How is breast reduction done?
Preparation:
- Anaesthesia: The procedure is performed under general anaesthesia to ensure you are comfortable and pain-free.
- Marking: Mr. Green uses a pen to mark the incisions on your breasts while you are standing standing to guide the procedure.
The inverted-T reduction:
An inverted-T breast reduction, also known as a "Wise pattern" or "anchor" breast reduction, is a surgical technique used to reduce breast size and reshape the breasts. It gets its name from the incision pattern, which resembles an inverted "T" or an anchor. Here's how the procedure is typically performed:
Incisions:
- Around the areola: A keyhole incision is made to reposition the areola, and an incision around the areola itself (red).
- Vertical incision: Extends from the bottom of the areola (blue).
- Horizontal incision: Runs along the natural curve of the breast crease (yellow).
Tissue removal and reshaping
- Excess breast tissue, fat, and skin are removed to achieve the desired breast size and contour.
- The remaining tissue is reshaped to create a firmer, lifted breast.
- The areola may be resized to better match the new breast proportions.
- The nipple and areola are moved to a higher, more natural position on the reshaped breast.
Closing the Incisions:
- The breast is repaired with sutures placed deep within the tissue to support the new breast shape.
- The skin is closed using invisible, dissolvable sutures and adhesive strips or surgical tape.
- The breasts are covered with dressings or bandages, and a surgical bra is worn for support.
- Mr. Green does not usually use drains.
- Most patients can return to light activities within 1-2 weeks, but complete recovery may take several weeks.
How much breast tissue will be removed, and how much will be left?
The amount of breast tissue removed corresponds to the tissue below the markings made for the “Wise pattern.” These markings are based on the ideal position of the nipple, typically level with the midpoint of your upper arm.
Mr. Green determines the correct nipple position by measuring from the collarbone to the nipple and considering where your bra usually fits. Once the nipple position is established, skin markings for the incisions are made. All breast tissue below these markings is removed.
Most women have enough breast tissue above the markings to achieve a breast size proportionate to their height and frame. Some adjustments can be made, but it is essential to avoid undermining the upper breast, as this can cause permanent deformity.
If there isn’t enough tissue above the markings, it may be possible to fold some tissue from the lower breast into the upper breast to achieve a satisfactory result.
Techniques for moving the nipple and areola:
Most women want to preserve their nipple as part of a breast reduction procedure. This involves relocating the nipple to the correct position while ensuring it has a healthy blood supply. A significant risk of this surgery is that poor blood supply may cause part or all of the nipple/areola to die, increasing the risk of infection.
Mr. Green uses three techniques to ensure proper healing of the nipple and areola:
Superior/Medial Pedicle Technique
- When Used: If the nipple needs to be lifted up to 10cm.
- How It Works: The nipple and areola remain attached to the breast via a strip of thinned skin and tissue originating from the upper/inner part of the “Wise pattern.”
- Benefits: Provides a good long-term breast shape, and the nipple often retains some sensation.
- Considerations: The lower edge of the breast may “pinch” until the scarring settles.
Central or Inferior Pedicle Technique
- When Used: If the nipple needs to be lifted more than 10cm.
- How It Works: The nipple remains attached to a central or lower stalk of tissue.
- Benefits: Heals well and avoids “pinching” of the scar at the lower breast.
- Considerations: Over time, the breast may “bottom out” due to the weight of the pedicle on the lower breast.
Nipple Graft or Tattoo
- When Used: If the nipple needs to be lifted too far for a pedicle to be safe.
- How It Works: The nipple/areola is removed and grafted to the correct position as a skin graft. Alternatively, a specialist tattooist can later tattoo the nipple/areola.
- Benefits: Achieves an excellent cosmetic result, even when a pedicle is not viable.
- Considerations: Healing takes longer, and sensation in the nipple is lost.
What can’t be done?
Restore Fullness to the Upper Breast
- While the breast will be significantly lifted, achieving upper breast fullness may require a well-fitted bra or, in some cases, a small silicone implant behind the breast.
Completely Flatten Skin Folds in the Flank
- Some women develop skin folds on their sides due to the weight of their breasts pulling downward. Mr. Green can narrow and flatten these folds to some extent, but complete flattening may not be possible.