Breast reduction, or reduction mammaplasty, is a surgical procedure to reduce the size and contour of large breasts. It can allow more comfortable physical activity, relieve weight-bearing pain in the breasts, shoulders, neck and back, and improve an individual's overall appearance. A consultation with a plastic surgeon is the first step an individual should take if considering reduction mammaplasty. You should discuss candidly your expectations regarding the size and contour of your breasts following surgery, while keeping in mind that the desired result is improvement, not perfection. We will conduct a routine breast exam­ination and, depending on your age and family history, may determine that mammograms, or breast x-rays, are required. After examining you, we will discuss other variables that influence the decisions involved in reduction mammaplasty, such as the size, shape and skin tone of your breasts. Since the ability to breast-feed following reduction mammaplasty is unpredictable, you should discuss the matter with us at this time. During the initial visit, we will explain specific details of your case, including the surgical technique to be used, the anesthesia and what the surgery realistically can accomplish. Additional factors to consider before undergoing reduction mammaplasty, such as risk and cost, should be discussed during the consultation. Thousands of reduction mammaplasties are performed successfully each year. Nevertheless, you should be aware of the potential risks of surgery and specific complications associated with reduction mammaplasty. Postoperative complications, such as delayed healing, infection or localized collections of blood are uncommon. Poor healing may necessitate subsequent scar revision. Risk of complications can be minimized by closely adhering to our advice on follow-up care during the healing process.

SURGERY
Reduction mammaplasty typically is performed to reduce disproportionately large, sagging breasts. It also can reduce the size of the areola (the dark pink skin surrounding the nipple) which frequently becomes enlarged as the breast develops. (Fig. 1) The extent of the procedure depends on what changes are desired and what your surgeon deems appropriate.

Working through the incisions, excess tissue, fat and skin on the sides of the breast are excised (Shaded area, Fig. 2) Skin is removed from the area within the vertical incision and around the areola. The nipple, areola and underlying tissue are moved through this space to a new higher location. (Fig. 2). After the nipple is repositioned, skin on both sides of the breast is moved down and around the areola and then brought together to recontour the breast. Sutures close the wounds under the breast and around the nipple area. (Fig. 3) Following surgery, a gauze dressing may be applied to the breasts, or the patient may be placed in a surgical brassiere. Depending on the extent of the surgery, the procedure usually lasts three hours or longer.

Recently vertical mammaplasty techique is most popular in breast reduction. The advantages of this technique are the elimination of the horizontal incision and the provision of an attractive breast shape without the areolar enlargement. Another technique involves completely detaching the nipple from the breast before relocating it. Since a transplanted nipple loses all sensitivity, this approach is performed only when deemed necessary for patients with extremely large breasts.

Reduction mammaplasty patient, shown before surgery with oversized heavy breasts and shoulder indentations caused by tight brassiere straps.	Breast tissue, fat and skin in the shaded area are removed, and the nipple is relocated to a higher position.
Sutures close the incisions, leaving permanent scars that are concealed easily by a nor mal brassiere or bathing suit.	The postoperative patient is seen with smaller, well contoured breasts,

POST - SURGERY

After surgery, pain that is controlled easily by medication will subside in a day or two. The patient can be discharged from hospital a few hours after the surgery. Swelling and skin discoloration around the incisions generally will subside in a few days. After surgery, there may be a temporary loss of sensation in the nipples and breast skin. If it occurs, this condition will improve with time. Sutures will be removed within two weeks of surgery. The patient can return to normal daily activities in a few days.

Although we make every effort to keep scars as inconspicuous as possible, reduction mammaplasty scars are extensive and permanent. The patient must be willing to accept the change from large uncomfortable breasts without scars to small comfortable breasts with scars. Scars remain highly visible for a year following surgery, then fade to some degree. Since incisions were made around and below the nipples, scars should not be noticeable even in low-cut clothing.

The objective of this surgery is smaller breasts which are in better proportion to the patient's physique. (Fig. 4) Since no two breasts are the same size and shape before surgery, a slight variation can be exist after surgery.

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