Breast reducing operation EXPERIENCE IN USA, CALIFORNIA DR.BUNKIS PRIVATE CLINIC AT ORANGE COUNTY RIGAS STRADINA UNIVERSITY 6TH YEAR MEDICAL STUDENT MARA SNEIDERE
You may be good candidate for breast reduction if you have one or more of the fallowing conditionsBreast that are too large in propotion to your body frameHeavy, pendulous breast with nipples and areolas that point downwardOne breast is much larger than the otherBack, neck or shoulder pain caused by the weight of your breastsSkin irritation beeath your breastsIndentations in your shoulders from tight bra strapsRestriction of physical activity deu to the size and weight of your breastsDissatisfaction or self- consciousness about the largeness of your breasts
Risks associated with breast reductionPossible asymmetrySensation problemsFuture breast feeding issuesassociated with breast reduction surgery
Breast reduction complicationsPoor reaction to anesthesiaBleedingInfectionHeatomaBreast reduction scars
Female breast anatomyThe breasts of an adult women are tear- shaped glands, supported by and attached to the front of the chest wall on either side of the breast bone or sternum by ligaments. They rest on the major chest muscule, the pectoralis major.
Female breast anatomy The breast has no muscule tissue. A layer of fat surrounds the glands and extends throughout the breast. Each breast contains 15 to 20 lobes arranged in a circular fashion. The fat (subcutaneous adipose tissue) that covers the lobes gives the breast its size and shape. Easch lobe is lobe is comprised of many lobules, at the end of which are tiny bulb like glands, or sacs.
Female breast anatomyThe breast is responsive to a complex interplay ofhormones that cause the tissue to develop, enlarge andproduce milk. The three major hormones affecting thebreast areEstrogen,Progesterone andProlactinWhich cause glandular tissue in the breast and theuterus to change during the menstrual cycle.
Female breast anatomyLYMPH NODES1. Cubital2. Apical axillary3. Lateral axillary4. Lateral axillary5. Central axillary6. Brachial axillary7. Interpectoral8. Paramammary9. Parasternal
Female breast anatomy VASCULAR SYSTEM A.thoracica interna ( aa. Intercostales anteriores) A. thoracica lateralis (rr. mamarii) aa. Intercostales posteriores V. thoracica interna-> v.subclavia, V.thoracica lateralis-> v.axillaris vv.intercostales-> v.azygos
Female breast anatomy NEURAL SYSTEMPlexus braehialis-> nn.intercostales
Types of breast reductionPedicle MethodFree Nipple GraftInverted T resection (Anchor incision pattern)LeJour incisin patternLiposuction
Pedicle MethodPedicle method- it means surgeon leaves a pedicle with nerves and vessels what supplies breast. Superior, lateral, medial, inferior and central pedicule can be chosen
Inferior pedicleInferior pedicle proved tobe sufficient to sustain thenipple areola complex andalso had other advantages– good circulation, goodsensation and possibility ofbreastfeeding. As a result,it replaced the verticalbipedicle
Superior pedicleSuperior pedicle has goodcirculation but is not veryeasy to inset and has to bethinned for better inset.Being a dermal pediclebreast feeding is no longerpossible
Lateral pedicleThis pedicle is half thepedicle of Strombeck’smethod and it is easier toinset, also has goodviability and is based onthe lateral thoracic arteryperforators; this pedicle isnot as commonly used asthe rest
Medial pedicleSimilar to the lateralpedicle, it has becomepopular following therealization that it has goodsensation and good bloodsupply and can be insetrelatively easily
Central pedicleThe Central pedicle is amodification of the Inferiorpedicle with the removal ofthe dermal bridge. The bloodsupply is the same -perforating branches of theintercostal arteries. Thevenous drainage follows theartery so a dermal bridge isnot required. However onemust be very careful aboutshear injuries to the pedicleat its base on the pectoralmuscles
Free nipple- graft techniqueThe breast reduction performed with the free nipple- grafttechnique transposes the nipple- areola complex (NAC) asa tissue graft without a blood supply, without a skin andglandular pedicle. The therapeutic advantage is the greatervolume of breast tissues that can be resected to produce aproportional breast. The therapeutic disadvantage is abreast without a sensitive nipple- areola complex, andwithout lactation capability. The medical indicatedcandidates are: the women whose health presents a highrisks of ischemia of the nipple- areola complex, whichmight cause tissue necrosis, the diabetic woman, thewoman who is a tabacco smoker, the women whoseoversized breasts., and the women who has macromastiorequires much resecting of the breast tissue.
Experience at dr.Bunkis private clinic. USA, California, Orange County Breast reducing operation Inverted T resection (Anchor incision pattern) Accompanied by Rigas Stradina university 6th year medical student Mara Sneidere
Operative techniqueWith the patient in a sitting position, suprasternal notch, midclavicular points are markedA vertical line joining the suprasternal point to the xiphoid is marked.The breast meridian is marked next, it may or may not go through the nipple.
Operative techniqueThe proposed nipple level is marked by the marking of the inframammary crease onto the breast surface by the finger method, this is a point A.
Operative techniqueThe angle of the vertical limbs is marked next, by placingthe thumb and index finger of one hand and pinching thebreast about 6.5 cms from point A
Operative techniqueThese are B (lateral) and C (medial) and they should be equidistant from the breast meridian
Operative techniqueThe medial limit of resection (point E) is marked by gently displacing the gland laterallyThe lateral limit of resection (point D) is marked by gently displacing the gland medially, it should be placed on the gland itself
Operative technique New shape of areola was made. In point A as a central point of new areola was chosen and using round shaped instrument, new place for areola was made. After de- epithelialisation skin around old and new marked areola, new form of breast are created by excision of the breast tissues. Superior pedicle was left.
Operative techniqueAn adequate opening for the nipple areola complex is created and the suturing is done with 4-0 monocryClosure is performed by using 3-0 monocryl
HONORARY CONSULATE OF THE REPUBLICOF LATVIA IN SAUTHERN CALIFORNIA USA