Basic principles of reduction mammoplasty

Any method of reduction mammoplasty involves solving three main problems:

• resection of excess glandular tissue;
• elimination of prolapse of the nipple-areolar complex;
• removal of excess, overstretched skin covering the gland.

Obviously, the severity of each of the listed problems varies from patient to patient, and only a thorough analysis of each specific case allows the surgeon to choose the optimal technique for reduction mammoplasty.

The ideal method of reduction mammoplasty is an operation that can solve the following problems:

• reduction of the volume of the mammary gland while ensuring normal nutrition of the remaining tissues of the gland and the nipple-areolar complex;
• creation of an aesthetically beautiful shape of the mammary glands with the achievement of their symmetry;
• postoperative scars of minimal length located in a hidden area;
• maintaining sensitivity of the nipple, areola and skin of the gland;
• possibility of lactation;
• sufficiently long-term preservation of the results of the operation.

During the marking process, with any surgical technique, some parameters of the mammary gland remain unchanged and:

• the diameter of the areola is 4.5-5 cm;
• the new position of the areola and nipple should correspond to the level of the submammary fold and be located at a distance of (21 ± 3) cm from the jugular notch along a line passing from the notch through the nipple;
• The distance from the mammary fold to the lower edge of the areola should not exceed 5 cm (except for vertical mammoplasty).

The new level of the nipple-areolar complex is always determined with the patient in an upright position.

The nipple-areolar complex is always moved on a dermal pedicle (Schwarzmann principle). Deepidermization is performed as the first stage. When the skin is connected to the parenchyma of the gland, this stage is much easier to perform. Deepidermization must be performed carefully and thoroughly to maintain good nutrition of the areola and nipple, as well as their sensitivity.

Reduction of the gland. The approximate volume of tissue to be removed is usually known before the operation. To reduce blood loss during resection, it is necessary to pre-infiltrate the gland tissue with a solution of adrenaline in a dilution of 1:200,000, and dissect the tissue with an electric knife.

In the vast majority of cases, tissue is resected in the lower sector of the gland. The remaining glandular tissue should be additionally fixed retromammary to the fascia of the pectoralis major muscle and modeled with additional sutures.

Formation of skin flaps and wound closure. The final stage of the operation is the formation of skin flaps and creation of the final shape of the mammary gland. Skin and fat flaps are formed mainly in the lower sector of the gland. Their configuration depends on the chosen surgical technique. The wound is closed with sufficient tension on the edges of the skin flaps that cover the dermal pedicle of the nipple-areolar complex. Excessive tension on the suture line may subsequently cause the formation of coarse scars and flattening of the gland. At the same time, excess skin flaps contribute to the prolapse of the gland as a whole and the upward tilting of the nipple-areolar complex.

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