Enlarged breasts cause functional and appearance problems. The excessive weight often results in complaints of upper torso pain, neck pain and possibly upper extremity sensation problems. Affected women often suffer from “bra strapping” (deep grooves on the shoulders caused by bra straps), rashes and skin macerations under the breast and find it difficult to participate in sports or find clothing. In addition, they often feel self conscious due to the size of their breasts.
Quality of life studies conducted before and after breast reduction surgery found an impaired preoperative quality of life comparable to having to live with a chronic disease such as stable angina or life with a kidney transplant, while these scores approached the population average after breast reduction.
Breast reduction is aimed at reducing the size and thus weight of the to alleviate the aforementioned complaints. As this is a purely mechanical problem addressed by an appropriate mechanical strategy (surgical removal of excess breast tissue) it tends to be very successful with more than eighty percent of patients being very satisfied and regretting not having had the surgery earlier.
In addition to removing excess weight the surgical techniques employed at Trinidad Institute of Plastic Surgery are also designed to reshape the breast and create a more natural, smaller and uplifted appearance. These considerations however are secondary to the functional gains.
The main tradeoff in breast reduction surgery are the permanent scars resulting from the operation. The still most widely used scar pattern is the inverted T or anchor closure results in scars in the fold under the breast and vertically from the fold to and around the nipple-areola complex. Depending on the breast it may be the way to go. However, at Trinidad Institute of Plastic Surgery we try to either use the vertical or horizontal limb of the inverted T plus the scar around the nipple-areola complex thus reducing the length of scars and decreasing the likelihood of scar related problems after the procedure.
Short scar reduction techniques for breast reduction refer to operations trying to avoid the long inframammary scar in the design of the skin reduction pattern.
The idea was first published by the German surgeon Lotsch in 1923 and with a modification in 1925. His two techniques were equally applicable to breast reduction and breast lifting. One of the eternal principles resulting from the revolution in breast surgery in Europe between 1920 and 1930 is the paradigm that reshaping of the breast and reduction of the skin envelope are the two pillars for successful cosmetically acceptable results in breast surgery. Thus the short, vertical scar can be employed in conjunction with almost all reshaping and nipple-areola repositioning techniques. This technique goes nicely with the principal paradigm of all cosmetic surgery at Trinidad Institute of Plastic Surgery – we create structure as structure is beauty, the skin just drapes over it.
Some 60 years later Lassus and Marchac in France and Lejour in Belgium expanded upon Lotsch’s discoveries and made one more of its qualities apparent, which may not have been truly appreciated by Lotsch’s contemporaries (see also “Deformities and Cosmetic Operations of the Female Breast”, by Hermann Biesenberger). When breast reshaping was carried out by resecting the lower and lateral drooping and enlarged breast tissue and carrying the nipple-areola complex on one of the superior pedicles durable uplifting, a smaller footprint of the breast base on the chest wall and a dramatic increase in projection could be achieved. Not only was the scar vertical, but the entire concept is one of movement in a vertical direction – namely up. Thus, “vertical breast reduction” is a term still in common use in Europe.
The second alternative is accepting the scar in the fold under the breast and around the nipple-areola complex but avoiding the scar from the fold to the nipple-areola complex. In 1925 Raymond Passot contended that this is the most advantageous scar pattern. Decades later this idea came to be termed “no vertical scar” breast reduction, as it avoids the scar connecting the periareolar with the inframammary scar as used in the popular inverted T pattern or combination of periareolar scar and vertical scar only as employed in vertical, short scar techniques.
I find Passot’s technique favorable in darker skinned patients, who tend to form unfavorable scars and are prone to hypertrophy and long lasting dyspigmentation. While this occurs infrequently in the periareolar scar, it is not unheard of and may become disturbing in a visible, vertical scar on the breast. An unfavorable inframammary scar on the other hand remains hidden. Passot’s technique is applicable in cases of extreme gigantomastia or long breasts. Shaping the breast in Passot’s operation may require internal modifications in an effort to avoid the bane of the technique, which is a slightly more boxy than rounded shape.
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Posts (63)
1. A Cleft Pastiche
2. A Cure for Migraine Headaches: Botox, Nerve Decompression, Brow Lifting and Septoplasty
3. Abdominoplasty (Tummy Tuck)
4. Aesthetic Craniomaxillofacial Surgery of the Midface
5. Applied Aesthetics of the Female Breast
6. Autologous Breast Augmentation with Fat Grafting
7. Autologous Breast Augmentation with Micro Fat Grafting and External Expansion
8. Blepharoplasty – Eyelid Reshaping and Eyelid Tightening
9. Botox in Aesthetic Medicine
10. Breast Augmentation and Enhancement – Breast Implants
11. Breast Implants for Breast Augmentation and Enhancement: Teardrops, Gummy Bears, Furry Brazilians and the Baywatch
12. Breast Lift (Mastopexy)
13. Breast Reconstruction
14. Breast Reduction – Before and After
15. Breast Reduction – Reduction Mammaplasty
16. Breast Reduction – Techniques and Indications
17. Candidate Selection for Abdominal Wall Contouring
18. CEO Announcement: Aesthetic Medicine and Skin Therapy
19. CEO Announcement: New Plastic Surgery and Cosmetic Surgery Forum at Trinidad Institute of Plastic Surgery
20. CEO Announcement: Telemedicine and Virtual Consultations at Trinidad Institute of Plastic Surgery
21. Cleft Lip and Palate – Yardsticks for Perfection
22. Correcting Crooked Noses and Faces
23. Cosmetic and Plastic Surgery Abroad for the Medical Tourist
24. Craniofacial Surgery
25. Denise’s (Bridgetown/Barbados) Experience at Trinidad Institute of Plastic Surgery
26. Electrical Injuries – The “Great Masquerader” in Burn Surgery
27. Face Lift – Rhytidectomy – Rhytidoplasty
28. Fronto-orbital advancement for correction of craniosynostosis
29. Gunshot Injuries of the Hand
30. Healthgrades
31. Incisions for Breast Augmentation
32. Kayla’s (Georgetown/Guyana) Experience at Trinidad Institute of Plastic Surgery
33. Laser skin rejuvenation in dark skin types
34. Laser Tattoo Removal in Dark Skin Types
35. Lip Enhancement
36. Liposuction – Lipoplasty – Liposculpture
37. Malar Bags and Festoons
38. Maria’s (Port-of-Spain, Trinidad) Experience at Trinidad Institute of Plastic Surgery
39. Midface Lift
40. Mini Abdominoplasty
41. Optimal Implant Size for Breast Augmentations and Enhancements
42. Options in Breast Reconstruction
43. PIP Implants – Removal or Exchange after Breast Augmentation
44. Plastic Surgery – A Plastic Surgeon’s Perspective
45. Rhinoplasty – Nose Reshaping
46. Simone’s (Bridgetown, Barbados) Experience at Trinidad Institute of Plastic Surgery
47. Six Packs and the Male Abdominal Wall
48. Skin therapist Areana Emmanuel featured
49. Skin Therapy and Aesthetic Medicine Service Menu September 2010
50. Smoothing the Wrinkles
51. Specialist Treatment of Burn Injuries
52. Structural Abdominoplasty – Tummy Tuck
53. Tendon Problems in the Fingers and Hand – Trigger Finger, Trigger Thumb and de Quervain’s Disease
54. The Art of Reducing Excessive Sweating
55. The Culture of Aesthetic Surgery
56. Trinidad Institute of Plastic Surgery Featured in Caribbean Belle Magazine
57. Trinidad Institute of Plastic Surgery in Caribbean Beat Magazine
58. Verdine’s (Miami/FL) Experience at Trinidad Institute of Plastic Surgery
59. Vertical Breast Reduction and Breast Lifting with Short Scars
60. What is cosmetic surgery, what is reconstructive surgery, what is everything in between ?
61. What is the cost of … ? And why are there consultations ?
62. Worst Wrists
63. Writing for the gallery
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