Breast reduction surgery or reductive mammoplasty consists, as its name suggests, mainly in a reduction of breast volume in proportion to the patient’s anatomy. In addition, this intervention also allows correcting other associated alterations such as, for example, the great fall of the breast (ptosis) as well as the excessive size and sagging of the nipple-areola complex (CAP).
This type of surgery is mainly intended to unload weight and breast volume to the patient, relieving the permanent tension supported by the skeletal muscle structures of the neck and back and that in the long run, end up causing real pain, discomfort and even incurvation of the spine.
Therefore, as pointed out by Dr. Andrés Merlo, this type of surgery can be considered as a repairing surgery, although secondarily it also improves the aesthetic aspect of the breast, harmonizing and adapting the shape and size of the breasts to the woman’s anatomy as a whole.
Other techniques: Mastopexy or breast lift
Breast lift or Mastopexy is a technique aimed at correcting the abnormal sagging or drooping of the breast that occurs over time, but can also occur as a result of breastfeeding or excessive thinning. It can also be appropriate in women who present gigantomastia from the beginning and in which there is, in addition to sagging, very bulky breasts.
When a breast presents descent of the lower segment below the submammary fold, it is considered a ptotic or sagging breast. Depending on the volume of the breast, there are different techniques to correct its sagging. Thus, for those cases of low breast volume, associated with little sagging, with skin with almost no stretch marks and good quality, more common in young women, mammoplasty with submuscular implant is usually sufficient to raise the breast to its optimal point.
On the other hand, if the sagging is greater as a result of excess skin with less amount of gland, it will be necessary to resort to different techniques to remove this excess skin and reposition the breast. In this case we would be talking about simple mastopexy. However, if in addition to raising the breast it is necessary to proportionally increase the volume of the breasts, so it will also be necessary to resort to the placement of implants, we will be talking about a composite mastopexy (elevation and prosthesis).
In cases of gigantomastia it is necessary to perform a reduction mammoplasty with other types of techniques whose main purpose is to reduce the volume of the breast and secondarily to correct the sagging of the breast and the position of the PDA. The indication of the most suitable technique is determined by the situation of the caudal pole of the breast, that is to say, the portion of the breast that goes from the PDA to the submammary fold. When this portion exceeds the sulcus we are talking about ptosis or sagging and there are different medical degrees of sagging depending on the severity of it. Any woman who presents this problem is a candidate for this type of surgery.
What is the most appropriate technique for each case?
The choice of technique depends on several factors such as: the degree of ptosis, the volume of the breast, the quality of the skin, the size of the areolas, the age of the patient or the level of psychological impact.
Breast augmentation surgery requires a thorough examination of the patient as well as providing her with all the detailed information concerning the surgical procedure (type of anesthesia, approach route, pocket location, etc.), characteristics of the implants and, very importantly, the possible complications in the short, medium and long term.
This information is essential because when a foreign body is permanently introduced into the body, our body will always react against it, in one way or another, and sometimes it produces important consequences that require secondary surgeries (encapsulation, malposition or deterioration of the implants).
The patient interested in breast augmentation should be very well informed about the professional who is going to operate, since it is very important that this surgery is always performed by an experienced surgeon in a suitable hospital environment, an approved operating room, and fully equipped, with a well-equipped resuscitation and a qualified anesthesiologist.
It is advisable that the preoperative also includes a bilateral ultrasound of the breasts and armpits to rule out previous pathology at these levels and to have that reference for future controls and medical reviews of your breasts. Regarding the type of prosthesis to be used, the choice of the same is conditioned by different factors, such as:
- Volume and shape
- Quality of the breast skin
- Patient’s age
- Height and body structure
- Desired degree of augmentation
In general, implants can be round or anatomical, with smooth or textured surface and of different volumes and profiles, which gives an immense variety of possibilities to choose the most appropriate option for each case. All implants marketed in our country are safe and approved by the European Medicines Agency and have passed all health controls required by our current legislation.
What recommendations should be followed once the surgery has been performed?
Regardless of the type of technique performed, the operated breast always needs a bra, preferably without underwire, wide band or sports type that contains its weight so that the anatomical support structures of the breast do not suffer. It is an essential garment to guarantee the result over time and delay the aging of the breast.
Likewise, the operated woman must be very careful with the movements of her arms and trunk because any action of the upper limb has direct repercussions on the breast. She should also avoid exertion in the immediate postoperative period until the surgical wounds are sufficiently well healed, and she can progressively engage in physical activity as her discomfort improves.
More in the long term, if the patient performs intense physical exercise, it is advisable to wear an adequate restraint (strong bra) to avoid the swaying of the breasts that tend to weaken the ligaments and other supporting structures and that eventually tend to sag the breasts, especially if there are implants included. These recommendations are also important to obtain a good quality scar and that, in any case, your surgeon should monitor how they evolve and apply the necessary measures to ensure that the healing process runs smoothly.
In the particular case of mammoplasty with the inclusion of implants, it is very important the controlled mobilization of both breasts from a few weeks after the intervention, in order to achieve the adaptation of the pocket to the shape and volume of the implant and to avoid, with time, capsular contractures that require additional surgery.
It is also important to avoid trauma that directly affects the breast, as well as extreme physical activity (weight training) due to the risk of breakage or deterioration of the prostheses. A patient with prostheses should be checked by her surgeon at least once a year while she is wearing them.