Breast reduction plastic surgery is conducted in cases where women have unnaturally large breasts, pendulous breasts or excessive large breasts due to some genetic or hormonal problems.
Breast reduction surgery can not be performed if the woman is lactating, or has recently ceased lactating; if her breasts contain unevaluated tissue masses, or unidentified microcalcifications; if she is suffering a systemic illness;
if she is unable to understand the technical limitations of the plastic surgery; and her inability to accept the possible medical complications of the procedure.
Additionally, recent research has indicated that mammograms should not be done with any increased frequency in patients undergoing breast surgery, including breast augmentation, mastopexy, and breast reduction.
Breast reduction by liposuction only can not be performed upon a woman whose mammogram indicates that the oversized breast is principally composed of hypertrophied milk glands.
The breast reduction performed with the vertical scar technique usually produces a well projected bust featuring breasts with short incision scars and a nipple areola complex (NAC) elevated by means of a pedicle (superior, medial, lateral) that maintains the biologic and functional viability of the NAC
. The increased projection of the reduced bust is achieved by medially gathering the folds of the skin envelope and suturing the inner and outer portions of the remaining breast gland to provide a support pillar, and upward projection of the NAC.
The vertical scar reduction mammoplasty is best suited for removing small areas of the skin envelope and small volumes of internal tissues (glandular, adipose) from the lateral and the inferior portions of the breast hemisphere; thus the short incision scars.
The breast reduction performed with the horizontal scar technique features a horizontal incision along the inframammary fold (IMF) and a nipple areola complex (NAC) pedicle.
The horizontal scar technique best applies to the woman whose oversized breasts are too large for a vertical incision technique (e.g. the lollipop pattern); and it has two therapeutic advantages: no vertical incision scar to the breast hemisphere, and better healing of the periareolar scar of the transposed NAC.
The breast reduction performed with the free nipple graft technique transposes the nipple areola complex (NAC) as a tissue graft without a blood supply, without a skin and glandular pedicle.
The therapeutic advantage is the greater volume of breast tissues (glandular, adipose, skin) that can be resected to produce a proportionate breast.
The therapeutic disadvantage is a breast without a sensitive nipple areola complex, and without lactational capability.
The medically indicated candidates are: the woman whose health presents a high risk of ischemia (localized tissue anemia) of the nipple areola complex, which might cause tissue necrosis; the diabetic woman; the woman who is a tobacco smoker; the woman whose oversized breasts have an approximate NAC to IMF measure of 2060; cm; and the woman who has macromastia, requiring much resecting of the breast tissues.