Breast Reduction: New Study Addresses Women's Concerns
NEW YORK, NY (October 4, 2004) — Women who undergo breast reduction often seek relief from physical discomfort and also hope to attain a more aesthetic breast shape. More than 147,000 breast reduction surgeries were performed in 2003, an increase of 207 percent since 1997, making breast reduction the fourth most frequently performed plastic surgical procedure among women, according to statistics compiled by the American Society for Aesthetic Plastic Surgery (ASAPS). However, the possibility of numbness or hypersensitivity of the nipple-areola complex (NAC), which includes the nipple and surrounding pigmented skin, may deter some women from having the operation or, if changes in NAC sensation occur, decrease their satisfaction with the results. A new study published in Aesthetic Surgery Journal (ASJ) , the peer-reviewed AS APS journal, for the first time precisely quantifies NAC sensation in post-reduction patients. Results confirm that commonly performed breast reduction "pedicle" techniques in which the NAC is repositioned while remaining attached to a tissue flap can preserve normal to near-normal sensation in most cases.
The history of breast reduction goes back as far as the 6th century AD, but it was not until 1931 that the first pedicle technique was reported. Multiple techniques using a pedicle have been developed, including two variations compared in the ASJ study: the medial pedicle and the inferior pedicle techniques. The primary difference between medial and inferior pedicle techniques is the rotational direction of the tissue flap that provides the continuous blood supply to the NAC.
Free nipple transfer is another breast reduction method that predates the pedicle technique and usually is reserved for women requiring very high-volume reduction or those judged to have insufficient blood supply to the NAC. In this technique, the NAC is totally detached and then reattached to the new, smaller breast mound. Although free nipple transfer can help avoid serious complications that might result in loss of the NAC in this select group of patients, its disadvantages include altered sensation or absence of sensation, inability to lactate (breast feed), and hypopigmentation (lightening in color) of the NAC.
Study Methods and Results
The study's authors, associated with Johns Hopkins University School of Medicine in Baltimore , compared NAC sensation in 42 women who were divided into 4 groups on the basis of the breast reduction technique performed: medial pedicle (9 patients), inferior pedicle (8 patients), free nipple transfer (8 patients) and a control group of 17 patients. All breast reduction patients had undergone removal of at least 1000 grams of tissue per breast and were at least 6 months post-surgery. NAC sensation was quantified with the use of a special instrument called the Pressure Specified Sensory Device (PSSD), a handheld device with 2 pressure-calibrated, computer-linked sensors. Results were compared considering a variety of factors including the amount of breast tissue removed and the distance of relocation of the NAC. Institutional review board approval was granted for this retrospective study.
There was no significant difference in NAC sensation when women in the medial pedicle group were compared with women in the inferior pedicle group. Both groups generally showed preservation of normal to near-normal sensation, although women in the medial pedicle group, on average, had larger breast reductions. As expected, women who had undergone free nipple transfer had significantly less NAC sensation than women in either of the pedicle groups, even though there was no significant difference between the free nipple and medial pedicle groups in terms of the amount of breast tissue removed. It was this finding that led the authors to conclude that the medial pedicle technique can more often be used for large-volume breast reduction to optimize sensation of the NAC.
"Breast reduction with a medial pedicle technique was originally designed as an alternative to free nipple grafting, and we believe that it can be used more frequently in large-volume reductions," says plastic surgeon Navin Singh , MD , one of the study's five co-authors. "The medial tissue flap provides an excellent blood supply and also avoids disruption of the nerves that control sensation in the NAC. Prior studies demonstrated that, using the medial pedicle technique, the viability and sensation of the NAC was retained in 98 percent of women requiring large reductions in their breast volume, and our study is generally consistent with this finding." However, Dr. Singh says no one can guarantee that NAC sensation will be preserved in all cases. In addition, he emphasizes that the specific surgical technique chosen remains a matter of the plastic surgeon's judgment and must be based on an evaluation of individual patient factors.
Breast reduction is an evolving area of plastic surgery in which a number of advances have been made in recent years. Technical variations have been developed to help reduce scarring on the breast's surface. For some patients, liposuction alone may provide sufficient reduction of breast volume. However, traditional breast reduction techniques remain popular due to consistent and predictable results that hold up well over time.
"In plastic surgery, one can never take a 'cookie-cutter' approach," says Peter Fodor, MD, president of the American Society for Aesthetic Plastic Surgery. "As plastic surgeons, we always try to select the least invasive technique that will provide the best outcome for each individual. But no two patients are alike, and what works well for one may not be the right approach for another. Breast reduction is an operation that inevitably involves some tradeoff, but patients generally are very pleased with the final results."
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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