Adolescents may experience severe breast enlargement at puberty which may bring them to the Plastic Surgeon. This is called virginal hypertrophy, and can create serious self image problems in addition to restrictions to extreme physical exercise. Breast reduction is indicated in this age period although patients are warned that additional breast growth may occur, and the breasts may experience further physiological alteration that comes with maturity, childbirth, and hormonal changes. The risk of secondary procedures if often an acceptable tradeoff in light of the discomfort and self-consciousness that comes with massively enlarged breasts. Since many patients can have moderately sized breasts then the use of a purse string breast reduction and skin repair may recommended in lieu of other methods that require more skin scar. The time when an adolesecent is coping with the dramatic changes that come with womanhood, this transition may be adversely affected with the sudden onset of overgrowth of breast tissue. A moderate reduction is indicated and over-reduction is to be avoided. The adolescent female rapidly adjusts to a breast reduction and incorporates it nicely into the developing body image that should occur. The patients are appreciative of the removal of focus on very large breasts following reduction surgery. The use of minimal scar methods of reduction can further improve self-esteem and acceptance of the surgical recovery process itself.
ADULT BREAST DISPROPORTION
Often women with larger breasts are not distressed since there remains some upper breas fullness and no ptosis or significant sagging. When these two elements occur, then interest in breast reduction arises. These woman do not wish a large reduction, but only to the degree that the breasts are in harmony with the rest of their body and they can better choose more appealing wearing apparel. Estimating the proper reduction is more challenging for the Plastic Surgeon. Skin tape binding of the breasts into a more appealing shape is done at the time of consultation to glean a better understanding of the patient's goals.
HIGH BODY FAT
Women with marked breast enlargement and higher body weight will present to the Plastic Surgeon with significant body image concerns They feel the large breasts . make them look heavier, and seek reduction as a remedy for one element of their weight concerns. While it is best to have such patients lose as much weight as is sensible before surgery, they often have difficulty doing so. The results of breast reduction in this group of patients is very rewarding since it removes one part of the self-esteem issue more expeditiously so they can focus if possible on correcting the weight itself. It is also best not to reduce these patients too significantly.
Women who seek breast reduction following childbirth frequently find that their breasts exhibit more loss of upper breast fullness and true sagging or ptosis. A gain of weight during the reproductive period may heighten a woman's awareness of larger breasts. They may think a major reduction of volume is indicated, but again, they should seek a bust line commensurate with their current frame size.
AFTER MASSIVE WEIGHT REDUCTION
Patients who shed weight massively either by diet and exercise, or as a result of weight reduction (bariatric) surgery present with a difficult set of problems. Usually their body habitus or shape can still be on the large side. An extreme excess of skin and distortion of the breast anatomy can make a standard reduction surgery more difficult. Careful planning of the skin markings and avoidance of over-reduction is important. Often these patients are advised to have a staged approach, where perhaps a reduction and lift is performed in the first stage to recreate normal relationships of skin to breast volume, and restoration of proper nipple relocation. In a second stage, a small augmentation may be performed or additional lifting is added. These patients characteristicly have very loose elastic skin that does not tolerate the rigors of a major lift and reduction. This patient is a candidate for a two stage approach. She felt there was too much breast tissue under the arms and could not find a proper brassiere following weight loss.
Following menopause, many women with heavy breasts seek surgery for relief of symptoms in addition to cosmetic concerns. Strap grooves in the shoulders, shoulder, neck, and back pain are common problems. Rashes may occur beneath the breasts. They are often tired of carrying around large breasts. They are rather realistic in seeking enough reduction to improve their symptoms but frequently desire an outcome that permits them not to wear support and underwire bras.