Breast Reduction: Be Fit and Fit Better

Be Fit

The procedures we use in Breast Reduction have changed dramatically over the years. The groundbreaking procedure was the Wise, or keyhole pattern, developed by Dr. Robert Wise. In this operation, a superior pedicle lifted the nipple as the breast tissue was reduced. Dr. Ivo Pitanguy elaborated on this in the late 1960's with a keel excision from beneath the nipple area as the breast was lifted and reshaped, removing a little boat shaped area of breast tissue in the central portion of the breast.

A persistent problem with the shape of reduced breasts was addressed when Dr. Madeline Lejour and others emphasized the vertical scar for excision, producing a breast with more projection. Lejour's advances, and the consideration of elasticity of the breast skin, allow us to avoid the flatness or boxy shape produced by earlier breast reductions.

Complaints of a post operative shift or "bottoming out" are prevented by anticipating this natural increase in the elasticity of the skin by designing an initial breast shape that is rather flat on the bottom and full on the top, planning for the post operative relaxation of tissue. The breast falls into its anticipated position at about six weeks after the operation. See video: Reduction Comparison (40DD to38C)

This design lends itself to short scar techniques. The horizontal incision is eliminated or reduced, avoiding the long medial and lateral scars of the early Wise pattern or keyhole techniques. This shape is well maintained over time. First utilized in the 1970's, the results have been persistent and recurrence unusual. One concern has been the ability to breast feed. The superior pedicle leaves the ductal tissue uninterrupted in much of the circumference of the nipple. Starting in the 1970s, I asked patients to send me a postcard and let me know if they were able to breast feed. The postcards reported successes with breastfeeding. Later studies have confirmed the postcards results. Not everyone is able to breast feed, but unless the nipple has been moved as a full thickness graft, breast feeding is often possible.

Patient comfort is often dramatically improved with breast reduction. Many patients comment on the change in the immediate post-operative period. The weight of large heavy breasts pulls on bra straps, producing deep grooves and straining the neck shoulders and back; this discomfort is relieved right away by reduction. It is suddenly possible to exercise without discomfort, and changes in posture and activity levels are often impressive.

For years we insisted that, before undergoing breast reduction, patients bring their body mass index to a near normal range. Starting in the 1970's we tried an alternate tack, and found that breast reduction often jump started a weight loss. For some women, breast reduction made it possible to be physically active for the first time in their adult lives.

If you would like to schedule an appointment to discuss breast reduction, contact us at Asheville Plastic Surgery.