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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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7.2 Breast Reduction/Breast Lifting
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Breast reduction is governed by the same set of rules as breast lifting
methods for the female breast. As early as in 1912, E. Lexer described
oneofthefirstmethodsforthecorrectionofmacromastia.
A significant aspect of the planning and performance of breast reduction surgery is a precise knowledge of the blood suppl y to the breast
and nippel-areola-complex. This must be sufficiently maintained under
all circumstances. The parenchyma of the breast, which consists of
15–20 glandular lobes, is supplied mainly by the internal mammary
artery and the lateral thoracic artery. The intercostal arteries also
extend from the ribs to the parenchyma.
Many of the surgical methods for breast reduction are influenced not
only by the shape and size of the breast, but also by the skin quality and
degree of ptosis.
The objectives of breast reduction surgery include:
1. Alleviation of pain and weight-related discomfort
2. Reduction of the breast to a normal size
3. Appropriate and satisfactory breast contour
4. Normal sensation in the mamillae
5. Short scars
6. Intact milk ducts
7. Breast size which enables examination
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Preoperative marking of the most important marking lines/resection
lines. (Fig. 7.36)
It is important to ensure that the jugulum-NAC distance is between
18 and 21 cm. In particular, nipples that are positioned too high are difficult to correct later. In order not to compromise blood supply to the
stalk, the base of the stalk should not be less than 6–7 cm wide. The
distance between the lower margin of the nipple and the inframammary fold is determined by the desired cup size (B cup: approximately
5–7 cm, C cup: approximately 7–9 cm).
a) Vertical line fromthe jugulum to the navel
Medioclavicular line
Jugulum-NAC co nnecting line
Determining the T-point
(Fig. 7.37)
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Fig. 7.36
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Fig. 7.37
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b) Determining the new position of the NAC at the level of the
inframammary fold (Fig. 7.38)
c) Centrocaudal pillar in the medial region: rotation of the breast in a
lateraldir ection,marking of the perpendicular lin eon the T-point
(Fig. 7.39)
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Fig. 7.38
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Fig. 7.39
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d) Centrocaudal pillar in the lateral region: rotation of the breast in a
medial direction, marking ofthe perpendicular line on the T-point
(Fig. 7.40)
e) Medial and lateral tissue triangle intended for resection (Fig. 7.41)
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Fig. 7.40
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Fig. 7.41
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2. Prior to the start of the operation, incision lines are infiltrated with
tumescence solution. This serves on the one hand for hemostasis,
while on the other hand the hydrodissection facilitates de-epithelialization of the tissue (Fig. 7.42)
3. Markingoutoftheareolawiththeareolaring(38or42mm)
(Fig. 7.43)
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Fig. 7.42
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Fig. 7.43
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4. Cutting around the areola with a number 15 scalpel (Fig. 7.44)
5. Incision of the marking lines is then carried out (Fig. 7.45)
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