Breast Reduction Emily Beacham

Removal of excess tissue from the breast to reduce the size of the breasts.

Relieves legitimate medical problems due to the weight of the breasts.

Back, neck, and shoulder pain

Skeletal deformities

Skin irritations Decrease in

respiratory problems

What and Why

Starting to cover breast reduction surgery because it’s easier for them to pay for a reduction that have to pay for back, neck, and shoulder surgeries later.

Insurance

Nipple Areola Adipose tissue of

the breast

Anatomy

Padded footrest for modified sitting position Suction Fiber-optic headlight and light-source ESU with needle tip and extension tip Autotransfusion system (available)

Equipment

Basic pack Basin set Gloves/Gown Several #15 blades Suture, drains,

dressings: surgeon’s preference

Drapes Banked blood

Local anesthetic (if used)

Marker Medical scale

(weighing tissue) Lap sponges Areolar template

(cookie cutter) Liposuction (if

requested)

Supplies

Plastic instrument set

Basic or minor procedure tray

Instrumentation

Incision lines and landmarks are marked with the marker in Fowler’s position prior to anesthesia, may be before patient’s in the operating room.

Patient may require blood transfusion and may be asked to donate blood before surgery for possible reinfusion.

A pre operative mammogram may be requested.

Special Considerations

Position◦ Supine with each arm at 90 degrees on armboard

Prep◦ Chest and breast from chin to the hips and entire

width of patient including axillae Draping

◦ Folded towels and transverse sheet or folded towels and chest drape

◦ Applied to expose entire chest and secured with staples

Anesthesia◦ general

Pre-Op

TIME OUT Initial incision with #15

blade around areola Ensure a perfectly round

incision for resizing with a nipple pattern marker.

Second incision is vertical, beginning at the bottom center or areola and continue to inframammary fold and lateral to each side with #15 blade.

Procedure

Deepithelization is the process of separating the skin from underlying tissue

Dissection begins at the inverted “T” in the existing incision at the inframammary fold and extends laterally until the circumference of the breast is exposed, this is done with a #15 blade and forceps or electrosurgically.

Continued

A pedicle is created that includes the nipple and areola, preserving blood supply and innervation this done with a #15 blade◦ Pedicle remains in situ and a new opening in the

skin is created to accommodate existing tissue Breast tissue is debulked, involving the

removal of wedges of tissue radially with ESU

Continued

Some surgeons may want the removed tissue to be weighed on the scale.◦ Make sure scale is zeroed

before the procedure starts

◦ Keep tissue specimens separate (right from left)

After all wanted tissue is removed the new “keyhole” incision is made with a new #10 or #15 blade.

Continued

Wound is temporarily closed with staples, excess skin is removed (#1 suture).

Process is repeated on the other breast◦ Due to difference in breast size, the exact same

amount (weight) of tissue may not be removed bilaterally.

Once both sides are temporally closed the patient may be placed in Fowler’s to assess size and symmetry.

Continued

It is common for the surgeon to reopen one or both wounds to make adjustments◦ Repositioning repeatedly may be necessary

Placement of nipple and areolar begins the permanent closure (2-0 maxon).

If drain place laterally◦ Have drain available but open upon request

Remaining wound edges are approximated with 2-0 or smaller suture◦ Liposuction may be performed at this time

Continued

Fluff-type dressing is applied, followed by a postsurgical bra.

Expected to remain 1-3 days in the hospital

Narcotics may be indicated for the first 24 hours.

Patient should be educated in wound care and management of drains before leaving hospital

Post-Op

Patient will have large permanent scars

Expected to have full recovery, return to normal activities in about 2 weeks

Refrain from vigorous exercise for 6-8 weeks

Repeat mammogram may be requested for comparison to pre-op study in 6 months

Prognosis

Hemorrhage Infection Scar tissue Patient dissatisfaction with appearance,

requiring further intervention.

Complications

Before and After