This content created by Mustafa Murat Öztürk, MD with attribution to scientific articles.
Breast reduction surgery, which is defined as 'reduction mammaplasty' in medical language, is a preferred type of operation depending on whether the breasts are larger and sagging than normal or the medical problems they cause. In other words, breast reduction surgery can be performed due to medical problems as well as aesthetic concerns. In addition to the reduction of large breasts genetically, breast reduction operation, which is applied to lift the sagging breasts after the breastfeeding period, is also applied to prevent back and shoulder pain, wounds and infections under the breasts depending on the size of the breasts. Breast reduction operation can be performed depending on the relief of the pressure on the shoulders caused by the bra straps and the restriction of physical activity.
In addition to all these, breast reduction surgery can only be performed on people who are uncomfortable with the appearance of their breasts. The operation, which takes approximately 2.5 to 4 hours depending on the breast size, is performed by removing the skin and breast tissue using inverted T or lollipop incision methods. After the operation, the patient can continue her/his daily life within 1 week. Small incisions and stitch marks that are visible after the operation turn into skin color after about 3-4 months and become vague.
Breast reduction surgery, or in other words, reduction mammoplasty, can be performed for medical reasons besides aesthetic concerns. The operation is usually performed for reasons such as sagging, not looking beautiful, not being symmetrical, not being able to find clothes, depending on the size of the breasts. Medical reasons are applied to relieve shoulder, neck and back pain or to prevent humpback caused by the size of the breasts and thus their weight. Depending on the size of the breasts, prevention of diaper rash, fungus, infection or wound formation under the breast, elimination of pressure sores caused by bra straps are among the reasons of breast reduction surgery performed due to medical reasons. People with large breasts also encounter difficulties during daily physical activities.
In addition to genetic factors, a person's lifestyle can also cause breasts to grow or lose shape over time. Factors such as being overweight, pregnancy, breastfeeding, hormonal irregularities, some disorders and age may also cause breasts to grow or lose their shape. In this respect, breast reduction surgery is performed to eliminate both aesthetic concerns and medical problems. The aim of breast reduction surgery is to obtain a breast in the desired size, equal size, symmetrical and aesthetic appearance with the least scarring possible.
Breast reduction surgery, which is performed by removing the fat tissue in the skin and breast, is a type of operation applied to people aged 20 and over, whose body development is completed. Breast reduction surgery, which requires completion of physical development as well as hormonal regulation, can be applied to people under this age only in the presence of medical necessity. Breast reduction surgery is performed under general anesthesia. The surgery is completed within 2.5 to 4 hours, depending on the size of the breast, using lollipop incision and inverted T incision methods.
In determining the method, parameters such as breast size, position of the nipple according to the breast fold, breast tissue, skin structure, distance between nipple and shoulder and hip are taken into consideration. In the lollipop incision method, the circumference of the nipple is cut circularly and then the breast tissue and excess skin tissue are removed. In the procedure performed considering the physical appearance of the person, the nipple can be moved upwards when necessary.
Taking care not to damage the milk ducts, the skin is closed and the surgery is completed by placing a drain in the area to accelerate the healing and expel the blood accumulated in the breast. In the reverse T incision method, an inverted T letter incision is made at the bottom of the breast. After the excess breast tissue and skin are removed, the operation is terminated as in the lollipop type incision method. After breast reduction surgery, the patient must stay in the hospital for one day.
After the drain is removed and the dressing is done, the patient is discharged. Control is done at the end of the 1st and 2nd week after the operation. During the control in the 2nd week, stitches are removed and special creams are used to reduce the scars. Thanks to the special bra, the patient can return to her/his daily life after 1 week of home rest. However, it is recommended to wear a special bra similar to a sports bra for 6 weeks. A mild stinging and aching may be felt in the breasts for 6 to 12 months after the operation. However, this feeling is not of a nature that will reduce the quality of life of the person.
It is recommended to rest at home for at least 3, optimum 7 days after breast reduction surgery. It is extremely important to use antibiotics and pain medications prescribed by the physician after the operation at the specified dose and time. The use of a sports bra that does not put pressure on the breasts and prevents shaking is also of great importance in reducing the amount of pain and shaping the breast. After the operation, the doctor determines the dressing days. Dressing on these dates accelerates healing while reducing the risk of possible infection. It is necessary not to carry heavy loads, push and pull movements for about 4 weeks.
Light exercise movements can only be done after the first month. Lifting weights and movements that force the arm and chest muscles should also be avoided. After breast reduction surgery, the breast tissue appears edematous and swollen. This swollen appearance decreases in about 3 to 4 weeks and it takes about 1 year for the breasts to regain their real appearance. Smoking and alcohol consumption should be stopped for at least one month after breast surgery for rapid recovery of tissue and scar tissue. Since smoking and alcohol consumption affect cell regeneration, it also negatively affects the visibility of the surgery scar.
As with any operation, there are some risks in breast reduction surgery. There may be bleeding, blood loss, hematoma (blood accumulation in the tissue) during or after breast reduction surgery. A certain amount of blood loss occurs with the removed breast tissue. For this reason, it is important to have blood values within normal limits before surgery. Conditions such as delayed wound healing or significant scarring (hypertrophic scar - keloid) may occur especially in diabetics, heavy smokers or those who are familially prone to bad scar development. These patients can be treated with some special methods.
Breast reduction surgery cannot be done without cutting the milk ducts. Some, if not all, of the milk ducts are cut with the breast tissue removed. Therefore, there may be a breastfeeding problem after surgery. However, by using some special techniques, this possibility can be kept at very low rates. There may be infection, inflammation, wound opening, stitch burst. These situations can be corrected with timely intervention. The opened stitch can be sewn again. After breast reduction surgery, there may be fat necrosis, that is, breakdown and melting of fat tissue.
Therefore, discharge may occur from the wound edge or between the stitches. After breast reduction surgery, there may be pain, burning and stinging sensation in the breasts. There is a risk of losing the nipple when using methods that protect the nipple in very large and sagging breasts. It would be more appropriate to prefer techniques in which the nipple is applied in the form of a patch to patients with such a risk. It is possible to reconstruct the nipple by using methods that combine surgical methods with tattoo application in patients with nipple loss.
As with almost all operations, there may be a scar on the skin after breast reduction surgery. The shape and size of the leave varies according to the technique used during the operation. Surgical scar is less in the type of lollipop type operation. The reason for this is that the incision is small and the incision is around the nipple. In other words, the scar between the skin and the nipple is almost not noticeable due to the color difference in this area. In reverse T type surgery, the scar is larger. The incision down the nipple becomes less pronounced by gaining skin color over time. The horizontal line at the folding point of the breast is not visible unless you look from the opposite side. The surgery scar also varies depending on how much the breast sags or how much it wants to be reduced.
The size of the breast, the position of the nipple in relation to the breast (the rate of sagging in the breast), the age of the patient and the plan to have a child later are the effective factors in the selection of breast reduction technique. It is possible to preserve the breastfeeding function with techniques that protect the mammary gland and its connection with the nipple. However, breastfeeding function can be sacrificed within the knowledge of the patient in order to provide sufficient reduction in excessively large breasts. Actually, there is no clear answer to this question. It is useful to know that there is a risk.
Breast reduction surgery does not cause cancer development. However, the possibility of an undiagnosed cancer should be eliminated with some preoperative examinations (mammography, ultrasound) in patients with a family history of breast cancer and those over the age of 40.
In addition, the breast tissue removed by surgery should be sent to pathological examination, and whether there is an overlooked condition before surgery should be controlled. Since most of the breast tissue is removed with breast reduction surgery, the possibility of cancer formation later decreases. Some studies on a large number of patient groups originating in the United States support this argument.
After breast reduction surgery, the hospital stay is usually 1 day. Drains that remove the accumulated fluids in the operation area are not used much recently. However, it is used in very large breasts. After these are removed and the dressing is completed, the patient who wears a sports bra is discharged. Controls are done in the 1st and 2nd week. After the stitches are removed in the second week, scar treatment is continued. Shower can be taken on the 4th postoperative day. Generally, 1 week of rest is sufficient after the operation. Since the sports bra is used, the patient feels safe and can go to work.
Breast reduction surgery can also be performed on men. The development of feminine breast tissue in male patients is called Gynecomastia. While gynecomastia occurs in everyone during adolescence, it does not regress in 10-15 percent of the patients in advanced ages and becomes permanent.
breast size may occur in men.
Before deciding on breast reduction surgery in men, the reason for breast size should be determined first. The amount of skin and how much tissue excess should be taken into account when making a decision for gynecomastia correction. While the fatty tissue is removed by liposuction method, the hard tissue remaining under the nipple is removed with a small incision made in the dark area of the nipple without leaving any scar. If the excess skin in the breasts is too advanced, it may be necessary to perform breast reduction with traces, as in women breast reduction.
The patient's shoulder width, chest circumference and general dimensions of her/his body are the criteria used to obtain a breast that is aesthetically proportional to the patient's body. In patients whose breastfeeding function is essential (unmarried, young patients who have not given birth), breast can be reduced to a certain extent. The doctor should evaluate the measurements s/he will make during the examination and inform the patient about how much her breast can shrink.
Pain after breast reduction surgery is not different from other surgeries. Pain can be easily controlled with painkillers and ice application. There may be occasional burning, stinging and slight tingling in the breasts for 6 - 12 months postoperatively. However, there is no severe pain.
Published: 11 Ekim 2020
Updated: 25 Şubat 2021