Breast reduction in women (mammary reduction)
Very heavy breasts may severely impact a woman’s mental health as well as her movement patterns (activities of daily living, sport, social context), therefore impairing quality of life. It is almost impossible to achieve a reduction in size of natural, but excessively large breasts by physical exercise only. Reasons for breasts growing large can be either genetic or hormonal (puberty, following pregnancy, following the climacteric/menopause or weight fluctuations). It is not rare to find substantial congenital differences between the two breasts (asymmetries) or an imbalance may arise due to the removal/reconstruction of one breast, e.g. in cases of breast cancer, because of a remaining large breast on the other side. Physical symptoms are mostly found in the region of the thoracic and cervical spine and at the transition point of the neck and shoulders (brachio-cervical region). These symptoms, which often result in a severe impairment of self-confidence in addition to tenseness, pain and poor posture, cause female patients to decide in favour of a breast reduction during puberty or at any later stage in life. The goal of surgery is the removal of excess skin, adipose and glandular tissue, while obtaining an aesthetically natural and pleasing result and theoretically maintaining the ability to breastfeed. The technical options are numerous and include more than 40 established techniques. The incision is made either around the areola (periareolar), below the areola (subareolar) and/or in the fold under the breast (submammary). As a very broad distinction, the techniques can be classified as “t-shaped technique” (wise pattern) or “keyhole technique” (vertical technique). These designations result from the external incision direction, whereby both techniques include an incision around the areola and vertically downward; the T-technique additionally includes an incision in the fold under the breast (submammary fold).
This description only explains the external aspects, however; there are many options to shape the mammary gland after tissue removal and to define the perfusion paths of the areola. Due to the very diverse techniques, an individual informed consent discussion will be held, in which all the arguments as well as potential complications will be highlighted.