Breast reduction surgery is getting popular day by day awareness about the cosmetic surgery. Females with excessively large breast which are out of proportion to their body make them psychologically depress and they develop social issues.
Patient become more concerned about their large size breast because they are not able to wear dresses of their own choice and feel shy to go in parties with short dresses .
Candidates for breast reduction
- Females who are at young age before marriage around 15-20 year age and their breast becomes very large due to hormonal problem (gigantomachia)
- Females at puberty or after it develop some benign swelling and their breast size increases much.
- Females who are obese or overweight and their breast becomes huge in size
- Females who develop v large breast after multiple pregnancies due to hormonal changes which occur with feeding and pregnancy and their breast becomes large and also loose.
Evaluation and assessment
Patient visit the clinic and Dr Abdul Malik himself with her female assistant takes the detailed history including last breast Feed, Family completion or future conceiving, any lump or swelling in breast, any history of diabetes, blood pressure, heart problem or medications. Then Dr Abdul Malik examine the patient. During the examination he assess about size of breasts , shape of breast , asymmetry between two breast , asymmetry between location of nipples , any chest or breast deformity , size of chest , sogginess of breast , any lump in breast or any other associated problems . Then Dr Abdul Malik guide the patient about the technique of surgery, their pros and cons, side effects of each procedure, outcome and recovery and complications. Then base line blood tests are advised to patient including chest X-ray and ECG for fitness for anesthesia.
Type of incisions
Donut shape incision – mean incision or cut around nipple areola complex – with this incision mild to moderate breast reduction is possible
Lollypop incision / vertical technique- in this cut is made around areola and then cut comes down on breast. With this technique moderate to large size breast reduction is possible.
Inverted T incision – with this technique cut is made around nipple then comes down on breast and extends along the infirmary fold. With this large breast reduction is possible
Breast amputation with free nipple graft – in this technique when there is very large breast, use of this technique is helpful in which almost 80-90 percent breast is removed and nipple is repositioned as free nipple graft.
Vascular pedicle to preserve nipple blood supply
Blood supply to nipple is v important and different vascular pedicles are used for this purpose
1- superior pedicle
2-medial pedicle
3- superomedial pedicle
4- inferior pedicle with inverted T technique
5- central mound pedicle
Procedure
Procedure is usually performed under general anesthesia and before procedure marking is done in standing position. Position of infirmary fold is marked, new nipple position is marked, distance from clavicle is marked, distance from upper breast border is marked, vascular pedicle is marked and skin incision is marked. Then anesthesia is given and in supine position patient is paint and draped. Then infiltration of solution is done to decrease bleeding. Incision is given according to marking, de epithelisation of skin is done, then nipple is lifted up on vascular pedicle, then proposed breast tissue is removed. Hemostasis is secured, nipple is placed and stitched at new position. The same process is repeated on opposite side, symmetry is checked, then breast tissue is stitched and skin is closed and dressing done.
Post operative care and recovery
Patient is shifted to recovery room after the procedure and keep admitted in hospital for one day. Antibiotics and pain killers are given to patient. On next day patient is advised to mobilize herself and is discharged from hospital. For next 3-5 days antibiotics and pain killer are continued. Swelling and bruising can occur which usually settled in one to two week time period. After one week patient can return to work usually. Massage is advised to achieve symmetry and good healing. After 2-3 months good results are achieved.
Benefits
If procedure is performed by proper trained plastic and cosmetic surgeons then patient can get benifts in forms of
- Good shape
- Symmetry
- Increase confidence
- Pains which may occur with large breast are alleviated
- can wear dresses of their own choice
- reintegrate back /join the society
- long lasting results
Side Effects
Side effects are usually minimal in experienced hand but can occur which usually settle with time. These include
- Swelling
- bruising
- Pain
- Redness
- Infection
- Wound dehiscence
- Altered nipple sensation
- Compromise of nipple blood supply
- Asymmetry
- Scars hypertrophy
- Recurrence
Cost
Cost of procedure is variable depending on which technique of surgery is required by the patient. Cost is usually in range of 150 thousand to two lac rupees.