Skip to main content
SpringerLink
Log in

Breast Reduction and Mastopexy

  • Chapter
Plastic and Reconstructive Surgery

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

Summary

A vast array of techniques have been developed and abandoned since the first reported breast reduction by Dieffenbach, 160 years ago. The current trend, particularly in Europe, is toward short scar techniques. In this chapter the pertinent aspects of breast anatomy and physiology are delineated as well as the medical indications and psychological aspects inherent in macromastia patients. In addition, necessary preoperative classification and planning are discussed in conjunction with technique selection and execution. This is followed by a detailed description and step-by-step photograph demonstration of our preferred technique, mainly influenced by the Z-plasty technique of Maillard and the short vertical scar technique of Lassus. The complication and revision rates of major studies are compared to our own series of 3,554 breast reductions using this technique. Finally, the medicolegal aspects are discussed focusing on the fact that breast reductions and mastopexies are the most frequent causes of law suits in plastic surgery in the U.S. due to scar problems.

There is no doubt that breast reduction provides enormous benefits to patients, physically als well as psychologically. Even from an economic point of view, insurance companies would benefit from paying for this procedure, since the health condition of patients improves enormously after breast reduction.

Breast reduction and mastopexy are among the most common procedures in plastic surgery. Outcome studies demonstrate that patients' satisfaction postoperatively is very high for this procedure.

However the degree of patient's overall satisfaction is strongly correlated with patient's satisfaction with her scars.

Therefore, there is an urgent need for techniques that are associated with shorter and/or less visible scars.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 259.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Aiache A. History of the circumareolar procedure. In: Wilkinson TS, Aiache A, Toledo L, eds. Circumareolar Techniques for Breast Surgery. Berlin/Heidelberg/New York: Springer; 1995:31.

    Google Scholar 

  2. Baran CN, Peker F, Ortak T, Censöz Ö, Baran NK. Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple. Aesthetic Plast Surg. 2001;25:286–289.

    Article  PubMed  CAS  Google Scholar 

  3. Benelli L. Technique de plastie mammaire “round block”. Rev Chir Esth Langue Fr. 1988;13(50):7.

    Google Scholar 

  4. Benelli L. A new periareolar mammaplasty: the “round block” technique. Aesthet Plast Surg. 1990;14:99.

    Article  Google Scholar 

  5. Boschert MT, Barone CM, Puckett CL. Outcome analysis of reduction mammoplasty. Plast Reconstr Surg. 1996;98(3):451–454.

    Article  PubMed  CAS  Google Scholar 

  6. Brown FE, Sargent SK, Cohen SR, Morain WD. Mammographic changes following reduction mamma-plasty. Plast Reconstr Surg. 1987;80:691–698.

    Article  PubMed  CAS  Google Scholar 

  7. Caouette-Laberge L, Duranceau LA. Breast feeding after breast reduction. Ann Chir. 1992;46(9):826–826.

    PubMed  CAS  Google Scholar 

  8. Courtiss EH, Goldwyn RM. Reduction mammaplasty by the inferior pedicle technique. Plast Reconstr Surg. 1977;59:500–507.

    PubMed  CAS  Google Scholar 

  9. Craig RD, Sykes PA. Nipple sensitivity following reduction mammaplasty. Br J Plast Surg. 1970;23:165.

    Article  PubMed  CAS  Google Scholar 

  10. Dabbah A, Lehman JA Jr, Parker MG, Tantri D, Wagner DS. Reduction mammoplasty: an outcome analysis. Ann Plast Surg. 1995;35:337–341.

    Article  PubMed  CAS  Google Scholar 

  11. Davis GM, Ringler SL, Short K, Sherrick D, Bengtson BP. Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction. Plast Reconstr Surg. 1995;96(5): 1106–1110.

    Article  PubMed  CAS  Google Scholar 

  12. Farina MA, Newby BG, Alani HM. Innervation of the nip-ple–areola complex. Plast Reconstr Surg. 1980;66:497–501.

    Article  PubMed  CAS  Google Scholar 

  13. Georgiade NG, Serafin D, Morris R, Georgiade G. Reduction mammaplasty utilizing an inferior pedicle nipple–areolar flap. Ann Plast Surg. 1979;3:211.

    Article  PubMed  CAS  Google Scholar 

  14. Goes JCS. Periareolar mammaplasty: double skin technique. Rev Soc Bras Cir Plast. 1989;4:55–63.

    Google Scholar 

  15. Goldwyn RM. Classification of the breast and the hyper-trophic breast and note on arrangement of chapters. In: Goldwyn RM, ed. Reduction Mammaplasty. Boston, MA: Little Brown & Co; 1990:91–93.

    Google Scholar 

  16. Goldwyn RM. Complications and unfavorable results of reduction. In: Goldwyn RM, ed. Reduction Mammaplasty. Boston, MA: Little Brown & Co; 1990:561–578.

    Google Scholar 

  17. Goldwyn RM, Courtiss EH. Reduction mammaplasty by the inferior pedicle (pyramidal technique). In: Goldwyn RM, ed. Reduction in Mammaplasty. Boston, MA: Little Brown & Co; 1990:73–90.

    Google Scholar 

  18. Gonzalez F, Brown FE, Gold ME, Walton RL, Shafer B. Preoperative and postoperative nipple–areola sensibility in patients undergoing reduction mammaplasty. Plast Reconstr Surg. 1993;92(5):809–814.

    PubMed  CAS  Google Scholar 

  19. Gonzalez F, Walton RL, Shafer B, Matory WE Jr, Borah GL. Reduction mammaplasty improves symptoms of macro-mastia. Plast Reconstr Surg. 1993;91(7):1270–1276.

    Article  PubMed  CAS  Google Scholar 

  20. Gorney M. Ethical and legal issues. In: Siemionow M, Eisenmann-Klein M, eds. Plastic and Reconstructive Surgery. Berlin/Heidelberg/New York: Springer; 2008/2009.

    Google Scholar 

  21. Graf R, Biggs TM. In search of a better shape in mas-topexy and reduction mammoplasty. Plast Reconstr Surg. 2001;10:309–317.

    Google Scholar 

  22. Gruber RP, Jones HW Jr. The “Donut” mastopexy: indications and complications. Plast Reconstr Surg. 1980;65:34.

    Article  PubMed  CAS  Google Scholar 

  23. Hall-Findlay EJ. A simplified vertical reduction mamma-plasty: shortening the learning curve. Plast Reconstr Surg. 1999;140:748–759; discussion 760–763.

    Google Scholar 

  24. Harris L, Morris SF, Freiberg A. Is breast feeding possible after reduction mammaplasty? Plast Reconstr Surg. 1992;89(5):836–839.

    Article  PubMed  CAS  Google Scholar 

  25. Heine N, Eisenmann-Klein M, Prantl L. Gigantomasty: treatment with a short vertical scar. Aesthet Plast Surg. 2008;32:40–47.

    Article  Google Scholar 

  26. Hester TR, Cukic J. Central breast pedicle and “free-hand” technique for alteration of volume and skin envelope of the breast. Clin Plast Surg. 1988;15:613–625, 1988.

    PubMed  Google Scholar 

  27. Hinderer UT. The dermal brassiere mammaplasty. Clin Plast Surg. 1976;3:349.

    PubMed  CAS  Google Scholar 

  28. Hinderer UT. Development of concepts in reduction mammplasty and ptosis. In: Georgiade NG, Georgiade GS, Riefkohl R, eds. Aesthetic Surgery of the Breast. Philadelphia, PA: WB Saunders; 1990:565.

    Google Scholar 

  29. Hinderer UT. Aesthetische mammachirurgie bei ptosis und hypertrophie. In: Berger A, Hierner R, eds. Plastische Chirurgie Mamma Stamm Genitale. Berlin/Heidelberg/ New York: Springer; 2007:133–154.

    Chapter  Google Scholar 

  30. Hinderer UT. Entwicklung der Mammaplastik be Ptosis und Hypertrophie in Plastische Chirurgie Mamma Stamm Genitale. Berlin/Heidelberg: Springer; 2007:1–90.

    Google Scholar 

  31. Hinderer UT, del Rio JL. Treatment of hypertrophy and ptosis: dermal brassiere mammaplasty. In: Georgiade NG, ed. Aesthetic Breast Surgery. Baltimore, MD: Williams & Wilkins; 1983:306.

    Google Scholar 

  32. Hirohata T, Nomura AMY, Kolonel LN. Breast size and cancer. Br Med J. 1977;2:641.

    Article  PubMed  CAS  Google Scholar 

  33. Hoffman S. Complications of reduction mammaplasty. In: Noone RB, ed. Plastic and Reconstructive Surgery of the Breast. Philadelphia, PA: BC Decker; 1991.

    Google Scholar 

  34. Hollyman JA, Lacey JH, Whitefield PJ, Wilson JS. Surgery for the psyche: a longitudinal study of women undergoing reduction mammoplasty. Br J Plast Surg. 1986;39:222–224.

    Article  PubMed  CAS  Google Scholar 

  35. Joseph J. Zur operation der hypertrophischen hängebrust. Dtsch Med Wochenschr. 1925;51:1103.

    Article  Google Scholar 

  36. Kappel RM, Dijkstra R, Storm van Leeuwen JB, Houpt P, Kuyper M. Nipple sensitivity and lactation in two methods of breast reduction. Eur J Plast Surg. 1997; 20:60–65.

    Article  Google Scholar 

  37. Karabela-Bouropoulou V, Liapi-Avgeri G, Iliopoulou E, Agnantis NJ. Histological findings in breast tissue specimens from reduction mammoplasties. Pathol Res Pract. 1994;190(8):792–798.

    Article  PubMed  CAS  Google Scholar 

  38. Kayar R. The 200-gm reduction of breast should be enough for insurance coverage of reduction mamma-plasty. Plast Reconstr Surg. 1996;97(6):1312.

    PubMed  CAS  Google Scholar 

  39. Klassen A, Fitzpatrick R, Jenkinson C, Goodacre T. Should breast reduction surgery be rationed? A comparison of the health status of patients before and after treatment: postal questionnaire survey. Br Med J. 1996;313(7055): 454–457.

    Article  CAS  Google Scholar 

  40. Klinzing S, Kunert P. Mammaformung. In: Berger A, Hierner R, eds. Plastische Chirurgie Mamma Stamm Genitale. Berlin/ Heidelberg/New York: Springer; 2007:91–132.

    Chapter  Google Scholar 

  41. Lassus C. A technique for breast reduction. Int J Surg. 1970;53:69–79.

    CAS  Google Scholar 

  42. Lejour M. Vertical Mammaplasty and Liposuction. St Louis, MO: Quality Medical; 1994.

    Google Scholar 

  43. Letterman G, Schurter M. The effects of mammary hypertrophy on the skeletal system. Ann Plast Surg. 1980;5(6):425–431.

    Article  PubMed  CAS  Google Scholar 

  44. Lotsch F. Über Hängebrustplastik. (Vortrag, gehalten in der Berliner Gesellschaft für Chirurgie am 14. Mai 1923.) Zentralbl Chir. 1923;50:1241–1244.

    Google Scholar 

  45. MacKinnon SE. Preoperative and postoperative nipple– areola sensibility in patients undergoing reduction mam-maplasty. Plast Reconstr Surg. 1993;92(5):815–818.

    Google Scholar 

  46. Maillard GF. A Z-mammaplasty with minimal scarring. Plast Reconstr Surg. 1986;77:66.

    Article  PubMed  CAS  Google Scholar 

  47. Marchac D, Olarte G. Reduction mammaplasty and correction of ptosis with a short inframammary scar. Plast Reconstr Surg. 1982;69:45–55.

    PubMed  CAS  Google Scholar 

  48. Marshall DR, Callan PP. Nicholson W. Breastfeeding after reduction mammaplasty. Br J Plast Surg. 1994;47(3): 167–169.

    Article  PubMed  CAS  Google Scholar 

  49. McKissock PK. Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg. 1972;49:245–252.

    Article  PubMed  CAS  Google Scholar 

  50. Mottura AA. Zirkumvertikale mammareduktionsplastik. In: Lemperle G (Hrsg). Ästhetische Chirurgie. edn 1 IX-4. Landsberg, Germany: Ecomed; 2003.

    Google Scholar 

  51. Nahabedian MY, Mofid MM. Viability and sensation of the nipple–areolar complex after reduction mamma-plasty. Ann Plast Surg. 2002;1(49):24–32.

    Article  Google Scholar 

  52. Peixoto G. Reduction mammaplasty: a personal technique. Plast Reconstr Surg. 1980;65:217–225.

    Article  PubMed  CAS  Google Scholar 

  53. Pitanguy I. Breast Hypertrophy. Transact II International Congress Confederation Plastic Surgery London 1959. London: Livingstone; 1960:509.

    Google Scholar 

  54. Pitanguy I. Surgical treatment of breast hypertrophy. Br J Plast Surg. 1967;20(1):78–85.

    Article  PubMed  CAS  Google Scholar 

  55. Platt R, Zucker JR, Zaleznik DF, et al. Perioperative antibiotic prohylaxis and wound infection following breast surgery. J Antimicrob Chemother. 1993;32(suppl B): 43–48.

    Article  Google Scholar 

  56. Poell JG. Vertical reduction mammaplasty. Aesthet Plast Surg. 2004;28:59–69.

    Google Scholar 

  57. Regnault P, Daniel RK, eds. Aesthetic Plastic Surgery. Boston, MA: Little Brown & Co; 500.

    Google Scholar 

  58. Ricbourg B. Applied anatomy of the breast: blood supply and innervation. Ann Chir Plast Esthet. 1992;37(6): 603–620.

    PubMed  CAS  Google Scholar 

  59. Robertson JL. Changed appearance of mammograms following breast reduction. Plast Reconstr Surg. 1977;59(3): 347–351.

    Article  PubMed  CAS  Google Scholar 

  60. Romm S. Endocrinology and physiology of the breast. In: Goldwyn RM, ed. Reduction Mammaplasty. B o s t o n, M A : Little Brown & Co; 1990:29–34.

    Google Scholar 

  61. Saletti JM, Reading G, Caldwell E, Wray RC. Long term patient satisfaction following reduction mammaplasty. Ann Plast Surg. 1992;28:363–365.

    Article  Google Scholar 

  62. Schnur PL, Schnur DP, Petty PM, Hanson TJ, Weaver AL. Reduction mammaplasty: an outcome study. Plast Reconstr Surg. 1997;100(4):875–883.

    PubMed  CAS  Google Scholar 

  63. Seitchik MW. Reduction mammaplasty: criteria for insurance coverage. Plast Reconstr Surg. 1995;95:1029.

    Article  PubMed  CAS  Google Scholar 

  64. Shakespeare V, Postle K. A qualitative study of patients' views on the effects of breast-reduction surgery: a 2-year follow-up survey. Br J Plast Surg. 1999;52:198–204.

    Article  PubMed  CAS  Google Scholar 

  65. Smith D. National endowment funds reduction outcome studies. Plast Surg News May. 1997;2.

    Google Scholar 

  66. Stroembeck JO, ed. Surgery of the Breast. Stuttgart, New York: Georg Thieme-Verlag; 1986.

    Google Scholar 

  67. White DJ, Maxwell G P. Breast reduction. In: Achauer BM, Eriksson E, Guymon B, Coleman JJ III, Russell RC, Nander Kolh A, eds. Indications, Operations and Outcome. St Louis, MO: Mosby; 2000;5:2705–2742.

    Google Scholar 

  68. Widdice L. The effects of breast reduction and breast augmentation surgery on lactation: an annotated bibliography. J Hum Lact. 1993;9(3):161–167.

    Article  PubMed  CAS  Google Scholar 

  69. Wise RJ, Gannon J P, Hill JR. Further experience with reduction mammaplasty. Plast Reconstr Surg. 1963;32(1): 12–20.

    Article  PubMed  CAS  Google Scholar 

  70. Woods JE, Borkowski JJ, Masson JK, Irons GB, et al. Experience with and comparison of methods of reduction mammoplasty. Mayo Clin Proc. 1978;53:487.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic and Aesthetic, Hand, and Reconstructive Surgery, Caritas-Krankenhaus St. Josef, affiliated with Regensburg University, Regensburg, Germany

    Marita Eisenmann-Klein

Authors
  1. Marita Eisenmann-Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Maria Z. Siemionow (Professor of Surgery, Director of Plastic Surgery Research, Head of Microsurgery Training) (Professor of Surgery, Director of Plastic Surgery Research, Head of Microsurgery Training)

  2. Department of Plastic and Aesthetic, Hand, and Reconstructive Surgery, Caritas-Krankenhaus St. Josef, affiliated with Regensburg University, Regensburg, Germany

    Marita Eisenmann-Klein (Director) (Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London Limited

About this chapter

Cite this chapter

Eisenmann-Klein, M. (2010). Breast Reduction and Mastopexy. In: Siemionow, M.Z., Eisenmann-Klein, M. (eds) Plastic and Reconstructive Surgery. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84882-513-0_30

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-513-0_30

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-512-3

  • Online ISBN: 978-1-84882-513-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation