Breast reduction surgery

One of the types of surgical correction of the breast is reduction mammoplasty, that is, operations to reduce the mammary glands.

The purpose of such an operation is to reduce the volume of mammary glands too large, incommensurable with the rest of the body.

[1], [2], [3], [4], [5]

Reduction mammoplasty: indications and contraindications

First of all, indications for a plastic surgery for reducing large breasts include sensed physical discomfort: when the owners of a lush bust feel constant pain in the back area due to increased stress on the spine and a prolonged strain of the muscles that straighten the back and lift the shoulder blade. This negatively affects the posture, forcing to stoop under the weight of the breasts. In addition, bra straps with a large breast often cut into the shoulder, the worn out blood vessels and nerves leading to the neck and head. So it can hurt not only the back, but also the head.

Also to reduce the mammary glands resorted in cases of permanent problems with the skin under the breast during mastoptoze (sagging of the mammary glands). Under the heavy glands that lie on the chest, the moisture emitted by the skin and sweat evaporate poorly. From this develops maceration, that is, loosening of the stratum corneum. As a result, the epidermis of wet areas can exfoliate, causing inflammation of the skin.

Among the indications for reduction mammoplasty specialists call hypermastia (abnormally large breasts) and asymmetry of mammary glands (when one breast is bigger than the other). Plastic surgeons can reduce breasts in men with gynecomastia.

In this case, surgery to reduce the mammary glands has the following contraindications:

• presence of respiratory infections at the time of surgery;
• any oncology;
• diabetes;
• severe forms of obesity;
• not diagnosed in the mammary gland;
• heart failure and circulatory disorders;
• chronic somatic diseases in the acute stage;
• decreased blood clotting;
• pregnancy and lactation;
• age to 18 years.

Preparing for an operation

About the preparation of the operation for breast reduction, patients are informed in detail by the surgeon who will conduct it.

Obligatory examination mammologist and a complete history of gynecological and general diseases, ultrasound or x-ray of the mammary glands, as well as ECG.

It is necessary to pass blood tests: general, biochemical, for sugar, for RW and hepatitis, for coagulability (coagulogram).

As a rule, with obesity, patients are recommended to first get rid of extra pounds and postpone the operation until the weight is lowered.

Two weeks before the scheduled operation, you should stop using alcoholic beverages, especially red wine; it is forbidden to take anticoagulants and antithrombotic drugs (Acetylsalicylic acid, Dicumarin, Warfarin, Fibrolizin, etc.).

After the shower, which must be taken on the eve of surgery, you can not apply cosmetics, use deodorant, cream, perfume, etc.

To make it easier to transfer anesthesia, you need to stop taking food and drink any liquids 5-6 hours before the scheduled operation to reduce the mammary glands.

Types of operations to reduce mammary glands

To date, such types of breast reduction operations as reduction (reduction plastic surgery) of mammary glands and mastopexy are performed. If the essence of mastopexy is only in lifting the sagging breasts by excising the skin, then in the course of reduction through the incision the surgical portion of the glandular and adipose tissue of the breast is preliminarily indicated by the surgeon, as well as the segment of the skin that becomes superfluous after a decrease in the volume of internal tissues. In addition, the nasal zone (areola) and nipple - with partial or complete separation - are raised and sewed higher.

All this is done under general anesthesia. After the sutures that tighten the edges of the postoperative wound, drainage is performed (with the drainage tube outward), then a sterile bandage is applied in the form of a gauze bandage around the upper part of the thorax. The duration of the entire operation ranges from three to five hours (depending on the volume of tissue removed and the size of the skin flap that closes the wound).

With a large volume of adipose tissue in the mammary glands, breast reduction with liposuction can be performed. But this is not suitable for all women. As experts in the field of plastic mammology note, liposuction for breast reduction is possible with fatty degeneration of the glands with the onset of menopause, and also to correct asymmetry of the breasts to one size. But with pronounced mastoptosis, fibrous cords in the breasts, low nipple location and loss of skin elasticity, liposuction is contraindicated even for a slight reduction in mammary glands.

Consequences and complications of the operation

Each patient is warned by the doctor about the short-term and possible long-term consequences of surgical intervention, and also instructs in detail about the postoperative period (changing bandages and cleaning the drainage tubes) - to avoid complications.

The consequences of the operation to reduce the mammary glands:

• discomfort and pain (to reduce it will require pain medication);
• hyperemia and swelling of mammary glands and adjacent soft tissues;
• numbness or change in nipple sensitivity;
• itching around the incisions on the chest and a feeling of increased hardness of the tissues in the mammary glands (lasting from several to three months after the operation);
• swelling of the hands and restriction of their mobility (from six to ten weeks).

Long-term consequences are expressed in the fact that in many cases the opportunity to breast-feed is lost, and the sensitivity of the breast and nipples is irreversibly reduced.

The most likely postoperative complications are the formation of hematomas; divergence of sutures on the wound; bleeding; infection and suppuration of the wound; deformities of the mammary gland; inflammation of the nipple or areola; formation on the site of postoperative scars of coarse keloid scars.

[6], [7], [8], [9], [10], [11], [12]

Rehabilitation period

It is important to consider that the duration of recovery after surgery - the rehabilitation period - varies depending on the individual characteristics of each patient. And with extensive excision of breast tissue this period will always be longer.

Usually after the operation, stay in the medical institution is no more than three days, and just on the third day, a bandage and drainage is removed. However, if the wound is not protected by absorbable suture material, the sutures are removed for 8-12 days. And before they are removed, you need to properly care for the seams: they need to be treated with medical alcohol and use only a sterile bandage.

In advance, you need to buy a specially designed for these patients compression bra, which must be worn for two months - round the clock.

Sleep and rest lying is necessary on the back, with a head raised to a height of 30-45 °. And that in a dream not to turn on its side, it is advised to put cushions on both sides of the body.

Physical exercise, except walking at a calm pace, is absolutely contraindicated for at least three months. Hot showers and taking baths under the ban for at least a month: the shower is only warm (and only after the removal of stitches). From ultraviolet rays should be sheltered in the shade (that is, sunbathing is contraindicated).

Also, you should increase the consumption of liquid (preferably water), and products and beverages containing salt should be avoided.

Observing the recommendations of doctors, after about six months you can see the real results of the operation to reduce the mammary glands.