Breast Reduction and Mastopexy
Breast size and sagging (ptosis) may occur alone or a (mostly) together. If each breast is heavier than 500 grams, the size can be discussed; and if the nipple or breast tissue reached or exceeded the inframammary line, the sagging can be discussed. Almost identical processes are carried out for both of these. In the both conditions, the nipple and areola are pulled to a higher position, and usually a certain amount of tissue is removed for recovering the breast tissue. The difference between them is related to the removed amount of the tissue. If less than 300 grams of breast tissue is removed from each breast, it is generally considered to be mastopexy.
Ptosis Classification (Regnault): Class A: Mild ptosis. The breast nipple is aligned to the inframammary line. Class B: Moderate ptosis. The breast nipple is below the inframammary line. Class C: Severe ptosis. The breast nipple is at the lower part of the breast contour. Class D: Glandular ptosis. The nipple is in its normal place. The breast tissue is saggy.
Complaints from patients, caused by breast bigness: Headache, neck ache, back pain, rashes under the breasts, formation of painful grooves caused by bra straps, fatigue, difficulty in breathing while lying on back, clothing problems etc. The patient usually buys clothes and underwear in sizes different from each other. The patient cannot obtain an adequate smallness in her breasts by losing weight. After breast reduction surgeries, patients become more motivated to lose weight.
Treatment options are as follows:
Augmentation (alone or in combination with a mastopexy technique)
Periareolar scar technique
Circumareolar scar technique (in combination with periareolar purse-string closure technique)
Vertical mastopexy (only vertical scar but it may rarely include a short horizontal component)
Vertical and horizontal scar technique
Free nipple-areola technique
All breast reduction and mastopexy operations definitely leave a scar. In all of them a scar definitely occurs around the areola. It is the only scar in some methods. This method can be used in the cases of mild sagging. But in more serious cases, a quite wide circular skin and tissue part around the areola need to be removed. This is often inadequate to produce the desired result, and also leads to two unfavorable results. Firstly, breast projection that is the most important component of mammoplasty decreases. The breast gets flattened as though they have hit somewhere. Secondly, the scar that occurs there gets increasingly wider even if the puckered tissue around the areola is said to be recovered, and even if it is really recovered. Therefore, in moderate and severe cases, you need to take the risk of at least a vertical straight line descending from the lower point of the areola towards the under breast line. This technique, known as vertical mammoplasty, I-scar, and lollipop scar technique, is the most widely accepted technique across the world in recent years. In very big and saggy breasts, a scar extending to the under breast line may occur, as well. In this way, an inverted T-shaped scar remains (horseshoe scar). In this method, much scar occurs, the nice appearance achieved at the beginning disappears in a short time, and the breast begins to sag (bottoming out). However, experienced breast surgeons perform reduction operation with vertical mammoplasty technique, in almost all breasts in any sizes. In this operation, excess skin tissue under the breast is shrunk and the breast tissue is pushed upward. This too much lifted and puckered appearance disappears upon the settlement of the tissues, within 1-2 months. At this point, since the lower breast tissues forming the sagging are already removed, the breasts maintain their lifted and aesthetic appearance for many years.
Problems in this case:
Early: Bleeding-hematoma-infection: It is very rare. * Nipple and areola necrosis. Despite being rare, it is a risk in too big breasts. Free nipple-areola technique is used in these cases. The nipple-areola is removed as a very thin layer, and then is placed in its new location as a graft.
Late: Breastfeeding: It generally depends on the technique used. If the patient definitely intend to breastfeed in the future, she should warn the surgeon in advance. * Sensation: The sensation of nipple in women with big breasts is already decreased. The sensation returns in the course of time (up to 6 months) but its extent depends on the technique used.