The breast volume reduction intervention , obtained through reductive mastoplasty, is a plastic and aesthetic surgery that allows you to reduce the size of a too voluminous and sagging breast or to correct a breast asymmetry. The breast reduction it also allows you to eliminate disorders related to excessive breast volume such as: back pain, cervical, lumbar and mammary region, headaches, breathing problems, dermatitis and ulcerations at the bra straps and in the submammary fold , as well as aesthetic and psychological problems resulting from the limitations that a too large breast can entail in the choice of clothing, in carrying out a sports activity, in the sexual life or in the social sphere of a woman.
The presence of very large breasts (hypertrophy) and sagging breasts (breast ptosis) can depend on genetic factors, hormonal receptivity of breast tissue or excessive weight gain. Breast hypertrophies can be classified according to Regnault and Hetter, Canada, in three different degrees (mild, moderate and severe) depending on the volume of the breast to be removed (up to 200 cc., Between 200 and 500 cc, between 500 and 800 cc. ) or based on the degree of relaxation of the breast and the position of the areola-nipple complex with respect to the submammary sulcus.
When the volume of the breast to be removed exceeds 800 cc. we speak of gigantomastia , a large breast hypertrophy associated, generally, with pathological alterations of the gland and supporting tissues. The surgical treatment of breast hypertrophy consists in the excision of the excess breast tissue, in the plication of the gland with fixation in a higher position and in the repositioning of the areola-nipple complex in a superior position. The reduction mammoplasty is a relatively complex operation which generally gives good results, provided, however, that it is performed by a specialist in plastic surgery, experienced in breast contouring, within duly equipped and authorized structures.
WHO IS THIS TYPE OF INTERVENTION FOR?
Reduction mammaplasty is indicated for women whose breasts, being too voluminous, can cause ailments such as:
- Back pain, especially in the cervical and lumbar region.
- Pain in the breast region.
- Breathing problems.
- Ulceration in the subammary fold and at the bra straps.
- Psychological and social problems that can condition women in daily life and / or sports and sexual activity.
A BIT OF HISTORY
The techniques for the surgical treatment of breast hypertrophy have undergone numerous changes over the years aimed at obtaining a harmonious breast, making results lasting over time, reducing the risk of complications and limiting scars as much as possible. The first reduction surgery was performed in England in 1669 by Durston. In 1854 Velpeau published a study on breast deformity classifying it as a pathology with harmful effects on health. In 1882 Thomas and Gaillard used a submammary incision fixing the gland at the height of the second costal cartilage. In 1897 Pousson performed a breast reduction through skin resections on the upper region and attachment of the gland to the pectoralis major muscle. The following year, Vercherè perfected this technique by practicing triangular resections on the external-upper region and removing the skin, adipose tissue and gland. In the years 1903 and 1907 Guinard and Morestin proposed an approach to the gland through the mammary sulcus with cone-shaped or discoid glandular resections. In the following years, elliptical resections were experienced in the upper part of the breast (Dehner), or of the entire lower edge of the gland at weekly intervals (Noel), or of circular cutaneous segments in one time and semilunar in two times (Kausch). In 1923 Kraske, describing a technique already used by Lexer since 1912, proposed a lower cuneiform resection that reduced the gland, fixing it to the pectoral muscle and bringing the areola up. In 1923 Lotsch invented a new technique, still widespread, which consisted of lifting the breast by moving the areola-nipple complex and removing excess skin through a vertical and periareolar incision. In 1927 Joseph proposed a different technique based on two incisions, the first rhomboid in the direction of the axilla and the second to sculpt an upper peduncle that was used to relocate the areola-nipple complex in the chosen location. Scharzmann in 1930 introduced a new technique called “peduncle” which consisted of isolating a peduncle in which the areola-nipple complex was included in order to maintain vascularization and avoid necrosis. An inverted T scar remained. In the 60s and 70s many other techniques were proposed by various authors including Strombeck (1960), Pitanguy (1960), Skoog (1963), Mc Kissock (1972), Pontes (1973), Regnault (1974) and Goldwyn (1977). Finally, starting from the 80s Gruber, Jones and Benelli were the promoters of the periareolar technique to correct moderate degrees of breast hypertrophy, while for the most severe hypertrophies and with a high degree of ptosis, different surgical techniques were designed with the aim of achieving an aesthetically more harmonious form with the least number of scars possible.
ARE THERE AGE LIMITS FOR SUBJECTING A REDUCING MASTOPLASTIC?
There are no age limits to undergo this type of intervention, but it is preferable to wait for the complete development of the breast which generally occurs around 16 years of age and in some cases to adulthood.
WHAT OTHER INTERVENTIONS CAN BE CARRIED OUT TOGETHER WITH REDUCING MASTOPLASTICS?
The reduction surgery of breast volume can be performed alone or in combination with other cosmetic surgery (eg. Mastopexy) provided they are not too heavy for the patient.
WHAT ARE THE RISKS AND COMPLICATIONS OF THIS TYPE OF INTERVENTION?
Reduction mastoplasty is a relatively complex surgical procedure that generally gives excellent results, of great satisfaction both for the patient and for the surgeon who performs it. When this type of surgery is performed by a specialist in plastic surgery, experienced in breast modeling and authorized facilities, the results are generally very good. However, it is a real surgical procedure where complications (bleeding, infection) are infrequent but can still happen and be easily resolved only if the intervention is performed by a specialist within duly authorized structures.
To reduce the risk of complications, however, it is essential to carefully follow the advice and instructions that the surgeon will give you before and after surgery. Smokers should decrease the use of cigarettes because smoking can increase the risk of complications and cause healing delays.
HOW IS THE PRE-OPERATIVE VISIT DONE?
Before proceeding with breast reduction surgeryit is necessary to undergo an accurate specialist visit during which the surgeon will measure the size, shape and position of the breasts, areola and nipple, and examine the quality and characteristics of the breast tissues in order to identify the degree of breast hypertrophy and choose the surgical technique that allows you to give your breast an adequate volume and a harmonious shape with a reduced scar outcome. During the visit, the surgeon will have to evaluate your current and previous health status in order to exclude the presence of complications such as high blood pressure, clotting or scarring problems, which could compromise the final outcome of the surgery.
WHAT TYPE OF ANESTHESIA IS PRACTICED?
The reduction mammoplasty is generally performed under general anesthesia with or without intubation (ie only with the aid of the laryngeal mask) in day-hospital regime.
In case of severe hypertrophy or gigantomastie , the operation is performed under general anesthesia and requires one or two nights of hospitalization in the clinic.
Before the operation, the anesthesiologist will proceed to a careful pre-operative visit and prescribe a list of routine tests such as: electrocardiogram Blood count PT, PTT, fibrinogen Electrolytes Glycemia, nitrogen, creatinemia Serology (hepatitis B, C and HIV virus) Visit breast with breast ultrasound and / or mammography
WHERE ARE THE ENGRAVINGS MADE?
Depending on whether they are small, medium or large reductions, the incisions can be made only around the areola or descend vertically up to the submammary sulcus and along the lower fold of the breast (so-called anchor-shaped or inverted T incision). Reduction mammaplasty will leave permanent scars that will still remain hidden inside the bra or swimsuit.
HOW LONG DOES THE INTERVENTION LAST?
The reductive mastoplasty operation lasts from an hour and a half to about three hours, is absolutely painless and ends with a small dressing and the use of a bra.
WHAT IS THE POST-OPERATIVE COURSE?
In the 48 hours following the reduction mastoplasty operation, you will have to rest. In the first two days, swelling and bruising may appear around the treated region. Bleeding, infection, keloid scars and changes in the sensitivity of the areola and nipple (especially in smoking patients) and difficulties in future breastfeeding may rarely occur. Starting from the third day, you can resume a normal life while avoiding strenuous activities, saunas, Turkish baths and sun exposure. After 7-10 days you can resume your work if not too tiring. Three weeks after the surgery, you will gradually resume all normal activities including sports.
WHAT TYPE OF RESULT CAN BE OBTAINED WITH REDUCING MASTOPLASTY?
The aesthetic result achievable with this type of intervention is generally very satisfactory and long-lasting but not permanent, as it will always be conditioned by your lifestyle (weight gain and loss, pregnancy, smoking, etc.) and by the inevitable effects of gravity and aging.
REDUCING MASTOPLASTY: COSTS
The breast reduction has a cost that can range from € 8,000 to € 12,000 depending on whether the operation is performed on an outpatient or inpatient.
FAQ REDUCING MASTOPLASTIC
Q. I am 15 years old and I already have a very large breast (7th size). What problems could it cause me in the future?
A. Gigantomastia (or breast hypertrophy), i.e. excessive breast volume and weight, can cause ailments such as back pain, especially in the cervical and lumbar region, pain in the mammary region, sometimes breathing problems, ulceration in the submammary fold and in correspondence with the bra straps, as well as psychological and social problems that can condition the woman in daily life and / or sports and sexual activity.
Q. What does the excessive breast volume depend on and how can it be reduced? Is a diet sufficient?
A. In non-overweight women, excessive breast volume is predetermined from birth. In a woman around 20 years of age, the breast volume is made up of about 50% of glandular tissue and about 50% of adipose (fat) tissue. Over the years the percentage of glandular tissue decreases to be replaced by adipose tissue. To decrease the volume of a breast that is too large, diet or exercise is not enough as neither one nor the other affect the percentage of glandular tissue that can be reduced only by means of a reduction mammaplasty intervention.
Q. After breast reduction surgery, will I be able to breastfeed normally?
A. Women who undergo breast reduction surgery may have problems breastfeeding, especially when the reduction in breast volume has been particularly abundant.
Q. How and where are scars done in breast reduction surgery?
A. Depending on whether they are small, medium or large reductions, the incisions can be made only around the areola or descend vertically up to the submammary sulcus and along the lower fold of the breast (so-called anchor-shaped or inverted T incision) . The reductive mammaplasty will leave more or less visible permanent scars that will remain hidden inside the bra or swimsuit.
Q. Is breast reduction surgery painful?
A. No. After surgery, a slight soreness may occur in the breast region which can be effectively controlled with analgesics.
Q. I am 38 years old and after two pregnancies my breast, which was previously a fourth size, has become smaller and sagging. What can I do to return as I was before?
R. The intervention indicated to solve your problem is breast lift, technically called mastopexy. The women who require this type of intervention are mainly those whose breasts have lost their original shape and volume due to factors such as pregnancy, breastfeeding, gravity and aging. The mastopexy intervention is particularly suitable for women with small and sagging breasts because in the case of very abundant breasts, the aesthetic result obtained can be subsequently compromised by the effects of gravity. If the patient wishes to raise the fallen breast and restore the volume that has been lost, it is advisable to associate the insertion of a small breast implant to the mastopexy.
D. I would like to lift the breast without putting on prostheses. Is there an intervention that gives me this result without leaving scars?
A. No. The intervention of mastopexy necessarily involves scars either only around the areola (in small round-block mastopexy) or periareolar and vertically up to the submammary sulcus (mastopexy with vertical scar) or even along the lower fold of the breast ( inverted T or anchor mastopexy).
Q. Are the scars in mastopexy and reductive mastoplasty very evident? A. Mastopexy and reductive mastoplasty leave scars whose best or worst quality will depend not only on the skill of the surgeon but above all on the congenital ability to heal of the individual patient.
Q. Will my nipple sensitivity remain the same after breast reduction surgery?
A. Sometimes there is an alteration of the sensitivity of the areola and the nipple which is in most cases transient and only rarely permanent.
Q. How do you apply for funding for reductive mastoplasty surgery?
A. It is possible to request the payment in installments of the reductive mastoplasty intervention , asking your cosmetic surgeon what are the methods of financing cosmetic surgery in cases where there is no immediate financial availability to pay for an intervention.
Q. Do I have to give my consent to breast reduction surgery?
A. Yes, before undergoing surgery, the patient must give their informed consent to the surgery.
Q. Is reductive mammaplasty loanable?
The reduction mammoplasty is loanable only and exclusively in cases of gigantomastia true , namely in those cases where big breast has the size resulting in a reduction during the operation of at least one 1 kg of glandular and fatty tissue for each breast. To give an order of measurement, interventions ranging from the seventh measurement upwards can generally be carried out .
Many women turn to public facilities to request this surgery, but the hospital doctor often refers the patient back because the woman has too small breasts.