Central mound technique for breast reduction

Abstract

As Western women, particularly American women, have grown significantly over the last two decades, so have women's breast sizes and the symptoms that accompany them. This phenomenon has led to an increased number of women seeking breast reduction, as well as an increase in the amount of breast tissue to be reduced. Many excellent techniques for breast reduction have been described and are utilized today [1-6]. The larger amount of breast to be reduced commensurately reduces the surgical options. The greater the reduction size, the greater the risk of nipple necrosis and fat necrosis secondary to decreased blood supply because of an increased length of the pedicle. Unfortunately, weight loss and exercise discipline in these patients has not resulted in any meaningful reduction in the size of the breasts. Therefore, a surgical solution is usually necessary. In general, if the nipple needs to be moved 10 cm or less superiorly and (if there are no underlying medical problems such as diabetes or environmental problems such as smoking that would interfere with the vascularity), the central mound technique is used [1, 4, 5]. This technique has the best chance of preserving sensation and viability of the nipple and reducing bottoming out of the breast inferiorly in the long term. The central mound technique also has the advantage of giving a good conical shape to the breasts. When the nipple needs to be moved superiorly more than 10 cm and the reduction is greater than fift een hundred grams, the nipple graft technique is considered. The inferior pedicle technique, where no vertical component of the scar is necessary is also an excellent option. The authors decline to electively operate on any patient whom we know is actively smoking. Large, heavy, pendulous breasts can be the source of significant difficulties, both mental and physical. In the young they can be a cause of considerable embarrassment, resulting in marked limitation of activities and social contacts. The breast can cause multiple functional problems through traction on the shoulders and spine, resulting in poor posture, neck strain, headaches, back pain and dermatitis. Without support, the weight of the breast pulls the shoulders forward and down, resulting in poor posture. With support from a brassiere, the weight of the breast is transferred to the shoulder straps, compressing the underlying soft tissue and the brachial plexus, which may result in paresthesias. The patient is frequently overweight, compensating for the abnormal proportions of her breasts, and reducing the disparity of contour. Many patients with large breasts have a poor body image. Reduction mammoplasty can eliminate the symptoms and reduce the psychological distress. The goal in breast reduction surgery is to reduce the above symptoms and obtain breasts of appropriate size, symmetry, and sensation. © 2009 Springer-Verlag Berlin Heidelberg.