Indications for breast reduction and fixation surgery: 1. Ptotic hypertrophic breasts reaching or exceeding the inframammary fold. 2. Unilateral or bilateral breast hypertrophy not caused by tumors. 3. Asymmetric hypertrophy of the breasts.
There are various types of breast reduction surgeries, and here we introduce three commonly used techniques. All three should be performed under sterile conditions with anesthesia. The surgical procedures are as follows:
1. Upper pedicle dermal flap breast reduction and fixation surgery
(1) A rubber tourniquet is placed at the base of the breast to control bleeding.
(2) The designed upper half-circle of the new areola's epidermis and part of the dermis are removed, forming a dermal subcutaneous tissue pedicle flap connected to the original nipple-areola complex.
(3) Excess skin, subcutaneous tissue, and mammary gland tissue are removed from the original areola and below the incision line down to the pectoralis major fascia. The remaining mammary tissue should be symmetrical on both sides.
(4) The nipple-areola complex connected to the dermal subcutaneous tissue flap is pushed upward to the new area. If there is tension preventing proper positioning, the skin of the dermal flaps on both sides of the areola can be cut to relieve tension.
(5) The dermal subcutaneous tissue flap is fixed with No. 1 silk suture onto the periosteum of the second rib in 2-3 stitches to prevent future nipple ptosis. Symmetry between the two nipples should be ensured during fixation.
(6) After transferring the areola to its new position, it is intermittently sutured to the surrounding skin with silk thread.
(7) The deep and superficial surfaces of the lower part of the mammary tissue are intermittently sutured with medical silk thread to close any dead space. The skin is then sutured properly.
(8) A rubber drainage strip is placed inside the wound followed by compression dressing. The excised mammary tissue is routinely weighed.
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2. Transverse double-pedicle breast reduction surgery
This surgery differs from the upper pedicle method in that it separately removes the upper and lower portions of the mammary tissue (according to a pre-designed plan), forming inner and outer transverse double-pedicle tissue flaps. The operation involves cutting along the edge of the areola to the dermis layer, removing a medium-thickness skin graft within the incision range. In the upper portion of the breast, excess skin, subcutaneous tissue, and mammary tissue around the new nipple-areola complex are removed according to the design size. In the lower portion, a wedge-shaped excision is made through an arc-shaped incision to remove excess skin, subcutaneous tissue, and mammary tissue, all reaching the pectoralis major fascia. After separating the already excised skin layer from the breast, inner and outer transverse double-pedicle tissue flaps are formed. After hemostasis, the double-pedicle tissue flaps connected to the nipple-areola complex are advanced upwards, transferred, and sutured into their new positions.
The above two methods have the advantage of causing less damage to blood circulation and milk ducts, ensuring the survival of the remaining tissue and preserving lactation function. They are suitable for women who need to retain lactation function.
3. Free nipple graft breast reduction surgery
This surgery involves cutting down a composite tissue flap including the original breast's epidermis, dermis, some muscle, and some ductal tissue around the nipple and areola, preparing for free grafting to a new areola location to form a new nipple-areola complex. The position of the new nipple is designed preoperatively, and the range of breast tissue removal is predicted. First, a circular nipple-areola composite tissue flap with a diameter of 4-5 cm is excised using radiofrequency technology for wrinkle removal and lipolysis.