Reductive Mastoplasty

Generality

Reductive mastoplasty is the surgical operation with which large breasts are reduced.

Figure: results of a reduction mammaplasty operation: before the operation (above), after the operation (below).

From the site: peterfodormdaspen.com

Performed by a cosmetic surgeon, the reductive mastoplasty involves the elimination of a part of the tissues - adipose, glandular and cutaneous - that form the breasts.

The procedure is invasive, requires general anesthesia and involves an incision designed to leave a scar more or less evident, depending on the technique used.

Before undergoing a reduction mammaplasty, it is necessary to perform some specific tests and comply with certain pre-operative indications

The post-operative phase can take several months, but the benefits are then tangible.

What is reductive mastoplasty?

Reductive mastoplasty is the cosmetic surgery to reduce breasts that are too large.

During its execution, the operating surgeon eliminates, first of all, part of the tissues - adipose, glandular and skin lining - which form the breasts. Then, reshape the area occupied by the nipples and the areola.

In most cases, reductive mastoplasty is reserved for women, however on some occasions it can also be performed on men.

WHAT DETERMINES THE GREATNESS OF A BREAST?

The size of the breast depends on genetic factors, the amount of circulating sex hormones, body weight and body size.

What sex hormones does breast size depend on?

To determine mainly the size of the breast, in a human being, are estrogens .

In a woman, estrogens are the most important sex hormones, as they contribute in a decisive way to the maturation of vagina, uterus, tubes and ovaries, that is the female reproductive organs.

In addition to the amounts of circulating estrogen, it is very important to consider the degree of sensitivity of the mammary tissues to their action.

When you run

The reduction mammaplasty has above all aesthetic purposes, but not only. A large breast, in fact, can be extremely annoying, as it can cause pain in various parts of the body, cause skin irritation, prevent the performance of some sports, etc. In other words, it can negatively affect a person's life.

The main reasons for reductive mastoplasty are:

• Chronic pain in the back, neck and shoulders, caused by the high weight of the breasts
• The chronic / recurrent skin irritations that occur in the lower part of the breast
• The deep furrows left on the shoulders by the bra straps . A large breast develops strong pressure inside the bra; this strong pressure pulls on the bra straps, causing pain in the shoulders.
• Misunderstanding and poor vision of one's image .
• Recurring problems in finding adequate clothes and adapting to body shapes.
• Difficulty while sleeping . An excessively large breast can be very bulky when you lie down in bed.
• Inability to perform any physical activity . Also in this case, the problem is related to the encumbrance of a breast that is too abundant.

WHAT IS THE BEST TIME TO OPERATE?

Reduction mammoplasty can be performed on patients of any age, even among adolescents. However, it is always advised to wait for the end of development and, if you intend to have children, wait until you have completed the desired pregnancies.

The breast, in fact, undergoes growth in pregnant women which could make the reduction mammoplasty operation partially useless.

Moreover, according to some studies, it seems that breastfeeding may be affected (NB: further research is needed on this).

WHEN DO YOU INTERVENE ON MAN?

The reductive mastoplasty can also be performed on humans, when this is affected by gynecomastia .

Gynecomastia is the medical term used to indicate an abnormal development of the male breast; literally, it means "woman's breast".

Gynecomastia can be linked to genetic, hormonal, pharmacological or other reasons, and often has serious repercussions on those affected, so much so that the breast reduction event is necessary.

Main causes of gynecomastia:

• Alcohol abuse
• Use of anabolic steroids
• Inborn diseases (for example, Klinefelter's syndrome)

risks

The reduction mammaplasty is safe. However, it still remains an invasive surgical procedure, so it is not entirely risk-free.

The most known complications are:

• Blood loss (or bleeding ).
• Wound infections .
• Adverse effects on anesthesia .
• Blood clot formation . A clot is a blood clot that can block the passage of blood into veins or arteries.
• Hematomas . They are due to a loss of blood that occurs towards the inside of the breast, where the adipose and glandular tissues are. To eliminate bruising, drainage is required.
• Scar appearance . The scars are all the more likely and the more evident the larger the portion of the breast to be eliminated.
• Loss of sensitivity at the nipple and / or areola . Due to an injury to the nerves, it manifests itself with an inability on the part of the nipple to become swollen.
• Difficulty breastfeeding . As mentioned, the effects of breast reduction mammaplasty have not yet been fully clarified.
• Asymmetry between the two breasts, due to a difference in shape and / or size between the two breasts. In these cases, a second correction may be necessary.

Preparation

Before proceeding with the reduction mammoplasty operation, the treating physician submits the patient to various checks and examinations, to make sure that there are no contraindications to the intervention.

First, it carries out an assessment of the current health status and an accurate investigation of the clinical history (pathologies suffered in the past, etc.). So, continue with:

• An accurate analysis of the breast (size, shape, particular characteristics, etc.)
• The prescription of some laboratory tests (for example, we measure the coagulative capacity of the blood to evaluate the tendency to haemorrhage)
• The observation of the last mammogram performed by the patient (if the latter does not have it, it is very likely that the doctor will prescribe one).

If the profile that emerges is positive (ie there are no contraindications to the intervention), the surgeon can deal with more specific aspects, such as:

• Ask the patient what he expects from the surgery and what size he would like for his breast. Clearly, it is then up to the surgeon to decide how and to what extent to intervene.
• Describe to the patient all the risks and benefits of the intervention, as well as the methods of hospitalization.
• Illustrate to the patient the implications of reductive mastoplasty (required anesthesia, pre- and post-operative limitations, drugs to avoid, etc.).
• Communicate to the patient the obligation to be accompanied at home, after the operation, by a relative or friend. This is a safety issue.

PRE- AND POST-OPERATIVE IMPLICATIONS

A reduction mammaplasty operation requires the patient to stop (at least temporarily) smoking, because cigarette smoking slows down and affects the skin healing process. In addition, it requires the suspension of any drug therapy based on antiplatelet agents (aspirin), anticoagulants (warfarin) and anti-inflammatory drugs (NSAIDs), because these drugs, by reducing the coagulation capacity of the blood, predispose to serious bleeding. Finally, on the day set for the operation, complete fasting is mandatory from at least the previous evening, as general anesthesia is provided.

NB: For complete fasting, we mean both abstention from solid food and abstaining from liquids (only water is allowed up to a couple of hours before).

Other pre-operative implications:

• For obese or overweight people, it is advised to lose weight
• Women are asked to stop taking the contraceptive pill or hormone replacement therapy ; otherwise, the risk of deep vein thrombosis would increase

Procedure

The actual procedure of reduction mammaplasty begins immediately after general anesthesia has taken effect. To eliminate excess adipose, glandular and cutaneous tissues, the surgeon must incise the breast starting from the areola. The latter, together with the nipple, can only be moved or, in cases of very large and drooping breasts, temporarily removed.

There are various methods of intervention (therefore various types of incision): these depend on the size and characteristics of the breast (which is why an accurate pre-operative examination of the breasts is required).

A reductive mastoplasty can last from 90 minutes to 4 hours and can require hospitalization for more than a day.

GENERAL ANESTHESIA

General anesthesia involves the use of anesthetics and painkillers, which render the patient unconscious and insensitive to pain.

The administration of these drugs, carried out intravenously and / or by inhalation, occurs before and throughout the duration of the surgery. At the end of the operation, in fact, the pharmacological treatment is interrupted to allow the patient to regain consciousness.

Upon awakening, it is likely that the operated person feels confused: it is a normal effect of anesthetics, which gradually fades within several hours.

MODE? INTERVENTION

Among the various possible intervention methods, the most practiced are:

• Reduction mammaplasty with periareolar incision, vertical and horizontal
• Reduction mammaplasty with periareolar and vertical incision
• Reduction incision with periareolar incision .
• Reduction mastoplasty with temporary removal of the nipple-areola structure .

Figure: comparison between reductive mastoplasty with periareolar and vertical incision and reductive mastoplasty with periareolar, vertical and horizontal incision. From the site: en.wikipedia.org

Obviously, any incision made is then closed with stitches .

NB: the term periareolar means "around the areola". If the incision is made in this area of ​​the nipple, the scar will generally be less evident, as it is mitigated by the passage of color between the areola and the skin that occurs at this point.

HOW IS THE INTERVENTION FINISHED

Once the breast volume has been reduced and the incisions closed, the surgeon wraps the operated breast to protect it from external insults (including infections), and inserts a small tube to drain the blood that could accumulate inside (NB: the tube is generally removed the following day).

At this point, the anesthesiologist stops the administration of anesthetics, the patient wakes up and begins the recovery phase.

Post-operative phase

Upon awakening, it is likely that the patient will experience breast pain : this is a completely normal sensation, which is usually attenuated after adequate painkillers are taken .

RESIGNATION

Discharges generally take place one or two days after surgery, as the patient must be hospitalized and scrupulously monitored for several hours.

If the operation has been very invasive, it is possible that the hospitalization lasts longer, even 3 or 4 days.

Shortly before leaving, the treating doctor will inform the patient when the various check-ups should take place.

MAIN RECOVERY STAGES

During the first week, the breast will appear sensitive, delicate, swollen and covered with bruises.

After that, the appearance and the pain will slowly start to fade.

At 2-4 weeks after surgery, the situation should have become sufficiently normalized, so that the patient can also resume his work.

For at least a month, the use of normal bra is not recommended; in their place, we recommend the brassiere for sport.

The scars will keep an intense red color for at least 6 weeks; to observe their concrete color change, it will be necessary to wait about 2 or 3 months.

Results

Although it takes several months to fully recover, and the sign of the scars is indelible, the reductive mastoplasty significantly improves the lives of patients who need it.