Breast reduction is a reliable surgical procedure that gives great benefits to patients, with improvements in appearance and comfort. When considering a breast reduction you are no doubt concerned about the general embarrassment and self consciousness that over large breasts can cause but you may also be experiencing many physical symptoms, such as shoulder and back pain, breast pain, soreness of the skin underneath the breasts or painful indentation of the skin over the shoulders. Large breasts are also often a physical encumbrance, limiting the pleasure of participating in sporting and leisure activities.
A breast reduction reduces the volume of tissue in the breast and to create a pleasing shape to the new breast the nipple is re-positioned, the breast mound is re-formed and excess skin removed. A critical part of a breast reduction is the re-positioning of the nipple. The new position of the nipple is determined relative to your infra-mammary fold. Blood supply to the nipple is maintained during re-positioning by leaving the nipple connected to the breast with a strip of tissue known as a pedicle. There are many different ways that this pedicle can be created but I use either a superior or inferior pedicle. The new breast is created from tissue in the upper outer and inner parts of the breast, with excess breast tissue and skin being removed from the central and lower parts of the breast.
When the nipple is re-positioned it is often appropriate to reduce the size of the areola, which is usually stretched in the larger breast. Re-positioning of the nipple leaves a circular scar around the areola which blends in well at the junction between darker and lighter coloured skin. The difference in colour and texture at this junction camouflages the scar well. The circular scar around the areola continues downwards as a vertical scar running over the lower pole of the breast to the fold underneath the breast. Depending upon your breast size, and your wishes, a vertical scar only may be required (vertical scar breast reduction) or there may be an additional horizontal scar in or about the infra-mammary fold.
My favoured technique for breast reduction is a superior pedicle breast reduction, with or without a horizontal scar. In most breasts this gives me the greatest flexibility in creating the new breast size and shape and creates a more stable breast shape in the long term. If you are very large we may need to use a more traditional inferior pedicle, with a horizontal scar.