Reduction Mammoplasty: “The Piece of Art”

Chapter

Abstract

The size, shape, and symmetry of the breasts can have a dramatic effect on the women’s well-being. Reduction mammaplasty is certainly one of the operations that plastic surgeons can significantly contribute to a woman’s quality of life. The history of breast reduction surgery is reviewed. The pathology of breast enlargement, gigantomastia, indications for surgery, goals and aesthetic concerns, and breast size after breast reduction are discussed. The author’s (FSF) personal technique is described. Possible complications of breast reductions are discussed.

References

  1. 1.
    Schaller H: Cited in Grimm K, Fritsche E (2000) Reduction of breasts… Hans Schaller and the first mammaplasty in 1561. Contribution to history of medicine. Handchir Mikrochir Plast Chir 32(5):316–320Google Scholar
  2. 2.
    Dieffenbach JF (1848) Die extirpation der bruestdruese. In: Dieffenbach JF (ed) Die operative chirurgie, vol 2. Brockhaus, Leipzig, pp 359–373Google Scholar
  3. 3.
    Thomas TG (1882) On the removal of benign tumours of the mamma without mutilation of the organ. NY Med J Obstet Rev 35:337Google Scholar
  4. 4.
    Guinard M (1903) Comment on: Rapport de l’ablation esthetique des tumeurs du sein, par M. H. Morestin. Bull Mem Soc Chir Paris 29:568Google Scholar
  5. 5.
    Morestin H (1909) Hypertrophie mammaire unilaterale ­corrige par le resection discoide. Bull Mem Soc Chir Paris 35:996Google Scholar
  6. 6.
    Villandre C: Cited in Dartigues L (1925) Traitement ­chirurgical de prolapsus mammaire. Arch Franco-Belg Chir 28:325Google Scholar
  7. 7.
    Lexer E (1912) Hypertrophie beider mammea. Munch Med Wochenschr 59:1702Google Scholar
  8. 8.
    Schwarzmann E (1937) Avoidance of nipple necrosis by preservation of corium in one-stage plastic surgery of breast. Rev Chir Struct 7:206–209Google Scholar
  9. 9.
    Bames HO (1948) Reduction of massive breast hypertrophy. Plast Reconstr Surg 3(5):560–569CrossRefGoogle Scholar
  10. 10.
    Aufricht G (1949) Mammaplasty for pendulous breasts. Empiric and geometric planning. Plast Reconstr Surg 4:13–29CrossRefGoogle Scholar
  11. 11.
    Wise RJ (1956) A preliminary report on a method of planning the mammaplasty. Plast Reconstr Surg 17(5):367–375CrossRefGoogle Scholar
  12. 12.
    Strombeck JO (1960) Mammaplasty: report of a new technique based on the two pedicle procedure. Br J Plast Surg 13:79–90PubMedCrossRefGoogle Scholar
  13. 13.
    McKissock PK (1972) Reduction mammaplasty with a ­vertical dermal flap. Plast Reconstr Surg 49(3):245–252PubMedCrossRefGoogle Scholar
  14. 14.
    Weiner DL, Aiache AE, Silver L, Tittiranonda T (1973) A single dermal pedicle for nipple transposition in subcutaneous mastectomy, reduction mammaplasty, or mastopexy. Plast Reconstr Surg 51(2):115–120PubMedCrossRefGoogle Scholar
  15. 15.
    Orlando JC, Guthrie RH Jr (1975) The superomedial dermal pedicle for nipple transposition. Br J Plast Surg 28(1):42–45PubMedGoogle Scholar
  16. 16.
    Courtiss E, Goldwyn RM (1977) Reduction mammaplasty by the inferior pedicle technique. Plast Reconstr Surg 59(1):500–507PubMedGoogle Scholar
  17. 17.
    Georgiade NG, Serafin D, Morris R, Georgiade G (1979) Reduction mammaplasty utilizing an inferior pedicle nipple-areolar flap. Ann Plast Surg 3(3):211–218PubMedCrossRefGoogle Scholar
  18. 18.
    Marchac D, de Olarte G (1982) Reduction mammaplasty and correction of ptosis with a short inframammary scar. Plast Reconstr Surg 69(1):45–55PubMedGoogle Scholar
  19. 19.
    Góes JC (1996) Periareolar mammaplasty: double skin ­technique with application of polyglactine or mixed mesh. Plast Reconstr Surg 97(5):959–968PubMedGoogle Scholar
  20. 20.
    Lejour M (1999) Vertical mammaplasty: early complications after 250 personal consecutive cases. Plast Reconstr Surg 104(3):764–770PubMedCrossRefGoogle Scholar
  21. 21.
    Lassus C (1999) Update on vertical mammaplasty. Plast Reconstr Surg 104(7):2289–2298PubMedCrossRefGoogle Scholar
  22. 22.
    Durston W: Concerning a very sudden and excessive swelling of a woman’s breast. Phil Trans Vol IV for anno 1669:1047–1049, Royal Society, London 1670Google Scholar
  23. 23.
    Netscher DT, Mosharrafa AM, Laucirica R (1996) Massive asymmetric virginal breast hypertrophy. South Med J 89(4):434–437PubMedCrossRefGoogle Scholar
  24. 24.
    Gliosci A, Presutti F (1993) Virginal gigantomastia: validity of combined surgical and hormonal treatments. Aesthetic Plast Surg 17(1):61–65PubMedCrossRefGoogle Scholar
  25. 25.
    Griffith JR (1989) Virginal breast hypertrophy. J Adolesc Health Care 10(5):423–432PubMedCrossRefGoogle Scholar
  26. 26.
    Pang S (1981) Premature thelarche and premature adrenarche. Pediatr Ann 10:29Google Scholar
  27. 27.
    Ilichi A et al (1984) Premature thelarche. Natural history and sex hormone secretion in 68 girls. Acta Paediatr Scand 73:756CrossRefGoogle Scholar
  28. 28.
    Root AW, Shulman DI (1986) Isosexual precocity: current concepts and recent advances. Fertil Steril 45(6):749–766PubMedGoogle Scholar
  29. 29.
    Jabs AD, Frantz AG, Smith-Vaniz A, Hugo NE (1990) Mammary hypertrophy is not associated with increased estrogen receptors. Plast Reconstr Surg 86(1):64–66PubMedCrossRefGoogle Scholar
  30. 30.
    Eliasen CA, Cranor ML, Rosen PP (1992) Atypical duct hyperplasia of the breast in young females. Am J Pathol 16(3):246–251CrossRefGoogle Scholar
  31. 31.
    Kupfer D, Dingman D, Broadbent R (1992) Juvenile breast hypertrophy: report of a familial pattern and review of the literature. Plast Reconstr Surg 90(2):303–309PubMedGoogle Scholar
  32. 32.
    Baker SB, Burkey BA, Thornton P, LaRossa D (2001) Juvenile gigantomastia: presentation of four cases and review of the literature. Ann Plast Surg 46(5):517–525PubMedCrossRefGoogle Scholar
  33. 33.
    Farrow JH, Ashikari H (1969) Breast lesions in young girls. Surg Clin North Am 49(2):261–269PubMedGoogle Scholar
  34. 34.
    D’Alessandro DR, Taylor FM (1986) Unilateral breast enlargement due to localized fibrosis. South Med J 79(11):1451–1453PubMedCrossRefGoogle Scholar
  35. 35.
    Letterman G, Schurter M (1980) The effects of mammary hypertrophy on the skeletal system. Ann Plast Surg 5(6):425–431PubMedCrossRefGoogle Scholar
  36. 36.
    Miller AP, Zacher JB, Berggren RB, Falcone RE, Monk J (1995) Breast reduction for symptomatic macromastia: can objective predictors for operative success be identified? Plast Reconstr Surg 95(1):77–83PubMedCrossRefGoogle Scholar
  37. 37.
    Klassen A, Fitzpatrick R, Jenkinson C, Goodacre T (1996) Should breast reduction surgery be rationed? A comparison of the health status of patients before and after treatment: postal questionnaire survey. Br Med J 313(7055):454–457CrossRefGoogle Scholar
  38. 38.
    Klassen A, Jenkinson C, Fitzpatrick R, Goodacre T (1996) Patients’ health related quality of life before and after aesthetic surgery. Br J Plast Surg 49(7):433–438PubMedCrossRefGoogle Scholar
  39. 39.
    Dabbah A, Lehman JA Jr, Parker MG, Tantri D, Wagner DS (1995) Reduction mammaplasty: an outcome analysis. Ann Plast Surg 35(4):337–341PubMedCrossRefGoogle Scholar
  40. 40.
    Boschert MT, Barone CM, Puckett CL (1996) Outcome analysis of reduction mammaplasty. Plast Reconstr Surg 98(3):451–454PubMedCrossRefGoogle Scholar
  41. 41.
    Davis GM, Ringler SL, Short K, Sherrick D, Bengtson BP (1995) Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction. Plast Reconstr Surg 96(5):1106–1110PubMedCrossRefGoogle Scholar
  42. 42.
    Raispis T, Zehring RD, Downey DL (1995) Long-term ­functional results after reduction mammaplasty. Ann Plast Surg 34(2):113–116PubMedCrossRefGoogle Scholar
  43. 43.
    Gonzalez F, Walton RL, Shafer B, Matory WE Jr, Borah GL (1993) Reduction mammaplasty improves symptoms of macromastia. Plast Reconstr Surg 91(7):1270–1276PubMedCrossRefGoogle Scholar
  44. 44.
    Netscher DT, Meade RA, Goodman CM, Brehm BJ, Friedman JD, Thornby J (2000) Physical and psychosocial symptoms among 88 volunteer subjects compared with patients seeking plastic surgery procedures to the breast. Plast Reconstr Surg 105(7):2366–2373PubMedCrossRefGoogle Scholar
  45. 45.
    Kerrigan CL, Collins ED, Kneeland TS, Voigtlaender D, Moncur MM, Matheney TH, Grove MR, Tosteson AN (2000) Measuring health state preferences in women with breast hypertrophy. Plast Reconstr Surg 106(2):280–288PubMedCrossRefGoogle Scholar
  46. 46.
    Kerrigan CL, Collins ED, Striplin D, Kim HM, Wilkins E, Cunningham B, Lowery J (2001) The health burden of breast hypertrophy. Plast Reconstr Surg 108(6):1591–1599PubMedCrossRefGoogle Scholar
  47. 47.
    Collins ED, Kerrigan CL, Kim M, Lowery JC, Striplin DT, Cunningham B, Wilkins EG (2002) The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg 109(5):1556–1566PubMedCrossRefGoogle Scholar
  48. 48.
    Penn J (1955) Breast reduction. Br J Plast Surg 7(4):357–371PubMedGoogle Scholar
  49. 49.
    Berry EP (1968) Geometric planning in reduction mammaplasty. Plast Reconstr Surg 42(3):232–236PubMedCrossRefGoogle Scholar
  50. 50.
    Goldwyn RM, Courtiss EH (1990) Reduction mammaplasty by the inferior pedicle (pyramidal) technique. In: Goldwyn RM (ed) Reduction mammaplasty. Little, Brown, Boston, pp 255–266Google Scholar
  51. 51.
    Palumbo SK, Shifren J, Rhee C (1998) Modifications of the Lejour vertical mammaplasty: analysis of results in 100 consecutive patients. Ann Plast Surg 40(4):354–359PubMedCrossRefGoogle Scholar
  52. 52.
    Kavka S (1999) A simple device for marking the areola in vertical mammaplasty. Plast Reconstr Surg 103(7):2087PubMedGoogle Scholar
  53. 53.
    Mendez-Fernandez MA (1991) An easy-to-make, easy-to-use device for preoperative marking for reduction mammoplasty and mastopexy. Ann Plast Surg 26(6):602–603PubMedCrossRefGoogle Scholar
  54. 54.
    Lazarus D (1998) A new template-goniometer for marking the wise keyhole pattern of reduction mammaplasty. Plast Reconstr Surg 101(1):171–173PubMedCrossRefGoogle Scholar
  55. 55.
    Beer GM, Morgenthaler W, Spicher I, Meyer VE (2001) Modifications in vertical scar reduction. Br J Plast Surg 54(4):341–347PubMedCrossRefGoogle Scholar
  56. 56.
    Paloma V, Samper A, Sanz J (1998) A simple device for marking the areola in Lejour’s mammaplasty. Plast Reconstr Surg 103(7):2134–2135Google Scholar
  57. 57.
    Fahmy FS, Hemington-Gorse SJ (2006) The sitting, oblique, and supine marking technique for reduction mammoplasty and mastopexy. Plast Reconstr Surg 117(7):2145–2151PubMedCrossRefGoogle Scholar
  58. 58.
    Bolger WE, Seyfer AE, Jackson SM (1987) Reduction mammoplasty using the inferior glandular “pyramid” ­pedicle: experiences with 300 patients. Plast Reconstr Surg 80(1):75–84PubMedCrossRefGoogle Scholar
  59. 59.
    Hunter JG, Ceydeli A (2006) Correlation between complication rate and tissue resection volume in inferior pedicle reduction mammaplasty: a retrospective study. Aesthet Surg J 26(2):153–156PubMedCrossRefGoogle Scholar
  60. 60.
    Regnault P, Daniel RK (1984) Breast reduction. In: Regnault P, Daniel RK (eds) Aesthetic plastic surgery: principles and techniques. Little Brown, Boston, pp 499–538Google Scholar
  61. 61.
    Hallock GG (1992) Prediction of nipple viability following reduction mammoplasty using laser Doppler flowmetry. Ann Plast Surg 29(5):457–460PubMedCrossRefGoogle Scholar
  62. 62.
    Roth AC, Zook EG, Brown R, Zamboni WA (1996) Nipple-areolar perfusion and reduction mammaplasty: correlation of laser Doppler readings with surgical complications. Plast Reconstr Surg 97(2):381–386PubMedCrossRefGoogle Scholar
  63. 63.
    Perbeck L, Proano E, Maattanen H (1991) Skin circulation in the nipple after reduction mammaplasty with a bipedicle vertical dermal flap. Scand J Plast Reconstr Surg Hand Surg 25(1):41–45PubMedCrossRefGoogle Scholar
  64. 64.
    Tracy CA, Pool R, Gellis M, Vasileff W (1992) Blood flow of the areola and breast skin flaps during reduction mammaplasty as measured by laser Doppler flowmetry. Ann Plast Surg 28(2):160–166PubMedCrossRefGoogle Scholar
  65. 65.
    Townsend PL (1974) Nipple sensation following breast reduction and free nipple transplantation. Br J Plast Surg 27(4):308–310PubMedCrossRefGoogle Scholar
  66. 66.
    Slezak S, Dellon AL (1993) Quantitation of sensibility in gigantomastia and alteration following reduction mammaplasty. Plast Reconstr Surg 91(7):1265–1269PubMedCrossRefGoogle Scholar
  67. 67.
    Gonzalez F, Brown FE, Gold ME, Walton RL, Shafer B (1993) Preoperative and postoperative nipple areola sensibility in patients undergoing reduction mammaplasty. Plast Reconstr Surg 92(5):809–814PubMedGoogle Scholar
  68. 68.
    Temple CL, Hurst LN (1999) Reduction mammaplasty improves breast sensibility. Plast Reconstr Surg 104(1):72–76PubMedCrossRefGoogle Scholar
  69. 69.
    Hamdi M, Greuse M, Nemec E, Deprez C, De Mey A (2001) Breast sensation after superior pedicle versus inferior ­pedicle mammaplasty: anatomical and histological evaluation. Br J Plast Surg 54(1):43–46PubMedCrossRefGoogle Scholar
  70. 70.
    Hamdi M, Greuse M, DeMey A, Webster MH (2001) A ­prospective quantitative comparison of breast sensation after superior and inferior pedicle mammaplasty. Br J Plast Surg 54(1):39–42PubMedCrossRefGoogle Scholar
  71. 71.
    Greuse M, Hamdi M, DeMey A (2001) Breast sensitivity after vertical mammaplasty. Plast Reconstr Surg 107(4):970–976PubMedCrossRefGoogle Scholar
  72. 72.
    Aboudib JH Jr, de Castro CC, Coelho RS, Cupello AM (1991) Analysis of late results in post-pregnancy mammaplasty. Ann Plast Surg 26(2):111–116CrossRefGoogle Scholar
  73. 73.
    Marshall DR, Callan PP, Nicholson W (1994) Breastfeeding after reduction mammaplasty. Br J Plast Surg 47(3):167–169PubMedCrossRefGoogle Scholar
  74. 74.
    Harris L, Morris SF, Freiberg A (1992) Is breast feeding possible after reduction mammaplasty? Plast Reconstr Surg 89(5):836–839PubMedCrossRefGoogle Scholar
  75. 75.
    Brzozowski D, Niessen M, Evans HB, Hurst LN (2000) Breast feeding after inferior pedicle reduction mammaplasty. Plast Reconstr Surg 105(2):530–534PubMedCrossRefGoogle Scholar
  76. 76.
    Beer GM, Komptscher P, Hergan K (1996) Diagnosis of breast tumors after breast reduction. Aesthetic Plast Surg 20(5):391–397PubMedCrossRefGoogle Scholar
  77. 77.
    Titley OG, Armstrong AP, Christie JL, Fatah MFT (1996) Pathological findings in breast reduction surgery. Br J Plast Surg 49(7):447–451PubMedCrossRefGoogle Scholar
  78. 78.
    Özmen S, Yavuzer R, Latifoglu O, Atabay K (2000) Coincidental breast carcinoma detection in reduction mammaplasty specimens (letter). Plast Reconstr Surg 106(5):1219–1220PubMedCrossRefGoogle Scholar
  79. 79.
    Mandrekas AD, Assimakopoulos GI, Mastorakos DP, Pantzalis K (1994) Fat necrosis following breast reduction. Br J Plast Surg 47(8):560–562PubMedCrossRefGoogle Scholar
  80. 80.
    Woods JE, Borkowski JJ, Masson JK, Irons GB (1978) Experience with and comparison of methods of reduction mammaplasty. Mayo Clin Proc 53(8):487–493PubMedGoogle Scholar
  81. 81.
    Samdal F, Serra M, Skolleborg KC (1992) The effects of infiltration with adrenaline on blood loss during reduction mammaplasty. Scand J Plast Reconstr Surg Hand Surg 26(2):211–215PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Plastic SurgeryCountess of Chester HospitalCheshireUK
  2. 2.Plastic Surgery DepartmentAin Shams UniversityCairoEgypt

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