Many women who are interested in breast reduction plastic surgery suffer from excessive breast weight (Breast Hypertrophy / Mammary Hypertrophy). Excessively heavy breasts are a major source of neck strain, shoulder pain, and strain, as well as back pain. In the advanced stages, they can lead to pressure on the nerves in the brachial plexus and cause numbness and discomfort in the fingers. In addition, excessively large breasts can throw the body into disproportion and result in an obese appearance. Finally, in most cases breast hypertrophy is asymmetrical, resulting in a significant size difference between the two sides.
BREAST REDUCTION SPECIFICATION
For these reasons, excessively heavy breasts have to be reduced to a smaller size and rendered as symmetrical as possible. It can be seen that this is not a purely cosmetic procedure, but rather both cosmetic and functional. Usually, breasts are not considered “hypertrophic” unless they are a full D cup or larger (DD, DDD, E, etc.). However, the general consensus, especially with insurance companies, is that the size of the breasts in proportion to the height and weight is more important. For example a D cup breast may be considered hypertrophic in a lady weighing 130 lb and 5′ in height, but not so hypertrophic in a lady weighing 180 lb and 6′ in height.
Most women who refer for a breast reduction surgery are so fed up with the excessively heavy breasts that they want their breasts to be reduced to the smallest size possible. However, the ultimate size has to be proportional to the body, height, and weight.
TECHNIQUES USED FOR BREAST REDUCTION
There are many techniques available for this procedure. The most common ones are the Wise pattern inferior pedicle and the Vertical superior pedicle mammoplasty. In terms of the scars resulting from this operation, it has to be understood that scarring is mainly determined by one’s genetics. However, during the past few years there have been significant developments in our understanding of scarring and things that can be done to minimize scarring.
- Wise Pattern Reduction Mammoplasty
This is the standard technique of breast reduction. It involves removing breast tissue in a vertical and horizontal direction. It is the gold standard by which other techniques are analyzed. As can be imagined, the scars resulting from this procedure consist of a scar around the areola, a scar down the middle of the breast, and a horizontal scar along the inframammary fold. The appearance of these scars primarily depends on the patient’s genetics and secondarily on the experience of the surgeon. Because of the shape of the resulting scar, this procedure is also known as the Full Anchor Breast Reduction or Full Anchor Reduction Mammoplasty.
- Vertical Mammoplasty or Lollipop Breast Reduction
In this technique the reduction is carried out only in the vertical position, leaving the patient with only a scar around the areola and a vertical scar down the middle of the breast. The advantage is that it avoids the horizontal scar along the inframammary fold. The disadvantage is that the segment that needs to be removed in the horizontal direction is left behind for the most part, usually leaving the patient with a long inframammary segment. As a matter of fact, in most studies, a high percentage, up to 50% of individuals undergoing this procedure end up having secondary revisions by removing the horizontal segment, and ending up with an anchor scar anyway.
- Peri-Areolar Reduction Mammoplasty
This technique is only mentioned for completion of this list. Otherwise, it is rarely done and there are very few candidates suitable for this procedure.
- Breast Reduction by Liposuction
Finally, there are a small number of individuals who can benefit from breast reduction using liposuction alone.
It is amazing that even though this is a large and extensive operation, the post-operative pain level is remarkably low and recovery is fairly rapid. Ladies who undergo this operation are usually able to return to work within 4-5 days.
Finally, because breast reduction surgery is primarily a functional operation, under certain circumstances insurance may cover part of the costs. What the insurance companies rely on in terms of approving this operation are the patient’s height and weight, how long they have had the symptoms, what conservative treatments have been tried and for how long, and how many grams of tissue is expected to be removed from each side.
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