Breast Reduction and Lift
Reductive mastoplasty is one of the most common procedures in Plastic Surgery. Besides being indicated to improve the shape of the breast it is also a complementary resource for prophylactic treatment in breast diseases, and a preventive approach to avoid problems caused by very large breasts. It is regrettable that many parents see their young teenage daughters suffer strong vertebral pain as well as psychological disorders, cases in which is advised a consult with the plastic surgeon, who will not only work the physical aspect but also increase the self-esteem.
Depending of the applied technique, we can have various results to the scaring. There is normally an inverted ‘T’ scar in the lower part of the breast. . The one in the areola is hidden by the color transition between it and the normal skin. Other types of scar like the ‘I’, ‘L/J’ or periaroleal are possible when well indicated..
During the first days of postop, a very generous cleavage can be worn since the scars will be well hidden. With time they will be more imperceptible.
Certain patients will have tendencies to hypertrophic scaring or queloids like we have previously informed.
Several clinical and surgical resources allow us to improve scars on its due time. We should never confuse the “immediate period” of normal scaring (30th day to 12th month) as part of scaring complications. Any doubt regarding your evolution should be consulted with your doctor and never with other people such as yourself. A very frequent question is:
How will my new breasts be in relation to size and consistency?
A. The breasts may have a reduced volume through surgery; also their consistency as well as the shape is improved through the surgery. That way we can opt for several different volumes for the cases involving reduction and lift with possibilities that allow us to plan the original breast without compromising it. Here, like in case of the breast augmentation, proportions between the new breast and the thorax should be balanced to maintain aesthetic harmony. In this occasion we try to improve the aspect in relation with the original shape and sagging of the breast. The new breasts go through several evolutionary periods in relation to its shape:
a) Immediate period: Goes up to day 30 postop. During this period, even though the breast presents a well improved aspect, their shape is still far from what it was planned, since for it to reach their definitive shape there are several apparent ‘little defects’ (unavoidable in all cases) that will disappear with time. It is important to emphasize that the final result will be achieved after the later period.
b) Mediate period: From the 30th day to the 8th month. During this period the breast starts to present an evolution of what usually is the definitive shape. In this period may appear a slight increase or decrease of sensibility in the nipple as well as increase or decrease of swelling of the breast. Even though the patients tend to be euphoric, we tend to tell them that the result is yet to improve, since this is the main part of the later period.
c) Later period: From the 8th month to the 18th month. The breast reaches its definitive aspect. During this period is that we tend to compare with photos of the preop look of the patient. It is of great importance to the final prognosis, the degree of elasticity of the skin of the breast as well as the achieved volume. The balance between them varies from one case to another.
Even though the immediate and mediate results satisfy the patient, only between the 8th month and the 18th month is where the breast reaches their definite form. It is of vital importance to the patients to go through a mammography a year after the surgery, since this will be the base mammography for later studies.
Post up is generally non painful as long as the doctor’s orders are followed regarding arm movement during the first few days.
Breast plastic surgery rarely has serious complications. This due to convenient patient preparations, as well as considerations about combining this surgery with others.
It falls down to the surgeon’s criteria the type of anesthesia to be employed for the procedure, whether local, general, epidural or associated.
Depending of the type of breast the surgery goes from two and a half hours to four hours or more depending on the case. Postop observation rarely exceeds 24 hours.
We use molding bandages and brassieres adapted to each case. Sutures are removed around day 12 of the postop.
Sudden arm movements should be avoided. Exercises should be slowly reincorporated. Lower body exercise can be started following the 15th postop day, and upper body exercises that include the thorax, driving included, should be avoided until day 45th.