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Breast Reduction

 

                                breast reduction surgery on CosmeticSurgeryForums.com

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Different Methods of Breast Reduction

 

With breast reduction, the pedicle method, the sensations in the nipple/areola complex and also the preserving milk production is of utmost importance.  Different pedicle methods have different incision patterns and scar patterns, so it is very important to go over what method is going to be right for you with your surgeon.  The goal of breast reduction surgery is to reduce the breast appearance, contour and volume while maintaining function and sensation of the nipples and breast.

 

 

  • Pedicle Methods

Different Pedicle Methods to preserve blood flow and nerves:

  • Inferior Pedicle – this method maintains the blood supply and the nerve viability from the lower pole of the breast mound to relocate the nipple.  The inferior pedicle technique is predictable, preserves nipple blood flow, has a short learning curve, and can be safely used in reductions mammoplasty for resection volume exceeding 1000 gm without added complications.

  • Superior Pedicle or Medial Pedicle - maintains blood supply and nerve viability from the upper pole section of the breast mound.  The nipple remains on the upper portion (superior) of the breast.  The medial tissue flap provides an excellent blood supply and also avoids disruption of the nerves that control sensation in the Nipple/Areola Complex.

  • Central Pedicle - this pedicle method is taken from the center of the breast mound.

  • Lateral Pedicle – this pedicle method from the side portions of the breast mound.

  • Bi-Pedicle – this method preserves the area taken both the superior and the inferior        pedicles.

     

                               

                                        Image showing Breast Reduction Methods -  Superior Pedicle, Lateral Pedicle, Medial Pedicle and Inferior Pedicle

                                   Copyright 2008 Nucleus Medical Art, Inc. - Used with permission

                                                   Illustration of Pedicle Methods

 

 

 

The two most popular techniques in the United States are the inferior pedicle and vertical scar techniques.  Both have the ability of leaving nipple sensitivity and capability to lactate for the patient as compared to other techniques of the past. 

Both the inferior pedicle and vertical scar techniques offer a better quality of life for the patient in the long run.  The newer liposuction only technique is now gaining popularity.  All the breast reduction methods include a breast lift except for the liposuction only method.

 

 

 

The anchor incision is the most common incision that is done with breast reductions.  The incision are made in a circular shape around the areola and vertically goes down the front of the breast to where it ends, near the chest wall, and then goes horizontally across the underside of the breast.   Basically it resembles an anchor incision used for breast lifts. 

The Anchor Pattern breast reduction technique is considered the traditional method of this procedure.  Because of the incision pattern, the Anchor Method also is known however; as the most invasive method of reducing the size of the breast.  Extra glandular tissue, adipose tissue (fat), and skin are removed.  The nipple/areola complex is displaced into a new higher position.

The anchor pattern or traditional method of breast reduction is highly effective for women who have more glandular tissue in their breasts rather than “fat”.  Most women who are very thin tend to have more glandular tissue, along with women who have not yet reached menopause.

 

 Anchor Method / Inferior Pedicle Procedure is called:

  • Anchor Incision

  • Bilateral Reduction Mammoplasty

  • T-Incision

  •  T-Scar

  • Inverted T Pattern

  • McKissock

  • Weiss Method

 

 

  • ADVANTAGES AND DISADVANTAGES OF ANCHOR PATTERN

ADVANTAGES OF TRADITIONAL ANCHOR PATTERN

This method allows for excess skin removal both vertically and horizontally, and it is typically the best method of women with extreme large size breasts.  This incision allows the plastic surgeon to remove more tissue than any other method.  The results after about a month are the breast tissue appears smooth and tight unlike the vertical method which can leave excess tissue on the breast and must rely on shrinkage for the final result.

 

DISADVANTAGES OF TRADITIONAL ANCHOR PATTERN

The anchor pattern method is very useful in reducing the size of excessively large breasts; however it is also the method with the most scarring. 

If the nipple needs to be detached from the blood vessels and milk ducts during surgery, there is also the increased risk for loss of sensation and loss of breastfeeding ability.

This method of breast reduction can sometimes yield breasts that appear wider in diameter and not have much projection compared to other breast reduction methods.

 

                 

             Pedicle Method of breast reduction vs. Lejour Method of breast reduction

               Copyright 2010 - American Society of Plastic & Reconstructive Surgeons - Used with permission

       

 

 

 

LeJour or Vertical Incision breast reduction is a newer technique that seems to be gaining interest however this can only be done on women who fit the criteria.  Also known as the “short scar” technique, women can be no larger than a DDD or less to qualify for this method.  This technique is gaining popularity due to its minimum scarring and round shape to the breast post surgery.  The surgeon uses the incision known as a “lollipop surgical incision” to the breast ensuring the least amount of scarring.  No horizontal incisions are made.

This is a fairly new technique that is gaining popularity and can only be performed on women who meet certain criteria, one of which is usually pre-operative size of DDD or less.  

The incision is similar to the Vertical Lift incision or Lollipop incision for Breast Lifts.  Because the incision is not done underneath the breast, the reduction sometimes will not have as much support as the traditional Anchor method.

 

Other Names LeJour Procedure is called:

  • Vertical Mammoplasty

  • Lassus

  • VOQ

  • Vertical

  • Regnought

  • The Lollipop Method

 

 

  • ADVANTAGES AND DISADVANTAGES OF LEJOUR METHOD

ADVANTAGES OF LEJOUR OR VERTICAL INCISION BREAST REDUCTION

The vertical incision breast reduction technique is only performed on women who require only a moderate amount of volume to be removed and the pedicle method of repositioning the nipple can be used.  This pedicle method or repositioning the nipple allows the tissue to keep most of the blood vessels and the milk ducts intact.  Because of preserving the blood flow and the nerves, the risk of permanent sensation loss to the nipple and surrounding skin is diminished.  This also increases the chance that the women will be able to breastfeed as well.

 

DISADVANTAGES OF LEJOUR OR VERTICAL INCISION BREAST REDUCTION

Because the excess skin is not removed during the LeJour / Vertical incision procedure, the skin is pleated up and must shrink, tighten, and smooth out over time.  In traditional breast reduction surgery procedure, the skin is smooth and tight after a month or so, because the excess skin is actually removed.

 

 

 

 

Newer Methods of Breast Reduction

 The “SPAIR” technique stands for short scar peri-areolar inferior pedicle reduction mammoplasty.  It combines the best of both worlds to achieve results that exceed either one alone.  With this technique, the inferior pedicle concept is preserved while the reduction of the breast tissue itself is performed within incisions that are confined to the area of the nipple and the areola. 

This procedure allows the shaping of the breast by restoring its normal fullness to the upper portions of the chest and the roundness to its overall shape.  This procedure significantly reduces the problems of bottoming out or hollowing out.

Scars are reduced by up to 50 percent or more over the traditional breast reduction methods used in this country.

 

                                Newer Methods of Breast Reduction surgery

                                              Copyright 2010 ADAM, Inc. - Used with permission

 

                                                         

There are many benefits associated with the method breast reduction using liposuction.  The main drawbacks to traditional breast reduction are the scars from the skin removal can sometimes be visible.  Also, the repositioning of the nipple/areola complex during the traditional technique can sometimes result in a loss or sensation or feeling in the breasts.

Patients who have good skin elasticity and only need a mild to moderate reduction can be good candidates for breast reduction using liposuction.  The scars are minor and normally hidden under the breast fold crease.  Preservation of the breast and the nipple/areola complex with sensation along with the ability to breastfeed can be achieved with using the liposuction method.

The excess fatty breast tissues are extracted by the use of a cannula or a medical tube; which is inserted through tiny incisions made in the breast crease area.  The results include a decrease in the size and weight of the breast with less physical trauma to the breast tissue and minimal risk of complication and scarring.

Women with breasts that are not too large (normally no bigger than a DD) and have good skin elasticity make the best candidates for breast reduction using liposuction.

Liposuction has been used as an adjunct to other breast reduction procedures for quite some time, but liposuction only techniques are not widely performed.

 

Advantages of breast reduction by liposuction over traditional methods:

  • Less trauma to the breast

  • Faster recovery

  • Less visible scars

  • Fewer postoperative complications

 

 

 

 

This Laser Bra of Breast Reduction was developed by Dr. W. Grant Stevens, and basically consists of creating an “internal bra” to produce internal support.  The incision pattern resembles the Anchor Method, as it does preserve the pedicle.  This internal bra is attached internally to the chest wall, and is made out of your tissue, so the chance of rejection is not there.  This Laser Bra does provide some distinct advantages, such as bottoming out doesn’t happen and also early sagging.

Read more about the "Laser Bra"

 

 

 

 

The surgery needed for a free nipple graft involves actually removing the nipple and part of the areola and grafting it to a new location as a skin graft.   Only the skin itself is removed, and all milk ducts are cut.  Since there is no pedicle involved, there is no blood supply from the actual breast itself. The blood supply in this procedure of a free nipple graft stems from the deep dermis, as all skin grafts do.  The fatty tissue is removed from the underside area of the nipple graft, and after the breast has been reduced and rebuilt, a circular area of skin the same size as the nipple graft is removed at the new nipple position and the nipple graft is sewn in place.  The nipple heals as all skin grafts do, by in-growth of new blood vessels from the underlying tissue.

With laser assisted breast reduction, it is not necessary to have a free nipple graft.  It is very important to make sure that if you need further surgery after your free nipple graft, that you tell your plastic surgeon exactly what you have had done.  Having a free nipple graft is easy to mistake it for the pedicle method of breast reduction.  It is vitally important to keep the blood supply to your free nipple graft; otherwise necrosis could happen to the nipple/areola complex area.

The incisions used for the free nipple grafts resemble the anchor pattern.

 

         Free-Nipple Graft - Breast Reduction Surgery     Free Nipple Graft - Breast Reduction Surgery

                                        2010 Copyright CosmeticSurgeryForums.com

              Patient with "Free Nipple Grafts" and also had a Full Breast Reduction

 

Free Nipple Grafts are not done that often because function and sensation are lost with this method.  With the procedure of Free Nipple Graft, the pedicle along with its blood supply and nerves are severed.  The entire nipple/areola complex is detached.  This procedure is normally reserved for women who have very large breasts.  This procedure is also reserved for older women who might not care as much if their feeling is loss in the nipple/areola complex area.

 

Medical conditions that might require your surgeon to perform a Free Nipple Graft include:

  • History of previous breast surgery

  • Radiation done to the breast

  • Diseases that damage blood supply or interfere with healing

  • Any medical condition that would require the patient to have the shortest possible general anesthesia

  • Gigantomastia (overly large breast)

 

 

  • ADVANTAGES AND DISADVANTAGES OF 'FREE NIPPLE GRAFT'

ADVANTAGES of Free Nipple Grafts:

 

DISADVANTAGES of Free Nipple Grafts:

  • Long residual scars

  • Nipple/Areola Complex Pigmentation

  • Sensory Changes

  • Possibility of incomplete graft take 

 

 

Some of the most common complication of the procedure Free Nipple Grafts:

 

Progression Photos of patient with Breast Reduction and Free Nipple Graft

 

 

 

 

More Links on Breast Reduction

 

 

Other Breast Health Links:

 

 

 

 

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