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. Breast asymmetry with hypertrophy.
Breast reduction surgery comes in various types, and three commonly used techniques are introduced here. These three shaping surgeries should all be performed under sterile anesthesia conditions. The surgical operations include:
1. Upper pedicle tissue flap breast reduction and fixation surgery
(1) Place a rubber tube tourniquet at the base of the breast.
(2) Remove the epidermis and part of the dermis of the upper semicircle of the new areola area according to the design, forming a dermal subcutaneous tissue pedicle flap connected to the original nipple-areola complex.
(3) Remove excess skin, subcutaneous tissue, and mammary gland tissue from below the original areola and the lower edge of the incision line, down to the pectoralis major fascia. The remaining mammary gland tissue should be symmetrical on both sides.
(4) Push the nipple-areola complex connected to the dermal subcutaneous tissue flap upward to the new area. If there is traction tension making it difficult to position the nipple-areola complex, the skin of the dermal flaps on both sides of the areola can be incised to reduce tension, solving the problem.
(5) Fix the dermal subcutaneous tissue flap to the periosteum of the second rib with 1 silk suture for 2-3 stitches to prevent future nipple ptosis. Pay attention to the symmetry and consistency of both nipples during fixation.
(6) After transferring the areola to the new position, intermittently suture it with silk thread to the surrounding skin.
(7) Use medical silk thread to intermittently suture the deep and superficial surfaces of the lower part of the mammary gland tissue to bring them together and eliminate dead space. The skin is sutured well with medical silk thread.
(8) Leave a rubber drainage sheet in the wound and apply pressure dressing. The excised mammary gland tissue is routinely measured.
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2. Transverse double-pedicle tissue flap breast reduction surgery
The difference between this surgery and the upper pedicle technique lies in the fact that breast tissue is separately removed from the upper and lower parts of the breast (according to the 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 as per the incision design, removing a medium-thickness skin graft within the incision range. In the upper part of the breast, remove the excess skin, subcutaneous tissue, and mammary gland tissue centered around the new nipple-areola complex according to the designed size. In the lower part, make a wedge-shaped resection through an arc-shaped incision to remove the excess skin, subcutaneous tissue, and mammary gland tissue from the lower part of the breast. Both reach down to the pectoralis major fascia. After separating the breast section with the already removed skin surface, form inner and outer transverse double-pedicle tissue flaps. After hemostasis, transfer the double-pedicle tissue flap connected to the nipple-areola complex upward to the new position and suture it into place.
Both of these 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 slice including the epidermis, dermis, some muscle, and some ductal tissue of the original breast, including the nipple and areola, for free transplantation to a new areolar position, forming a new nipple-areola complex. Before the operation, the position of the new nipple and the predicted range of breast tissue removal should be designed. First, cut out a round nipple-areola composite tissue slice with a diameter of 4-5 cm.