Breast reduction

Reduction mammoplasty (also breast reduction and reduction mammaplasty) is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the woman's body, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold — physical, aesthetic, and psychological — the restoration of the bust, of the woman's self-image, and of her mental health. Reduction mammoplasty (also breast reduction and reduction mammaplasty) is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the woman's body, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold — physical, aesthetic, and psychological — the restoration of the bust, of the woman's self-image, and of her mental health. In corrective practice, the surgical techniques and praxis for reduction mammoplasty also are applied to mastopexy (breast lift). The woman afflicted with macromastia presents heavy, enlarged breasts (>500 gm per breast per the Shnur Scale) that sag and cause her chronic pains to the head, neck, shoulders, and back; an oversized bust also causes her secondary health problems, such as poor blood circulation, impaired breathing (inability to fill the lungs with air); chafing of the skin of the chest and the lower breast (inframammary intertrigo); brassière-strap indentations to the shoulders; and the improper fit of clothes. In the woman afflicted with gigantomastia (>1,000 gm increase per breast), the average breast-volume reduction diminished her oversized bust by three (3) brassière cup-sizes. The surgical reduction of abnormally enlarged breasts resolves the physical symptoms and the functional limitations that a bodily-disproportionate bust imposes upon a woman; thereby it improves her physical and mental health. Afterwards, the woman's ability to comfortably perform physical activities previously impeded by oversized breasts improves her emotional health (self-esteem) by reducing anxiety and lessening psychological depression. The medical history records the woman's age, the number of children she has borne, her breast-feeding practices, plans for pregnancy and nursing of the infant, medication allergies, and tendency to bleeding. Additional to the personal medical information, are her history of tobacco smoking and concomitant diseases, breast-surgery and breast-disease histories, family history of breast cancer, and complaints of neck, back, shoulder pain, breast sensitivity, rashes, infection, and upper extremity numbness. The physical examination records and establishes the accurate measures of the woman's body mass index, vital signs, the mass of each breast, the degree of inframammary intertrigo present, the degree of breast ptosis, the degree of enlargement of each breast, lesions to the skin envelope, the degree of sensation in the nipple-areola complex (NAC), and discharges from the nipple. Also noted are the secondary effects of the enlarged breasts, such as shoulder-notching by the brassière strap from the breast weight, kyphosis (excessive, backwards curvature of the thoracic region of the spinal column), skin irritation, and skin rash affecting the breast crease (IMF). A woman develops large breasts usually during thelarche (the pubertal breast-development stage), but large breasts can also develop postpartum, after gaining weight, at menopause, and at any age. Whereas macromastia usually develops in consequence to the hypertrophy (overdevelopment) of adipose fat, rather than to milk-gland hypertrophy. Moreover, many women are genetically predisposed to developing large breasts, the size and weight of which often are increased either by pregnancy or by weight gain, or by both conditions; there also exist iatrogenic (physician-caused) conditions such as post–mastectomy and post–lumpectomy asymmetry. Nonetheless, it is statistically rare for a young woman to experience virginal mammary hypertrophy that results in massive, oversized breasts, and recurrent breast hypertrophy. The abnormal enlargement of the breast tissues to a volume in excess of the normal bust-to-body proportions can be caused either by the overdevelopment of the milk glands or of the adipose tissue, or by a combination of both occurrences of hypertrophy. The resultant breast-volume increases can range from the mild (<300 gm) to the moderate (ca. 300–800 gm) to the severe (>800 gm). Macromastia can be manifested either as a unilateral condition or as a bilateral condition (single-breasted enlargement or double-breasted enlargement) that can occur in combination with sagging, breast ptosis that is determined by the degree to which the nipple has descended below the inframammary fold (IMF). Breast hypertrophy (macromastia and gigantomastia) does not respond to medical therapy; yet a weight-reduction regimen for the over-weight woman can alleviate some of the excessive size and volume of her abnormally enlarged breasts. Physical therapy provides some relief for sufferers of neck, back, or shoulder pain. Skin care will diminish breast crease inflammation and lessen the symptoms caused by moisture, such as irritation, chafing, infection, and bleeding.