Surgical management
The established surgical approaches to breast reduction may be considered in terms of approaches to the soft tissue envelope - which determine the subsequent extent and positioning of scars as well as contributing to contouring - and the approach to the deeper fat and mammary gland that must sustain a blood supply to the nipple and areola - the 'pedicle'. The blood supply may come through the mammary gland or a combination of this and a de-epithelialised skin bridge - a 'dermoglandular pedicle'. Free nipple grafting has an indication for particularly large breasts. Additionally, liposuction may be used alone or as an adjunctive procedure.
The decision about which approach to adopt will largely depend upon:
- size of breast
- degree of ptosis
- asymmetry
- preservation of pedicle blood supply
- desire to breast feed
- attitude to the extent of scarring
- existing scars
- association of given techniques with preserved sensation
- associated surgery eg lumpectomy for breast cancer - oncoplastic breast reduction approaches
- reproducibility of results
- longevity of results
- surgical preference
Within the United Kingdom, an inverted 'T' or vertical and periareolar scar, and an inferiorly- or superomedially-based pedicle, remain popular.
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