The document outlines the history and techniques of reduction mammaplasty, highlighting its purpose of achieving smaller, aesthetically pleasing breasts and alleviating symptoms associated with mammary hypertrophy. It discusses various surgical techniques, classification of breast hypertrophy, potential complications, and emphasizes the high patient satisfaction and predictability of results. Overall, it demonstrates that reduction mammaplasty is a well-established procedure with significant benefits for patients suffering from large breast size.

1. JAYANTA SAHA

2.  Surgical reduction of breast to achieve
 A.smaller size,
 B.aesthetically shaped breast mound,
 C.Relief of symptoms of mammary
hypertrophy

3.  A.Reduction of gynaecomastia as early as 6th
century A.D.
 B.Breast amputation mammaplasty by Schaller
in 19th century.
 C.Dieffenbach performed lower pole reduction
in 1848.
 D.Reproducible breast reduction technique
hails from end of 19th century.

4.  A.Very large breast
 B.Shoulder pain
 C.Cervical and upper thoracic backache
 D.Severe embarrassment physically or sexually
 E.Recurrent intertigo

5.  A.Inability to exercise due to breast discomfort
 B.Difficulty with breathing during exercise
 C.Difficulty finding clothing to fit
 E.Grooving and hyperpigmentation of
shoulder of shoulder strap areas

6.  A.Early horizontal& combined scar technique:
 Passat procedure
 Schwarzmann medial dermoglandular pedicle
 Biesenberger technique
 B.Wise pattern approaches:
 Inferior pedicle technique(Courtiss,Goldwin)
 Superior pedicle technique(Pitanguy,Weiner)

7.  Horizontal bipedicle(strombech)
 Vertical bipedicle(Mckissock)
 Lateral pedicle technique.
 Superomedial pedicle technique(Orlando)
 Superolateral pedicle technique(Skoog)
 Central mound technique(Biesenberger)
 Breast amputation & free nipple graft.

8.  C.Short-scar technique:
 Lassus –Lejour technique
 Hall-Findlay technique
 Marchac short scar technique
 Regnault B technique
 L reduction
 Benelli round block technique
 Goes periarolar technique
 Hammond SPAIR approach
 D.Liposuction assisted reduction(Courtiss &
matarasso)

9.  Depends on
 breast size,
 estimated resection vol.
 breast shape,
 experience of surgeon.

10.  Breast hypertrophy may be divided into
 A.mild(resection <200g.)
 B.Moderate(<200-500g.)
 C.Severe(500-1500g.)
 D.Gigantic(>1500g.)

11.  A woman with 34” chest
circumference(beneath IMF & under arm) with
36” breast circumference(at nipple level) will
have 34B cup bra/34D cup bra for 38” breast
circumference.

12.  Size of cup bra:
 32’’-34” =100 gm.
 36”-38”=200 gm.
 40”-42”=300 gm.
 44”-46”=400 gm.
 So 40DD cup bra to 40C size needs resection of
300+300=600gm.of breast on each side.

13.  A.Nipple lies 21cm.from sternal notch &
midsternal point.
 B.nipple lies 7cm. from IMF.
 C.Nipple forms equilateral triangle with other
nipple & sternal notch.
 D.Pitanguy recommended new nipple level at
midhumeral point plus 2/3 cm.
 E.Average areolar diameter 38-45 cm.

14.  A.Vertical scar technique(Lassus-Lejour,Hall-
Findlay).
 B.Periareolar technique(Benelli,Goes).

15.  A.Vertical technique(Lassus-lejour,Hall-
Findlay,SPAIR)
 Wise-pattern technique(Inferior,central
pedicle,superomedial pedicle)

16.  If nipple distance is within 22 cm. from IMF
,Central mound reduction may be tried.
 Breast amputation & free nipple graft is meant
for gigantomastia.

17.  It includes
 A.Superior pedicle
 B.Inferior pyramidal glandular resection
 C.Closure with vertical scar

18.  Modification includes
 A.Skin undermining adjacent to vertical
parenchymal pillar edges
 B.Suture suspension of the pedicle to
pectoralis muscle fascia
 C.Total breast liposuction

20.  A.Midline of chest is drawn from suprasternal
notch down onto abdomen.
 B.Second line is drawn from midclavicular
point to nipple.
 C. New nipple position is marked on forward
projection of index finger onto anterior surface
of breast.
 .

21.  D.Lateral & medial lines are drawn by pushing
breast medially & laterally respectively.
 E.Lower mark ,a curved line is made joining
lower ends of medial& lateral lines between 4-6
cm. from IMF.
 F.Superomedial pedicle is designed with 6-
8cm. base & 1cm.cuff left around areola

23. A-B& A-C lines represent vertical closure after reduction,length is 5-8cm.,B-C =8cm.
C-D,B-E have lazy s shape

29.  A.Haematoma:<1% within 12 hrs. of
surgery,unilateral,manifested by pain,swelling
& bruising may lead to tension - induced
ischaemia .Treatment is surgical evacuation &
control of bleeding intercostal perforators.
 B. seroma:1%-5%,aspiration will suffice.
 C.Infection:cellulitis controlled with antibiotics
& abscess formation as a sequelae of infection
within undiagnosed haematoma & fat necrosis
needs open drainage.

30.  D.Skin necrosis:presents in tension related wise
pattern reduction at the inverted T flap due to
compromise at tip of skin flap.It is virtually
absent in vertical reduction.
 E.Fat necrosis:common in long central or
inferior pedicle in huge breasts.It may mimic
carcinoma & causes pt’s anxiety but
mammography & fnac will make diagnosis.

31.  F.Nipple loss:associated with smoking.Long
pedicle or thick pedicle folded in vertical
technique causes nipple loss due to inadequate
vascular perfusion.
 G.Nipple numbness:central pedicle preserve
more sensation than upper pole pedicle.

32.  H.Hypertrophic scars:occurs most medial &
lateral ends of horizontal limbs of wise pattern
technique.Reducing tension,postoperative
taping,silicon application,steroid inj. Maa be
helpful.
 I.Assymetry:what is removed is more
important than what is left in reduction
surgery.Prevention of this complication is
important because reoperation may be
required.

33.  J.Inadequate or overreduction:problematic for
neophyte than experienced surgeons with
vertical technique.Overresection is risky for
grade III ptosis with empty upper pole.
 K.Boxy breast deformity:presents in inferior
pedicle technique due to inadequate
inferomedial or inferolateral resection.

34.  L.Inflammatory scarring:visible on
mammography(whorled appearance).
 M.Recurrent enlargement:secondary to massive
weight gain & ongoing virginal
hypertrophy.Reduction should not be done
until breast growth is static for 1yr unless
symptoms are incapacitating or ulcers are
imminent.

35.  N.Inability to breast feed:breast feeding is
technically possible but succesful feeding is
rarely achieved.
 O.Cancer & breast reduction:reduction does
not cause cancer rather reduces risk due to
volume depletion.
 P.Inadequate mastopexy result:results from
inadequate skin resection to shape the gland or
breast suction.

36.  Q.Dog ear:occurs in medially & laterally in
wise pattern technique but inferiorly in vertical
technique.Minor adjustment under L.A. may
correct if deformity does not spontaneously
resolve within 6 months of original reduction.

37.  Reduction mammaplasty is an
establised,highly successful technique reduces
size of large female breast and also
complications associated with it.
 Satisfaction of pt. is high.
 Results are predictable.

38.  THANK YOU