Breast reduction is more commonly performed through incisions
with surgical removal of the excess fat, glandular tissue and
skin that contribute to large, pendulous breasts. The most common
approach is a keyhole incision pattern.
The nipple, which remains tethered to its original blood and
nerve supply, is then repositioned. The areola is reduced by
excising skin at the perimeter, if necessary. The vertical incisions
are brought together to reshape the now smaller breast. Non-removable
sutures are layered deep within the breast tissue o create and
support the newly shaped breasts; sutures, skin adhesives and/or
surgical tape close the skin.
There are alternative incision patterns that may be recommended
depending on the amount of tissue and skin to be removed and
the quality of skin elasticity. One is a circular pattern around
the areola. Another is a racquet-shaped pattern with an incision
around the areola and vertically down to the breast crease. Occasionally,
for extremely large pendulous breasts, the nipple and areola
may need to be removed and transplanted to a higher position
on the breast. In any case, the incision lines that remain are
visible and permanent scars, although usually well concealed
beneath a swimsuit or bra.
In some cases, excess fat may be removed through liposuction
in conjunction with excision techniques. If breast size is largely
due to fatty tissue and excess skin is not a factor, liposuction
alone may be used for breast reduction. In every case, the technique
used to reduce the size of your breasts will be determined by
your individual condition, breast composition, amount of reduction
desired, and patient and surgeon preference.