History of Breast Reduction
Scott W. Mosser, M.D.
article courtesy Scott W. Mosser, M.D.
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Breast reduction surgery has been performed for more than twenty years, but the procedure was not a common plastic surgery request until about six to eight years ago. It has now gained a popularity that puts it in the top five or six most frequently requested procedures.
The ultimate goal of breast reduction surgery (reduction mammoplasty) is to achieve a more pleasing balance between breast size and the other contours of the body and to relieve discomfort and symptoms associated with large breasts. Since size is a relative matter - what is the ideal size for one person may be too large for another - the motivations for seeking breast reduction surgery may vary considerably.
Where once women with overlarge breasts simply accepted their discomfort as their genetic heritage, just as small breasted women accepted theirs, the new openness and acceptance of a woman's right to control her own body contours has changed over the past twenty to thirty years.
The growing acceptance of cosmetic and corrective plastic surgery to obtain a balanced and more proportional body shape and the wealth of information available to the general public on this field of medicine has greatly increased the popularity of breast reduction surgery. Trends in health and fitness and more informal and revealing fashions in dress have also added to the desire to obtain a breast size that is in proportion to overall body shape.
For Medical Reasons or for Beauty?
The most common motivation for breast reduction surgery is to alleviate back and shoulder problems, neck pain and a host of other health and emotional problems caused by overlarge or disproportionate breasts. Difficulty in breathing and in sleeping comfortably, poor posture, and chronic rashes due to overlapping or drooping breasts are other disorders that can be minimized or eliminated. Many women also suffer emotionally from poor self image and lack of confidence.
Women who have undergone drastic weight loss may also need breast reduction surgery to bring their breasts into harmony with their new body contours, and to correct overextended and drooping breasts.
Another reason for breast reduction surgery is to correct inborn asymmetry between the two breasts, or in conjunction with reconstructive breast surgery following mastectomy on one side. Reducing the remaining breast in order to achieve a balance between the two is often necessary, especially if the patient is overweight.
Men also frequently seek breast reduction to correct gynecomastia, or enlarged breasts. This is a condition affecting a large number of men that is generally due to an excess of glandular tissue or as a symptom of various other medical conditions.
For whatever reason, breast reduction surgery is now among the top six reconstructive operations performed, with over 100,000 breast reduction procedures performed in the U.S. in 2004, according to the American Society of Plastic Surgeons. According to their statistics most women now seeking breast reduction surgery are young and in otherwise good health.
In cases where the reason is to correct a significant disability or disorder, the reduction surgery may be covered entirely or in part by the patient's insurance carrier. This is an issue that should be discussed at the outset with your surgeon, as specific preoperative documentation may be required.
Traditional breast reduction surgery techniques
In the mid 1980s the usual surgical method was the central pedicle reduction technique using the standard inverted T incision pattern, inferior pedicle technique reduction, or variations of the inferior pedicle technique.
Modern developments in breast reduction surgery include the limited incision techniques, using variations of the Lejour technique. The Lejour technique is a form of vertical mastopexy (breast lift) in which the blood supply of the nipple areola is superiorly based and the scar forms a lollipop appearance on the breasts (around the nipple areola and vertically from the areola to a point at the base of the breast). These techniques have a much lower risk of complications and less scarring.
Another advantage of this technique is that the surgeon can take up excess or loose skin at the same time the excess fat and tissue is removed from the breast and create an uplifted shape.
Breast reduction by Liposuction
There are many benefits to be gained by the newest methods of breast reduction using liposuction. Using the traditional breast reduction surgical techniques, sometimes the scars from skin removal can be quite visible. The nipple is also repositioned during the traditional technique that in some cases may prevent some women from breastfeeding after surgery. Loss of sensation or feeling in the breasts is also more likely following the traditional procedure.
Patients with excellent skin elasticity and requiring only a mild to moderate reduction are candidates for breast reduction using liposuction. From this procedure, the scars are relatively minor and are usually hidden under the breast fold. The preservation of breast and nipple sensation and the subsequent ability to breastfeed are more likely using liposuction because the nipple is less affected or not affected at all by this surgical procedure.
In breast reduction with liposuction the excess fatty breast tissues are extracted by the use of a cannula, or medical tube, inserted through tiny incisions made in the breast. This results in a decrease in the size and weight of the breast with less physical trauma to the breast tissue and minimal risk of complications and scarring.
The best candidates for breast reduction using liposuction are women with breasts that are not too large - usually no bigger than a DD - and have good skin elasticity.
Weighing your options in advance
Liposuction is a preferred option for many patients, but may not be indicated in some cases, and very satisfactory results can also be obtained from traditional surgical techniques. Depending on your medical history, your current health, your age, any planned weight gain or loss, anticipated breastfeeding, and your goals or expectations, you and your plastic surgeon can decide together on the method that will obtain the most satisfactory results for you.
As in all planned breast surgery, it is recommended that mammograms be obtained for patients aged 40 years and older. Some surgeons also advise mammography for patients aged 35-40 years who have a family history of breast cancer.
Whatever the motivation or technique, the goals are the same
The ideal breast reduction results in significant relief of symptoms while maintaining normal sensation and, in the case of young females, the ability to lactate. Additionally, the operation should result in an aesthetically pleasing breast shape with minimal scarring and a low complication rate.