Massive enlargement of the breasts may occur as
the result of glandular hypertrophy or from generalized obesity. Natural
reduction in breast size with weight reduction is dependent upon the relative
percentage of fat in the breast compared to glandular tissue. Some women
may have 75% glandular tissue, and 25% fat, while others 75% fatty tissue
and 25% glandular.
Symptoms accompanying very large breasts may include
backache, rashes under the breast, pain in the breasts, and changes in
sensitivity of the nipples. These disabling symptoms frequently allow for
coverage of breast reduction by insurance carriers.
Numerous operative procedures have been designed
for breast reduction. To some extent the amount of breast tissue to be
removed dictates the choice Of surgical procedure, and no one procedure
is applicable to all situations. Current popular techniques include the
McKissock, inferior pedicle, superior pedicle, combined horizontal and
vertical pedicle techniques. The risk attendant to surgery is somewhat
dependent upon the size of the reduction. Very large reductions have a
somewhat greater risk. Various possible complication include the usual
risks of infection, bleeding, abnornal scarring, but in addition, breast
reduction carries the added risk of possible loss of sensation of the nipple
and the risk of tissue necrosis, including complete loss of the nipple
skin. By far the most likely complication is that of abnormal scarring
and failure to achieve a satisfactory shape. Scars are inherently worse
near the midline and laterally, but poor scars may be present in spite
of the best surgical technique. There is tremendous variation among patients
relative to their capacity to form scar tissue and accounts for a great
deal of variation.
In terms of patient satisfaction, breast reduction
ranks very high. This in spite of the tendency of scars to widen and or
become hypertrophic. To a large extent, this may reflect the serious and
disabling symptoms of having very large breasts.
Preoperative and postoperative photos show various
examples of breast reduction, including major and minor reductions.
