Basic principles of reduction mammoplasty

Any method of reduction mammoplasty involves the solution of three main tasks:

• resection of excess gland tissue;
• elimination of the ossification of the nipple-areolar complex;
• Removing excess excess skin, covering the gland.

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

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

• reduction of the volume of the breast with normal nutrition of the remaining gland tissues and a nipple-areolar complex;
• creation of aesthetically beautiful form of mammary glands with the achievement of their symmetry;
• postoperative scars of minimal length with their location in a hidden zone;
• Preservation of the sensitivity of the nipple, areola and skin of the gland;
• possibility of lactation;
• long enough to save the result of the operation.

During the markup, any parameters of the operation, some parameters of the breast 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 from the jugular notch at a distance (21 ± 3) cm along the line passing through the nipple;
• the distance from c to the bummar fold to the lower edge of the areola should not exceed 5 cm (excluding vertical mammo-plastics).

The new level of the nipple-areolar complex is always determined with the patient's vertical position.

The movement of the nipple-areola complex is always performed on the dermal stem (Schwarzmann principle). Deepidermisation is carried out by the first stage. When the skin is connected to the parenchyma of the gland, this stage is much easier to perform. Deepidermisation must be performed carefully and carefully 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 surgery. To reduce blood loss during resection, it is necessary to pre-infiltrate the gland tissue with a solution with adrenaline at a dilution of 1: 200 LLC, and cut the tissue with an electron knife.

In the overwhelming majority of cases, the tissues are resected in the lower gland. The remaining glandular tissue should be additionally fixed retromammarno to the fascia of the large pectoral muscle and modeled by additional sutures.

Formation of skin flaps and wound closure. The final stage of the operation is the formation of skin flaps and the creation of the final form of the mammary gland. Skin-fat flaps form mainly in the lower sector of the gland. Their configuration depends on the chosen technique of operation. The wound is closed with sufficient tension on the edges of skin flaps that cover the dermal leg of the nipple-areolar complex. Too much tension on the seam line may subsequently cause the formation of gross scars and flattening of the gland. At the same time, an excess of skin flaps helps to lower the gland as a whole and to reset the nipple-areolar complex upward.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]