Patients with large breasts usually complaint about backache and difficulties to do daily routine. However BREAST reduction is not one technique fit is all type of surgery and the techniques vary according to the size of the BREAST, location of the Nipple related to the BREAST fold ( sagging degree) and the quality of the skin.

Patients without sagging nipple can get a good result with only peri areolar scar or vertical scar depending on the amount of BREAST to be removed. Patients with sagging nipples have to be lifted and the amount and quality of the extra skin will determine the extent of scars. So here is the point. BREAST reduction surgery is a trade off between sagging big breasts and the extension of the resulting scar to rebuild a new breast. Patient with mild to severe sagging of the Nipple will end up with what we call inverted T scar. Patients with bad quality skin as well will have an inverted T as well due to the inability of the skin to retract and pull around the breast after removing glands. So the trade off is clear and it is mainly the scar that need to be explained about to the patients. But there is one more variable that need to be explained. Any breast after been lifted will end up re locating downward because of the action of the gravity
So it will bottom out in diferente degrees and it depends on the remaining skin quality and the size that the patient chose to keep. A different approach to avoid any degree of bottoming out ( meaning any degree of descent of the breasts after reduction and lifting ) is the one where we remove a larger amount of gland and insert a implant that will stay in place which avoid any degree of bottoming out or downward resetting of the breasts. But in this last case patient would have to cope with changing implants after a while and the risk of having capsular contracture as well.

NOTES ON PRE OP PREPARATIONS

Include breasts ultrasound and mammogram that need to be done to check any suspicious or undetected Susie in the breasts , as well to be used for future reference to the patient breasts control imagining. Usually blood testing and any health related problem has to be controlled properly pior to the surgery.
Smoking has to stop 30- 45 days prior to surgery as the risk of Nipple loss skin and opening of the scars during the recovery time is high. Hypothyroidism has major influence too in the healing and scars can open or enlarge due to this health problem.

POST OP CARE

We ask patients to keep their scars clean and to use a bra made of cotton and without iron. Patients are asked to avoid sleeping on their breasts for 4 months to help the newly rebuilt breasts heal in a proper shape and to not force any internal stitches to loosen. Patient will go back to their routine lives after 3 weeks and to drive after 4 weeks. Scars are cleansed at the clinic three times at the first week , twice at the second week and once for the next 2 weeks.

REDUCTION OF THE BREAST WITHOUT SCARS WITH LIPOSUCTION

This can be done with liposuction alone and there are specific patients that may do this procedure. Patients with juvenile big breasts and small to no sagging can be submitted to this procedure. Patients with saggy breasts and nipple sagging cannot be submitted to liposuction for reduction purpose as the changes on the breasts can worsen the visual aspect of the sagging nipples. But in big breast sizes and small to no sagging liposuction is a very good surgery to remove breast gland without scars. One major complication is that the BREAST after liposuction becomes swollen and takes time to get to the result.

BREAST LIFT WITH THREADS

Another procedure breasts that we may apply to lift breasts are threads. However there are very few indications and usually we use them as an adjunct meaning as a support to the surgery itself in some cases. Threads can be absorbable or permanent. Permanent are usually used to support the lower fold under the BREAST when we do major lift in post massive weight loss and we want to raise the fold of the breast and change the imprinting site of the breasts. Absorbable are used to help support breasts after lifting to help support the breats for a while , during the healing time fo the scars to avoid downward pressure on the lower vertical scar so it may not have enlargement. That is empirical and there are no scientific papers proving this outcome.