article mentioned.