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.
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.
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.
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.
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.
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:
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.
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.
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:
Procedure time is short
and the patient is not under
anesthesia that long
