Breast Reduction Methods London

With the patient in the supine position, the patient is widely prepped and draped. A 38–42 mm areola marker is used to mark the new areola circumference. An inverted-U is marked around the new areola, extending inferiorly to the infra-mammary fold and delineating the inferior pedicle. The skin of the pedicle is infiltrated using local anesthetic with epinephrine and subsequently deepithelialized.

The medial, lateral and superior borders of the pedicle are incised down to the pectoral fascia, using caution to avoid undermining the pedicle. The infra-mammary fold is incised medially and laterally from the base of the pedicle. The adipocutaneous flap is then elevated off the chest wall superiorly to the level of the clavicles, medially to the sternum and laterally to the border of the latissimus dorsi muscle. A layer of adipose tissue is maintained on the pectoral fascia in an attempt to preserve nerve supply. The remaining specimen within the inverted-V skin markings is excised. If further resection is need, the adipocutaneous flap and pedicle can be thinned.

Closure is initiated by placing a triangular stitch in the corners of the flaps to the midpoint of the pedicle base. Drains are placed, exiting in the mid-axillary line bilaterally. Interrupted, buried deep dermal sutures are placed along the infra-mammary incision. Similarly, the vertical limb is closed over the pedicle.

The new nipple position is marked at the apex of the new breast mound using 38–42 mm nipple markers. The skin within the circumference is infiltrated using local anaesthetic with epinephrine and deepithelialized. Th e dermis is scored at the 12, 3, 6, and 9-o’clock positions to allow for tension-free inset of the nipple-areola complex. If the viability of the nipple is in question, a free-nipple graft should be performed. If well-vascularized, the nipple-areola complex is tacked in place using interrupted, buried dermal sutures. A running subcuticular stitch is placed along the entire incision. All sutures used are absorbable, with the exception of the drain stitch. Steri-strips are placed and the wounds are dressed.

The most common cause of patient dissatisfaction in breast reduction surgery is scarring. In one retrospective review assessing patients’ and surgeons’ perspectives on the scar components after breast reduction mammaplasty using the inferior pedicle technique, it was determined that patients were most satisfied with the periareolar scar and least satisfied with the infra-mammary scar.

Another potential aesthetic complication of the inferior pedicle technique is a “dog ear” at the medial or lateral edge of the infra-mammary incision. Dog ears are prevented by noting and addressing them intraoperatively. Additional adipose tissue may be excised in these regions with beveling of the fat away from the incision.

Skin necrosis and wound breakdown are most likely to occur at the intersection of the vertical and transverse incisions, which is the region of maximum tension. Careful tissue handling, maintenance of flap thickness at the corners, and a low-tension closure may help to prevent devascularization from occurring. If wound breakdown does occur, local wound care is usually the adequate treatment.

• Breast reduction
• Breast reduction techniques
• Breast reduction: further methods
• Breast reduction short scar methods