Full Text from Dr. Berman's Book

Chapter 16


(Breast reduction and lift)

We all come in different shapes and sizes. Certainly, that is one of the fun aspects of appearance; variety being the spice of life. Unfortunately, our shapes and sizes are not always the way we want them to be. This is especially true with breasts. Whether it is from development or changes associated with pregnancy or aging, it is not unusual to have excessively large or drooping breasts. If it bothers you physically (i.e. back or shoulder pain) or psychologically (you don't like the way it looks) then a surgical procedure, breast reduction or breast lift, might be indicated. The relief of discomfort and improvement in appearance generally make these very gratifying procedures.

Typically, the nipple/areolar complex is relocated higher on the breast skin, while a section of breast skin and various amount of breast tissue is removed to achieve reduction. The resulting scar is around the nipple, then vertically down from the nipple to the breast fold and finally along the fold under the breast (i.e. an inverted T scar). There are other approaches which are available. For suitable candidates a concentric section of breast skin and/or tissue is removed resulting in one scar around the nipple (the Benelli technique). Because there is a lot of breast skin being sutured to the smaller areolar tissue, there is a pleated appearance to the closure. Amazingly, over the course of time this tends to smooth out. This procedure may be combined with liposuction to help reduce breast volume. Another technique is referred to as the vertical lift where the resulting scar is placed around the nipple and then down the vertical axis of the breast without a horizontal inframammary scar (the Lejour technique). This technique can be combined with the Benelli procedure in select cases and seems to improve results.

With any technique, steri-strips are secured over the wound and then changed on a weekly basis for 3 - 6 weeks in an effort to minimize the tension across the wound and thus help minimize the resulting scar. In any case, the scars generally heal well around the nipple area and the vertical incision. Interestingly, the scar at the breast fold, the "hidden scar", is the one with the most difficulty healing because it's under the most tension. Scars may take six months to a year to mature, lighten in color and thin down. Occasionally, a scar revision is necessary.

The particular surgical technique will determine whether there are any changes in function or sensation. There are several well established techniques for breast reduction, and a discussion with your doctor should help you understand his/her preference and why. I generally prefer a reduction technique where I maintain the nipple over the central core of the breast tissue. The excess breast tissue can be trimmed and not infrequently, liposuction can be used to reduce some of the fat volume. This technique usually maintains normal function and sensation. Nonetheless, there is still some risk of numbness or loss of sensation. Fortunately, it is usually transient and returns within weeks or months.

This operation is usually performed under general anesthesia, although intravenous sedation and local anesthesia can be used in select cases. It is an out-patient procedure, so you can go home after surgery and even return to work within a few days. Sutures are generally removed after one week, but as noted, special tape (steri-strips) are usually kept over the wounds for several weeks. Obviously, activity will be reduced during the initial recovery, but should return to normal within a few weeks.

Following a pregnancy, this young woman was dismayed by the loss of volume and the resulting sagging of her breasts. Following a mastopexy (breast lift) procedure, her confidence is restored with the improvement in appearance.

With these very large, heavy breasts, this patient found it difficult to exercise, let alone the discomfort she suffered from backache and pressure from her bra straps. Following reduction mammoplasty, she was able to comfortably take up jogging.

Breasts can come in all sizes and shapes. There is no need to believe that you have to live with the hand your dealt when a reduction mammoplasty can give you a rather normal appearance.

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