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Breast Reduction - Surgical Techniques

How is Breast Reduction Performed?

According to the American Society of Plastic and Reconstructive Surgeons, the most common type of breast reduction surgery involves "an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast."

In summary, the surgery is generally performed by three incisions made by your cosmetic surgeon. One is made around the areola – the colored area around the nipple. A second incision is made vertically from the bottom of the areola to beneath the breast crease. A third incision curves in the under-breast (Inframammary) fold.

Following removal of the excess tissue, fat and skin and the shifting of the nipple and areola into their new higher position, the surgeon then "brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast."
Skin that was above the nipple is lowered to the breast crease, allowing the surgeon to bring skin together and to reshape the breast.

Will the Nipple-Areolar Complex be Detached?
As a rule, the nipple-areolar complex remains attached to its blood vessels and nerves. While attached to its roots, it is gently moved up to a higher position on the breast in order to correct sagging. Under this circumstance, the sensation of the nipples is mostly preserved.

However, if a woman has especially large or pendulous breasts, the nipples or areolas may have to be completely removed and grafted into a higher position – with a subsequent loss of sensation in the nipple and areolar area. Sometimes the areola will be reduced in size.

Can a Breast Reduction Be Combined with Other Procedures?
You cosmetic surgeon will determine, based upon your medical history and needs, how many procedures can be done simultaneously. However, often Breast Reduction is performed simultaneously with a Breast Lift, or "Mastopexy." This is to address the sagging skin that has been caused by the weight of large breasts over the years.

Many women need a Breast Lift in combination with a Breast Reduction. Because of the volume of excess fat and glandular tissue that made breasts large and heavy, the patient's sagging is often not fully corrected. A Breast Lift places the smaller breasts higher up on the chest for a perkier and more youthful outcome.

Liposuction is another procedure that may be combined with Breast Reduction. Often, women with Mammary Hypertrophy have excess fat and bulging in their lateral chest wall, which is not contained by their bras. This area can be liposuctioned at the time of a Breast Reduction to further contour a woman's upper body.

What is the Nipple Pedicle Technique?
The most common type of Breast Reduction utilizes a nipple pedicle technique that keeps the nipple-areolar complex attached to its deep blood supply pedicle, or to a superior pedicle of skin. Through this technique, the nipple-areolar complex is raised to a higher position, while leaving it attached to portions of the underlying breast tissue for nourishment. Areas of surrounding skin and breast tissue are then removed to create a smaller breast. Remaining skin and breast tissue is then wrapped around the nipple-areolar complex in its new location.

What Are the Advantages of the Nipple Pedicle Technique?
One advantage is a lower rate of nipple loss. Another is that the nipples usually maintain their color and sensitivity. Also, many cosmetic surgeons believe this produces the most aesthetically pleasing outcome.

A disadvantage of this technique is that it is technically more challenging in women with very large cup sizes (E or larger), or very pendulous breasts, because they are more likely to have problems with nipple loss or loss of nipple circulation. However, in my practice, I have been able to utilize this technique very effectively even in women with very large breasts in order to help preserve their nipple sensation.

What Is the Free Nipple Graft Technique?
With the Free Nipple Graft Technique, the nipple-areolar complex is first completely detached and removed, and preserved for later in the operation. After the removal of excess breast tissue and skin, the remaining tissues are reassembled to form the new breast shape. Trimmed to a smaller size, the nipple-areolar complex is sewn onto the breast as a skin graft.

Because this procedure is faster, it is recommended for elderly women, women with major medical problems and for women where very large amounts of tissue will be removed. Disadvantages of this surgery include the loss of nipple sensation, inability to breast feed, and a flattened looking nipple-areolar complex.

What is Scar-Less Breast Reduction?
Besides the conventional Breast Reduction, which involves actually removing segments of the breast tissue and skin, the volume of the breast can also be reduced with Liposuction. The utility of liposuction for breast reduction, also called "Scar-Less Breast Reduction" is limited. First, only excess fat and not the breast gland can be removed. Second, excess skin cannot be removed which can potentially lead to breast sagging. Third, it is difficult to evaluate the removed fatty liquid for evidence of breast cancer. Finally, the resulting scarring from liposuction can potentially hinder adequate assessment of breast lumps during mammography. Therefore, liposuction is used selectively in those who don't need large reductions of breast volume, and who have very tight and elastic skin with no concurrent sagging.

I Am a Longtime Smoker. Will I Have to Quit?
Stopping smoking will greatly reduce your risk of surgical complications, and of complications during healing. Nicotine chokes blood vessels that feed the nipple-areolar complex, putting a patient at great risk of loosing their nipple and parts of their breast skin after surgery. Therefore, almost all cosmetic surgeons will demand that you refrain from smoking for at least some weeks before, and after, your surgery.

How Long Will the Surgery Take?
Breast Reduction is a delicate and complex procedure that can take from 3-6 hours depending on the size of the breasts and the amount of lifting that is necessary.
At your consultation Dr. Younai will review your treatment options for Breast Reduction, including pros and cons of each procedure, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. There are also many before-and-after pictures and high resolution images of Reduction Mammoplasty available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.

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