This document discusses breast reduction techniques. It provides information on the anatomy and embryology of the breast. It describes various surgical techniques for breast reduction including the McKissock vertical bipedicle technique, Wise pattern marking design, and liposuction assisted reduction. Recovery, risks, and post-operative care are also addressed. The document aims to inform patients considering breast reduction surgery.
1. Breast reduction 2015Breast reduction 2015
Dr sumer yadavDr sumer yadav
Mch plastic and reonstructive surgeryMch plastic and reonstructive surgery
Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon ,
sumeryadav2004@gmail.comsumeryadav2004@gmail.com
2. Breast is the symbol of femininity .It is aBreast is the symbol of femininity .It is a
source of maternal and sexual feelingssource of maternal and sexual feelings
and is often the initiating focus of sexualand is often the initiating focus of sexual
intimacy. Its feel, sensation andintimacy. Its feel, sensation and
appearance, nurture the development ofappearance, nurture the development of
warm, interpersonal relationshipwarm, interpersonal relationship
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3. DefinitionDefinition
Surgical reduction of breast volume toSurgical reduction of breast volume to
achieve a smaller, aesthetically shapedachieve a smaller, aesthetically shaped
breast mound with concomitant relief ofbreast mound with concomitant relief of
the potential symptoms of mammarythe potential symptoms of mammary
hypertrophyhypertrophy
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4. Breast EmbryologyBreast Embryology
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5. Breast AnatomyBreast Anatomy
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6. Breast AnatomyBreast Anatomy
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7. Breast AnatomyBreast Anatomy
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12. Evaluation Of Breast EnlargementEvaluation Of Breast Enlargement
HistoryHistory
SymptomsSymptoms
Risk factorsRisk factors
Scarring tendenciesScarring tendencies
Reasons for wanting surgeryReasons for wanting surgery
h/o nipple sensationh/o nipple sensation
Smoking historySmoking history
Type of workType of work
General medical conditionGeneral medical condition
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13. ProblemProblem
Macromastia-is developmental increase inMacromastia-is developmental increase in
breast volume & weight. Reductionbreast volume & weight. Reduction
mammoplasty is indicated for symptomaticmammoplasty is indicated for symptomatic
relief as well as aesthetic improvementrelief as well as aesthetic improvement
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15. Physical ExaminationPhysical Examination
Complete general examinationComplete general examination
Local breast examinationLocal breast examination
-previous breast surgery-previous breast surgery
-expected reduction volume-expected reduction volume
-nipple-areola size &shape-nipple-areola size &shape
-asymmetry-asymmetry
-nipple sensation-nipple sensation
-right & left nipple to sternal notch-right & left nipple to sternal notch
measurementmeasurement
-right to left nipple to inframammary fold-right to left nipple to inframammary fold
measurementmeasurement
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17. Pre-op PhotographsPre-op Photographs
Front & lateral viewFront & lateral view
Marks at the normal nipple heightMarks at the normal nipple height
Nipple in relation to elbowNipple in relation to elbow
Shoulder groovesShoulder grooves
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19. Indications for surgeryIndications for surgery
MajorMajor – very large breast– very large breast
shoulder painshoulder pain
cervical & upper thoracic paincervical & upper thoracic pain
severe embarrassmentsevere embarrassment
recurrent intertrigorecurrent intertrigo
MinorMinor – inability to exercise due to breast– inability to exercise due to breast
discomfortdiscomfort
difficulty with breathing during exercisedifficulty with breathing during exercise
grooving & hyper pigmentation ofgrooving & hyper pigmentation of
shoulder strap areasshoulder strap areasDr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon ,
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20. ContraindicationsContraindications
Absolute-Absolute-extreme obesityextreme obesity
inadequate cardiac, pulmonary,inadequate cardiac, pulmonary,
renal reserverenal reserve
current or recent lactationcurrent or recent lactation
unevaluated breast mass orunevaluated breast mass or
mammographic findingsmammographic findings
RelativeRelative - current smoking history- current smoking history
> 30% ideal body wt. obesity> 30% ideal body wt. obesity
inappropriate psychiatric evaluationinappropriate psychiatric evaluation
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21. Selection of techniqueSelection of technique
Depends onDepends on
- beast size- beast size
- estimated resection volume- estimated resection volume
- breast shape- breast shape
- more elusive concept of- more elusive concept of
appearanceappearance
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35. McKissock vertical bipedicleMcKissock vertical bipedicle
techniquetechnique
HistoryHistory
– Modification of Strombeck procedure(1972)Modification of Strombeck procedure(1972)
AdvantagesAdvantages
– Well vascularised pedicleWell vascularised pedicle
– Excellent exposureExcellent exposure
– Maintenance of superior pole massMaintenance of superior pole mass
– Good long term result with breast shapeGood long term result with breast shape
– Flexibility in designFlexibility in design
DisadvantagesDisadvantages
– Sensory return – 65%Sensory return – 65%
– Nipple retractionNipple retraction
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51. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
HistoryHistory
– Arie(1957) – first describedArie(1957) – first described
– Ivo Petanguy (1967) – modificationIvo Petanguy (1967) – modification
AdvantagesAdvantages
– Best applied to breast reduction < 500gmBest applied to breast reduction < 500gm
– Excellent long term breast shapeExcellent long term breast shape
– Well vascularised pedicleWell vascularised pedicle
– Preservation of nipple sensationPreservation of nipple sensation
– Lack of interference with breast feedingLack of interference with breast feeding
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52. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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53. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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54. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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55. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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56. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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57. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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58. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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59. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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60. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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61. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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62. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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63. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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64. Pitanguy superior pedicle techniquePitanguy superior pedicle technique
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67. Inferior pyramidal pedicle techniqueInferior pyramidal pedicle technique
HistoryHistory
– Georgiade et al (1979)Georgiade et al (1979)
AdvantagesAdvantages
– Very versatile – use for reduction from 300-1500gmVery versatile – use for reduction from 300-1500gm
– Long lasting result even with ptosis & macromastiaLong lasting result even with ptosis & macromastia
– Well vascularised pedicleWell vascularised pedicle
– Less chances of nipple retractionLess chances of nipple retraction
– Excellent glandular exposureExcellent glandular exposure
– Maintenance of nipple sensibilityMaintenance of nipple sensibility
CriticismCriticism
– Flat breast with inadequate projectionFlat breast with inadequate projection
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83. SUPEROMEDIAL PEDICLE WITH WISE PATTERNSUPEROMEDIAL PEDICLE WITH WISE PATTERN
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84. Free nipple graft techniqueFree nipple graft technique
Procedure of choice in the treatment ofProcedure of choice in the treatment of
gigantomastiagigantomastia
It is a composite graft of skin, smooth muscle &It is a composite graft of skin, smooth muscle &
ductal elementsductal elements
AdvantagesAdvantages
– Rapid execution with minimal blood lossRapid execution with minimal blood loss
– Maintenance of glandular shapeMaintenance of glandular shape
DisadvantagesDisadvantages
– Loss of nipple sensibilityLoss of nipple sensibility
– Loss of lactating abilityLoss of lactating ability
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111. Central mound tech by hesterCentral mound tech by hester
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112. Vertical MammoplastyVertical Mammoplasty
Lassus(1964) emphasizedLassus(1964) emphasized
– Use of superior pedicle, inferior pyramidalUse of superior pedicle, inferior pyramidal
glandular resection, no skin undermining &glandular resection, no skin undermining &
closure with a vertical scar onlyclosure with a vertical scar only
Lejour(1999)Lejour(1999)
– Modified Lassus techniqueModified Lassus technique
– Prior liposuction of the breastPrior liposuction of the breast
– Superior pedicle for the nipple-areola complexSuperior pedicle for the nipple-areola complex
– Lower pole resectionLower pole resection
– New breast mound from suture plication ofNew breast mound from suture plication of
lateral pillarslateral pillarsDr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon ,
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137. Hall-Findlay Vertical scarHall-Findlay Vertical scar
MammoplastyMammoplasty
Variation of vertical scar themeVariation of vertical scar theme
Medial pedicle with inferolateral glandMedial pedicle with inferolateral gland
resectionresection
Particularly effective for small to moderateParticularly effective for small to moderate
reductionreduction
Forms a conical, well supported breastForms a conical, well supported breast
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139. Vertical reduction with short horizontalVertical reduction with short horizontal
scarscar
Marchac (1982)Marchac (1982)
Central resection with vertical closureCentral resection with vertical closure
having a horizontal component was anhaving a horizontal component was an
integral part of the pre-operative skinintegral part of the pre-operative skin
resection designresection design
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141. B & L-shaped scar reductionB & L-shaped scar reduction
Regnault (1974) – B techniqueRegnault (1974) – B technique
mammoplasty that eliminated the medialmammoplasty that eliminated the medial
component of the horizontal scarcomponent of the horizontal scar
– Nipple is preserved on superomedial pedicleNipple is preserved on superomedial pedicle
– Inferolateral glandular resectionInferolateral glandular resection
Born (1994) - modified L scar techniqueBorn (1994) - modified L scar technique
– Medial triangular flap interdigitating withMedial triangular flap interdigitating with
lateral rectangular flaplateral rectangular flap
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143. B techniqueB technique
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144. B techniqueB technique
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145. Horizontal scar reductionHorizontal scar reduction
Passot – first surgeon to describePassot – first surgeon to describe
horizontal scar reductionhorizontal scar reduction
– Inferior wedge resectionInferior wedge resection
– Nipple transposition in button hole incisionNipple transposition in button hole incision
higher up on the breast moundhigher up on the breast mound
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161. Sculpted pillar vertical reduction mammaplastySculpted pillar vertical reduction mammaplasty
Kent K. Higdon and James C. GrottingKent K. Higdon and James C. Grotting
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173. Special topics in breastSpecial topics in breast
reductionreduction
Secondary breast reductionSecondary breast reduction
– Increase in breast volumeIncrease in breast volume
– Poor shape or asymmetryPoor shape or asymmetry
– Recurrent symptomsRecurrent symptoms
Adolescent breast reduction for juvenileAdolescent breast reduction for juvenile
hypertrophy – wait until breast growthhypertrophy – wait until breast growth
stable for at least 1yrstable for at least 1yr
Oncoplastic breast reductionOncoplastic breast reduction
– Advocated by Adretsch & CloughAdvocated by Adretsch & Clough
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175. ComplicationsComplications
AsymmetryAsymmetry
Inadequate reduction or over reductionInadequate reduction or over reduction
Boxy breast deformityBoxy breast deformity
Recurrent enlargementRecurrent enlargement
Inability to breast feedInability to breast feed
Dog – earsDog – ears
Inadequate mastopexy resultInadequate mastopexy result
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