Excessively large breasts present many challenges for women.
For many people, large breasts can be perceived as a defect that must be kept hidden starting from puberty.
There are also difficulties in finding suitable clothes and underwear.
When the breasts grow a little bigger and heavier, the tedious difficulty of carrying this weight is also added to these concerns. Problems related to excessive sweating under the breasts are especially uncomfortable in summer months. Over time, the weight of the breasts causes hunched posture, neck, back and shoulder pain that do not get better. When the weight of the breasts is loaded on the special bras that are found with difficulty, the bra straps start to cut the shoulders.
The problems increase during pregnancy and lactation. It is also more difficult for the baby to suck milk from a large breast. In such cases, breast reduction surgery significantly improves the quality of life and can be performed from the age of eighteen.
Breast reduction surgery can be performed in various ways. The reason that different breast reduction surgery methods are still being used may be related to getting good results in most of them if applied well, certain methods being more appropriate for some people, better knowledge of some methods by the surgeon, and patient priorities.
How Is Breast Reduction Surgery Performed?
In all, the excess skin of the breast should be removed and the remaining skin recovered, the excess of breast tissue removed, and the nipple should be moved higher up, i.e. where it should be. Since all three of these processes can be performed in different ways, dozens of methods emerge. Which method is used affects the location of the resulting scars, the quality of the scars, the sensation of the nipple and the rates of milking. However, since there are some advantages and disadvantages in each method, there is no single method that is best for everyone. A good surgeon should be able to apply several methods according to the changing needs of the patient. On the other hand, patient satisfaction is determined by how skilfully the method is applied and an honest patient physician relationship, rather than which method is used.
Differences by Area and Quality of the Scar
- The area and amount of the scar is determined by where the excess skin is removed and how the remaining skin is recovered.
- In some methods, which have been used for the longest time in breast reduction surgery, there is a scar that is defined as “inverse T” due to its shape, which descends from the dark ring around the nipple, down to the inframammary fold and extends from the inside to outside on the inframammary fold. In these methods that are the most effective way to remove the excess skin and the best way to recover rest of the skin, the length of the scar is long but the shape of the breast and the scars even in the early period after surgery appear smooth and non-wrinkled.
- This method, which was thought to have no alternative for many years, was later altered by abandoning some advantages and new ones added. In the LeJour method and similar others, which aims to shorten the length of the scar by removing less skin, the marks are around the ring carrying the nipple and extending from there to the inframammary fold. No scars are formed on the inframammary fold unless necessary. However, as less skin is removed, the remaining skin needs to be recovered more, which makes it necessary to pucker the portion of the sutures which descends from the nipple, and it is not possible to give the breast the desired shape at first. In the months following the surgery, this puckered and amorphous appearance improve as a result of the sagging of the breast by gravity. In some people, this improvement may not occur; excess skin that is not removed from the inframammary fold in the first operation may need to be removed with a second operation at the expense of extending the scar.
- In the SPAIR technique, which is a new method, the placement of the scars is again around the nipple and from there to the inframammary fold and there is no scar on the inframammary fold. Remaining excess skin is now recovered around the nipple ring. In this method, although the breast is smoothly shaped from the early period and there is no need for secondary correction of the inframammary fold, the puckered appearance around the nipple may sometimes not improve naturally.
How the Nipple Is Moved Up?
In almost all methods, the nipple is moved in the body connected by a stem consisting of breast tissue and partially breast skin.
The blood vessels and nerves carrying the sense of the nipple pass through this stem and keep the nipple alive.
For breastfeeding, the amount of breast tissue connected to the nipple is also important.
Although most breast reduction techniques are able to preserve the nipple’s sensation and ability to give milk, these functions are preserved to a greater extent in methods that leave a larger amount of breast tissue under the nipple.
In some very large breasts, it is not possible to carry the nipple with a stem consisting of the breast tissue, because the stem is so large that it does not fit into the new breast of reduced dimensions. In these rare cases, the brown circle around the nipple is separated from the breast as a thin piece of skin and moved to the new location. In this case, the sense of the nipple is temporarily lost and the ability to breastfeed is prevented.
Before and After Surgery
Before the surgery, you decide with your doctor what kind of method to apply, new sizes of the breasts, location of scars and precautions to be taken against possible risks. As in every surgery, the general health status of the person to be operated is investigated.
It is beneficial for smokers to quit before surgery. On the day of the surgery, your doctor makes plans by drawing signs on your breasts.
After the surgery, your pain is relieved or alleviated with appropriate medication. Often you will find thin hoses called drains and their reservoirs attached to your clothes to remove liquids that may accumulate in your breasts. On the day after surgery, most patients feel well, the pain is very reduced and drains may have been removed. In the following two weeks, your examinations and dressings are performed at regular intervals and your stitches are removed.
Risks of Breast Reduction Surgery
As with any surgery, there are certain risks. These risks can be minimized by your doctor’s ability, experience, interest, and your compliance with your doctor’s recommendations. The majority of patients that go through breast reduction surgery, recover without any problems. In some patients, mild problems such as delayed wound healing, the removal of soluble sutures by the body, or rarely more serious problems such as bleeding within the breast, fat necrosis and infection may prolong the treatment period.