eMedicine Specialties > Plastic Surgery > Breast
Breast Reduction, Inferior Pedicle
Updated: Aug 5, 2008
Introduction
Patients with large breasts experience a significant range of symptoms, some severe enough to interfere with activities of daily living. Patients with large heavy breasts commonly report significant neck and shoulder pain. They may develop grooves in their shoulders from the weight of their bra straps, experience difficulty wearing clothes, and find that the heaviness of their breasts interferes with sports activities. Some patients have even had to eliminate some activities from their lives because their large breasts get in their way.1
Patients may present to plastic surgeons for reduction mammoplasty starting at puberty. If reduction mammoplasty is performed at an early age, such as age 14 years, the patient should be advised that she may require an additional procedure at a later time. If breasts are significantly large, surgery should be considered in the teenage years so the teenager's activities are not restricted, nor is she harassed.
The true genetics of breast development are not known. Even within the same family, one sister may have small breasts while the other has large breasts.
This article addresses the inferior pedicle technique for breast reduction, which is an alternative to free nipple and areola grafting.2 For details on other techniques, visit the Breast section of eMedicine’s Plastic Surgery journal.
Indications
In general, a patient is considered a candidate for breast reduction if the size and weight of her breasts cause her significant neck and shoulder pain. Criteria have been established by some insurance companies as to the amount to be removed from each breast according to a patient's height and weight. More recently, however, insurance companies have relied more heavily on symptomatology, such as neck and shoulder pain, to approve the surgery. Small reductions in which the breasts are not reduced by at least 2 cup sizes are not usually covered by insurance and would likely be considered a breast lift or mastopexy.
Contraindications
The only real contraindication to breast reduction surgery is if the patient is not medically able to undergo the surgery.
Scars are the main risk that should be discussed with the patient. The scars from this procedure extend around the nipple-areolar complex (NAC), vertically between the NAC and the inframammary fold (IMF), and under the IMF. The scars are placed such that the scar around the NAC blends in when the color change occurs. The wound under the breast is placed under the fold to be hidden by the natural overhang of the breast. Fortunately, the vertical component of the scar tends to heal very well, even in patients who may form hypertrophic or very noticeable scars elsewhere.
Keloids are a risk in some patients. The most common place for keloid formation is in the IMF, principally in the medial portion. Patients who have a history of keloids should be warned of the risk for keloid formation. However, in general, the scars respond to steroid injection and pressure.
Patients with extremely large breasts have a higher risk of problems, principally loss of the NAC. This risk is almost negligible in women with smaller breasts; if these women smoke cigarettes, the risk is increased. In women with extremely large breasts, the possibility of a conversion to a free nipple graft should be discussed with the patient.
The possibility of loss of nipple sensation exists, as does possible loss of the ability to breastfeed. Women have successfully breastfed following reduction mammoplasty, but patients should be warned that this may not be possible. In general, if loss of nipple sensation does occur, it usually improves over the course of the year or so following surgery.
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References
Blomqvist L, Eriksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconstr Surg. Oct 2000;106(5):991-7. [Medline].
Courtiss EH, Goldwyn RM. Reduction mammaplasty by the inferior pedicle technique. An alternative to free nipple and areola grafting for severe macromastia or extreme ptosis. Plast Reconstr Surg. Apr 1977;59(4):500-7. [Medline].
Brown MH, Weinberg M, Chong N, et al. A cohort study of breast cancer risk in breast reduction patients. Plast Reconstr Surg. May 1999;103(6):1674-81. [Medline].
Hidalgo DA, Elliot LF, Palumbo S, et al. Current trends in breast reduction. Plast Reconstr Surg. Sep 1999;104(3):806-15; quiz 816; discussion 817-8. [Medline].
Bostwick J. Breast reduction. In: Bostwick J, ed. Aesthetic and Reconstructive Surgery. St. Louis, Mo: CV Mosby; 1983.
Downey SE. Plastic surgery for common breast problems. In: Hindle WH, ed. Breast Care: A Clinical Guidebook for Women's Primary Health Care Providers. New York: Springer-Verlag; 1999.
Goldwyn RM. Reduction mammoplasty in the unfavorable result. In: Goldwyn R, Cohen M, eds. Plastic Surgery Avoidance and Treatment. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001.
Hoffman S. Inferior pedicle technique. In: Spear S, ed. Breast Reduction in Surgery of the Breast: Principles and Art. Philadelphia, Pa: Lippincott-Raven; 1998.
Ribeiro L. A new technique for reduction mammaplasty. Plast Reconstr Surg. Mar 1975;55(3):330-4. [Medline].
Further Reading
Keywords
breast reduction, reduction mammoplasty, inferior pedicle, heavy breasts, large breasts, nipple-areolar complex, NAC, nipple scar tissue, keloids, inframammary fold, IMF
