BREAST REDUCTION

Breast size causes important health problems such as neck, back and shoulder pain that also reduce the quality of life.

• the dimple created by the bra strap on the shoulder,
• rash and bad odor under the breast
• limitation of physical activity and therefore inability to do sports
• Inability to move comfortably due to the constant feeling of people watching and trouble choosing clothes

The size of the breast tissue is determined genetically, especially the virginal hypertrophies. In addition, obesity, pregnancy and breastfeeding are some of the factors that increase breast size.

With breast reduction, the complaints that arise due to size are eliminated, and beautiful-looking (drop-shaped, proportional and symmetrical breasts with the most projectile part of the nipple) are aimed. This aim is tried to be achieved with the least trace and maximum milk production capacity. However, the technique used may vary depending on the size of the breast, tissue turgor, skin quality, skin to breast tissue ratio and the presence of additional congenital pathology, and the resulting scars and the amount of lactation change.

Breast size and the amount of sagging are some of the most important factors that determine the breast reduction technique. The possibility of having a child again and breastfeeding, age of the patient, skin quality are among the other determining factors. Studies have shown that some techniques reduce the amount of lactation more, while others completely eliminate it.

Depending on the technique used after breast surgery, scars are left in varying lengths and regions. While these scars are pink in the first days or weeks, they fade and turn into skin color after 3-5 months. If mastopexy (breast lift) is included, scars are left in three main ways;

circumareolar (only around the nipple – in cases requiring minimal reduction or mastopexy)

circumvertical (nipple scar continues down. Also called lollipop scar technique. In moderately large breasts)

reverse T, L scar technique (used to remove excess skin when breast tissue is removed in large breasts)

This nomenclature describes the scars that will form on the breast skin. At the same time, the design of the tissue that will supply blood to the nipple (nipple-areola) is also important. The important thing here is to continue the blood supply of the nipple. The inferior pedicle is still the most commonly used design. Apart from this, superior pedicle, superomedial, superolateral and central pedicles are also used. In very large breasts, it is more appropriate to use the nipple as a graft (the blood supply has been cut) because the nipple blood supply will be very risky (“free nipple” graft technique).

Preoperative cancer screening with mammography is appropriate in patients over 40 years of age. Those under the age of 40 with a family history should also undergo mammography and ultrasound. In the case of a suspicious mass revealed by these examinations, the operation protocol should be changed and the general surgeon should be included.

In any case, the breast tissue obtained at the end of the reduction is taken into pathological evaluation. The average duration of the operation is 3 hours. Depending on the technique used, this time may be shortened or lengthened with the amount of stitches to be sewn. The hospital stay is usually 1 day. A drain can be placed to take out the accumulated fluid in the surgical field. These drains are removed in a few days. The first dressing is done the next day to check the suture lines and the vitality of the nipple.

The sutures are mostly in the subcutaneous region and are sparsely placed on the skin. They are also taken on the 7th day. After the surgery, sports bras that do not contain metal strips or bras produced for this purpose are worn. After 1-2 months, you can switch to a normal bra. Control examination varies from patient to patient. 1 week of rest after surgery is usually sufficient. Bathing is allowed 48-72 hours after the operation or 1 day after the drain is removed.

Pain in the postoperative period is as much as in other surgeries and is controlled with painkillers used in the first few days. Rarely, short-term complaints such as stinging, burning, tingling continue for a while. Postoperative physical activities should be done to the extent that there is no pain. It would be appropriate to avoid heavy sports activities for the first 2 months.

Breasts will appear swollen after surgery. Studies have reported that the breast size has decreased by an average of 17% at the end of 3 months. As in other parts of the body, healing or taking the final shape of the breast, softening and reaching its form takes 6-12.

How much the breast will be reduced is decided together with the patient. The size of the patient’s rib cage, age, breast shape and how much reduction he wants are evaluated.

There may be bleeding, hematoma (blood accumulation in the tissue) during and after the surgery. It is important to check blood levels before surgery and to block blood when necessary.

Surgical scars may heal in some patients with an over-healing reaction such as hypertrophic scar or keloid. This condition is difficult to predict and the cause is largely genetic.

 

In the free nipple technique, the possibility of giving milk is theoretically eliminated. In some methods, it can decrease up to 30%. The choice of method is important in this respect.

In very large breasts, smokers, systemic connective tissue or blood diseases, the nipple may go into partial or complete necrosis. Although this is a very low probability, it is one of the risks that should be known before surgery.

Infection at the suture lines, separation at the wound line, fat necrosis are some of the problems that may be encountered in the postoperative period. Subcutaneous suture reaction and related stiffness may be felt in the suture lines.It can pass over time or can be cleared with local anesthesia.