Breast Reduction Techniques

1. Vertical Bipedicle Technique for Breast Reduction: This method is designed for simplicity and ease of operation, featuring large pedicle mobility and easy nipple rotation. The resulting breast shape better aligns with aesthetic standards. It is suitable for moderate to severe cases of macromastia or ptosis, but not recommended for breasts exceeding 15cm in size or with severe nipple ptosis.

2. Horizontal Bipedicle Technique for Breast Reduction: Primarily applicable to moderately enlarged breasts. Its advantage lies in the absence of need for undermining of skin flaps. All breast tissue forms a bipedicle flap, supplied by internal and external thoracic arteries. The nipple is positioned centrally within the pedicle, preserving its attachment and blood supply. Despite the removal of epidermal tissue from the gland, the nipple remains covered by dermis, preserving sensation. This is an effective approach for breast reduction.

3. Double-Ring Breast Reduction: The double-ring incision technique addresses moderate to severe breast hypertrophy, achieving significant breast reduction. Understanding the surgical process beforehand can alleviate psychological stress for patients. So, how is breast reduction surgery performed?

1. Patient Position: Supine with arms extended and back slightly elevated.

2. Preparation of Dermal Tissue Flap: After excising the epidermis within the trapezoidal incision line, a cut is made along the upper margin of the areola. The incision extends upwards along both sides of the trapezoid, reaching the inframammary fold, penetrating deep into the subcutaneous layer.

3. Exposure of Glandular Tissue: Avoiding the trapezoidal area, the entire skin layer is excised along the crescent-shaped incision line. The epithelial flap is then lifted to expose the glandular tissue.

4. Resection of Internal Glandular Tissue: Depending on gland size, an S-shaped resection of the superior medial glandular tissue is performed near the midpoint of the superior edge of the gland, between the superior medial margin of the areola and the medial margin of the dermal tissue flap. The glandular wounds are then sutured together.

5. Repositioning the Nipple: A hole is cut along the designed line at the new nipple position. The nipple is lifted and passed through the hole beneath the epithelial flap, with the edges sutured and secured.

6. Closure of Incisions: If the dermal tissue flap is excessively long, it can be folded appropriately and secured with 1-2 stitches. The epithelial flap is then pulled down to cover the flap, and the flap edges are sutured to the lower incision edges.

Note: The dermal tissue flap pedicle should be sutured superficially and with as few stitches as possible to avoid disrupting blood supply.

7. Placement of Negative Pressure Drainage Tube: A 30cm latex tube is cut longitudinally into two halves for the first 10cm. These are placed under the flap on both sides, with the ipsilateral end shortened by 3cm. An additional puncture is made on the lateral chest wall for the posterior tube (to be connected to a negative pressure suction device after returning to the ward).

8. Dressing the Entire Breast with Thick Padding.