Patients who undergo breast reduction surgery frequently are seeking relief from physical symptoms caused by the excessive weight of large breasts. Breast reduction usually can solve these problems as well as improve the size and shape of the breasts. This is one of the most challenging procedures in Plastic Surgery. Several methods have been described, indicating that no single method is perfect for all types of breast enlargement. The most difficult decision is whether to leave the nipple on a pedicle, thereby retaining its sensitivity and erectile function, or whether to use it as a full thickness graft, in which case both are drastically reduced, sometimes lost. The decision is made based upon some calculations and some experience. The final call is the surgeons, often made on the operation table, and the patient must accept this in good faith.

I use the Modified MacKissock Vertical Pedicle design for reducing the breast, as I believe that the design is sturdy for pedicled transfer of the nipple and allows individual contouring of the different quadrants of breast tissue. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision follows the natural curve of the breast crease. Drains are inserted under the skin at the end of surgery followed by a compressive dressing.

General anaesthesia is used. Since the procedure is long, GA gives the best control over the patients vital parameters.

Patient stays in hospital until the drains are removed, generally 48 to 72 hours.

Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. Permanent loss of sensation in the nipples or breasts may occur rarely. Revision surgery is sometimes required in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

After drain removal, the patient may be allowed to shower lightly. A small dressing, held in place by a sports bra is quite adequate. Follow up is once in 3 to 4 days. Stitch removal is approx. 12 to 14 days after surgery. Most patients can get back to work within a week, all going well. Active exercises can start in about a months time.

There is a surprising lack of pain, in spite of the surgery being extensive. The scars of breast reduction are extensive and could be fairly visible in certain skin types. However, the patient must understand that they are exchanging breast size and shape, and all the discomfort, physical and social, for the scars. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing. Also, patients must be willing to undergo minor revision procedures if these become necessary.

The degree of freedom that this procedure bestows on patients is unmatched. I have had patients relieved of years of backache and shoulder pain when they had this surgery performed on them.