Breasts are one of the most significant body parts that make women feel happy and self-confident about her own body perception. Every woman wishes to have aesthetically beautiful-looking breasts. In addition, breast tissue which loses its volume due to growth retardation or postnatal weight loss may gain a droopy-looking because the skin covering breast loosens or breasts may be small or asymmetrical from birth.

In these cases, plastic surgery of breast is applied. The patient decides with her physician about which type of operation or operations will be performed. In the table below, it is indicated which operation is helpful in solving which aesthetic problem/s.

  • Operation for Aesthetical Problems of Breasts
  • Breast Augmentation for Small Breasts (silicone breast implant application)
  • Breast Lifting for Normal-Sized but Droopy Breasts
  • Breast Lifting + Breast Augmentation for Small and Droopy Breasts (silicone breast implant application)
  • Reduction Mammoplasty for Over-Sized Breasts
  • Augmentation, reduction or lifting depending on Asymmetrical Breasts

Why is reduction mammoplasty performed?

Mammoplasty reduction operations are different than other plastic surgeries of breast in one way: ıt is a plastic surgery performed not just for psychological reasons but rather for physiological reasons because women with oversized breasts have such problems as neckaches, backaches and low backaches, chronic breast paint due to droops, postural deformities, skin problems under breast caused by perspiration, pressure signs on shoulders due to bra straps. Apart from this, they have psychological and social problems such as not enjoying what they wear, sensing other people’s eyes are on her, having difficulty in sports activities. Breast is an organ consisting of fat and breast tissue. In some people fat tissue is more and sometimes related to being overweight. In this case, losing weight or liposuction may be effective, but in case breast tissue is excessive, the only option is mammoplasty reduction. During this operation, both breast is reduced and lifted.

When should it be performed?

Mammoplasty reduction operations can be performed on each woman whose growth of breast has ended. Even though nearly all techniques used today aim at protecting lactation feature, this possibility is 80- 90%. For that reason, it is a more preferred situation not to plan to be pregnant after the operation. Breasts are exposed to serious hormonal impact during certain periods of women life. One of them is puberty period. Juvenile breast hyperplasia (juvenile gigantomastia)  is breast growth which is relatively rare in puberty period. There is indication of early-age breast reduction operation in this case. Another period is pregnancy and lactation period. Breasts may grow bigger due to again hormones and weight gain. When lactation period is over, breasts can go back to their previous situation, remain bigger than before or get droopy and lose its volume. Before making a decision about the operation, you need to wait for a few months following the end of lactation period.

Pre-operative preparation

It is highly important to quit smoking or at least cutting down on before the operation in terms of non-occurrence of any problems with anaesthesia during the operation and with post-operative tissue feeding. As in all operations, intake of anticoagulant medication and food need to be stopped nearly ten days before the operation. Negotiations need to be made in order to determine if there are any heart-vascular diseases, diabetes, blood and thyroid diseases before the operation and if needed, consultation from relevant branch specialists need to be asked for. In pre-operative examinations, research should be made in order to detect if there is any benign or malign tumour. I definitely ask for breast USG (ultrasonography) from my below 40-year-old patients and mammography from over-40-year-old patients. Other necessary blood tests are made in hospital before the operation and evaluated by anaesthesiologist.

Operation

Reduction mammoplasty is performed in hospital under general anaesthesia. It takes nearly 3-4 hours. There are technically numerous types of methods for reduction mammoplasty. In all these methods, excessive skin, fat and breast tissue is removed. Sense and vitality of nipple- areola complex ( dark coloured nipple area) is stored and transferred to its location determined with drawings and measurements before the operation. A circular scar surrounding the nipple area and a vertical scar extending towards under-breast fold will definitely remain after the operation. In some techniques, also a T scar remains on the under-breast fold. Scars may be red and swollen in the beginning. It relieves within approximately a year and increasingly fades away. If the skin of patient tends to recover in red and swollen position (hypertrophic scar), certain silicone creams or materials may be used in order to help recovery. Hypertrophic scar treatment may be applied.

I generally prefer medial pedicled mammoplasty reduction operation which leaves a vertical scar but for giant breasts, I apply the technique of inferior pedicled breast reduction which leaves a T scar. The aim is to shape breast tissue and skin separately and to cover the skin without over tension and imposing burden on the skin and minimize the scar. If the breast is not extremely droopy, I cover it with vertical scar. As long as distance between the nipple and collar bone gets longer, “T” scar type covering should be preferred. When “T” scar is preferred, it is performed in order not to let it seem in triangle bikini top. Thanks to this technique preferred in mammoplasty reduction, we can gain a long-term lifted and shaped breast appearance which do not impact milk production adversely without spoiling the sense of nipple. Operation is more successful with this technique and post-operative appearance is longer.

Post-operative period

Mammoplasty reduction operation is not an extremely painful operation. Pain may be easily controlled thanks to painkillers. The patient needs to stay at hospital at the night when she has been operated. Generally next morning drains are removed and the patient is released from the hospital. A sports bra that the patient puts on during medical dressing should be used day and night for 3- 4 weeks, which is of importance in terms of the comfort and easy movement of the patient. As I generally use stitches that dissolve on its own inside the body, there is no need to remove them at hospital after the operation. The patient can go back to work 5-7days later on average. In the early post-operative period, neckache, backache and lower backache dramatically relieves or disappears. Posture improves. The patient has a great comfort in physical activities. She regains her self-confidence. It also decreases the potential of breast cancer to remove a part of the breast tissue.

Risks of the operation

As in all operations, some unfavourable results may be encountered in mammoplasty reduction operations. Bleeding can occur immediately after the operation. In such case, the patient is retaken to the operating room and bleeding is stopped . Infection is rarely encountered unless there are such disposing factors as diabetes or some skin infections. Pre- and post-operative antibiotherapy  also prevent the occurrence of infection. In early post-operative period, hematoma, collection of blood outside the blood vessels, may appear. Drains are generally used for precautionary aims. It may still occur in spite of drains. In this case, hematome is drained or we can let it go away on its own. The most serious complication is loss of skin or nipple. This situation may be triggered by being a smoker or diabetes disease. There might be numbness in the breast skin or nipple for the first six-month- period after the operation. It is generally temporary. Another problem that might be encountered in the late post-operative period is asymmetry. In fact breast of many women are not symmetrical to each other from birth. If this is disturbing the patient, correction operation may be needed.