BREAST REDUCTION (Reduction Mammaplasty)

 Background
 Patient Groups
 Patient Concerns and Planning
 Preparing for Surgery
 The Operation
 Recovery
 At Home
 Office Visits and Follow-up
 Outcome and Complications
 Case Histories (Before and After)

OUTCOME AND COMPLICATIONS
A range of 4 to 9 cm of nipple elevation can be performed with this purse string method of breast reduction making it suitable for more generous degrees of breast hypertrophy that otherwise would be treated with a vertical scar or T scar method. In its original inception, the circular breast scar reduction was limited to cases where the nipple would be elevated no more than 4 cm. Very large pendulous breasts can be quite long, such that elevation of the nipple may exceed a number of centimeters. With the purse string method, the nipple can be raised up to 9 e lcm. The amount of breast tissue that can safely and effectively beremoved should be no more than 600 grams, over which the creation of a beautiful shape is not as ideal with a circular skin repair. A vertical scar method can be used for reductions of over 1000 grams per breast, and over this weight, it may be necessary to resort to a T scar method with or without a free nipple graft. Patients with the very elastic and stretchy skin having marked stretch marks before surgery, can experience some recurrence of breast droop and widening of scars, but they represent a small subset of cases in this experience. Bottoming-out where the breast tissue falls below the level of the nipple which can be termed postoperative glandular ptosis is more characteristic of other methods of breast reduction but may be related to more massive tissue removals exceeding 1000 grams per breast. A boxy square shape of the breasts may be noted for a short period of time but is a very rare late result of this operation. This is seen occasionally with the reductions that approach 600 grams per breast. The near final shape of the breasts reduced with the purse string method comes into play around 6 weeks following surgery. Some flattening of the central cone of the breasts will even out rapidly after the first week and look great by six weeks. A more rounded tear-drop breast can result following breast reduction, and the best most projecting breasts are seen in patients who are younger, have thick elastic skin, dense full breast, and projecting central breast cones before operation. Patients who are heavy, have fatty breasts, extremely droopy and long breasts, and may have certain medical problems, as well as smokers, can enjoy the benefits of this operation being candidates for selection with special attention to details.

The incidence of major complications in this series of purse string breast reductions as well as the breast lift operations has been very low. Minor annoyances such as suture irritation slight scarring persistence of pleats around the purse string scar, and need to remove the purse string suture under local anesthesia, can occur, but are well tolerated by patients. Slight distension of the areolae can occur with a purse string method of skin closure. Major infection, delayed healing, and re-hospitalization for problems is exceedingly rare. The satisfactory breast shape with no other than a circular scar pattern, makes patient acceptance very high.