1. Breast Reduction
Emily Beacham

2. What and Why
Removal of excess tissue from the breast to reduce the size of the breasts.
Relieves legitimate medical problems due to the weight of the breasts.
Back, neck, and shoulder pain
Skeletal deformities
Skin irritations
Decrease in respiratory problems

3. Insurance
Starting to cover breast reduction surgery because it’s easier for them to pay for a reduction that have to pay for back, neck, and shoulder surgeries later.

4. Anatomy
Nipple
Areola
Adipose tissue of the breast

5. Equipment Padded footrest for modified sitting position Suction
Fiber-optic headlight and light-source
ESU with needle tip and extension tip
Autotransfusion system (available)

6. Supplies Basic pack Basin set Gloves/Gown Several #15 blades
Suture, drains, dressings: surgeon’s preference
Drapes
Banked blood
Local anesthetic (if used)
Marker
Medical scale (weighing tissue)
Lap sponges
Areolar template (cookie cutter)
Liposuction (if requested)

7. Instrumentation
Plastic instrument set
Basic or minor procedure tray

8. Special Considerations
Incision lines and landmarks are marked with the marker in Fowler’s position prior to anesthesia, may be before patient’s in the operating room.
Patient may require blood transfusion and may be asked to donate blood before surgery for possible reinfusion.
A pre operative mammogram may be requested.

9. Pre-Op Position Prep Draping Anesthesia
Supine with each arm at 90 degrees on armboard
Prep
Chest and breast from chin to the hips and entire width of patient including axillae
Draping
Folded towels and transverse sheet or folded towels and chest drape
Applied to expose entire chest and secured with staples
Anesthesia
general

10. Procedure TIME OUT Initial incision with #15 blade around areola
Ensure a perfectly round incision for resizing with a nipple pattern marker.
Second incision is vertical, beginning at the bottom center or areola and continue to inframammary fold and lateral to each side with #15 blade.

11. Continued
Deepithelization is the process of separating the skin from underlying tissue
Dissection begins at the inverted “T” in the existing incision at the inframammary fold and extends laterally until the circumference of the breast is exposed, this is done with a #15 blade and forceps or electrosurgically.

12. Continued
A pedicle is created that includes the nipple and areola, preserving blood supply and innervation this done with a #15 blade
Pedicle remains in situ and a new opening in the skin is created to accommodate existing tissue
Breast tissue is debulked, involving the removal of wedges of tissue radially with ESU

13. Continued
Some surgeons may want the removed tissue to be weighed on the scale.
Make sure scale is zeroed before the procedure starts
Keep tissue specimens separate (right from left)
After all wanted tissue is removed the new “keyhole” incision is made with a new #10 or #15 blade.

14. Continued
Wound is temporarily closed with staples, excess skin is removed (#1 suture).
Process is repeated on the other breast
Due to difference in breast size, the exact same amount (weight) of tissue may not be removed bilaterally.
Once both sides are temporally closed the patient may be placed in Fowler’s to assess size and symmetry.

15. Continued
It is common for the surgeon to reopen one or both wounds to make adjustments
Repositioning repeatedly may be necessary
Placement of nipple and areolar begins the permanent closure (2-0 maxon).
If drain place laterally
Have drain available but open upon request
Remaining wound edges are approximated with 2-0 or smaller suture
Liposuction may be performed at this time

16. Post-Op
Fluff-type dressing is applied, followed by a postsurgical bra.
Expected to remain 1- 3 days in the hospital
Narcotics may be indicated for the first 24 hours.
Patient should be educated in wound care and management of drains before leaving hospital

17. Prognosis Patient will have large permanent scars
Expected to have full recovery, return to normal activities in about 2 weeks
Refrain from vigorous exercise for 6-8 weeks
Repeat mammogram may be requested for comparison to pre-op study in 6 months

18. Complications Hemorrhage Infection Scar tissue
Patient dissatisfaction with appearance, requiring further intervention.

19. Before and After