Pittwater Life April 2017 Issue

Health & Wellbeing
Health & Wellbeing
What to do when breast
size causes discomfort
Nowadays breast
reductions are
commonly performed,
with generally very favourable
results.
It’s a fact that larger breasts
may contribute to poor
posture, shoulder, neck and
back pain, rashes under the
breasts and may also limit
exercise. Bra selection may
also be difficult and cause
grooving on the shoulders.
Reducing the size and weight
of breasts may improve these
conditions – although it
cannot be guaranteed.
There are many techniques
of breast reduction. These are
selected by assessing breast
and chest parameters, size of
reduction and scar tendency.
Mastopexy, or breast lift,
is a very similar procedure.
In breast lift, the remaining
breast tissue is rearranged to
create a breast cone. Skin is
removed and then redraped.
With breast reduction, both
skin and breast tissue are
removed and the remaining
breast tissue used to create a
breast cone to allow closure.
Larger breasts may also be
associated with a degree of
droop. The nipple position
is determined by using three
parameters: the position of
the infra-mammary fold (the
fold where breast meets chest
wall) projected forwards; the
midpoint of the humerus or
arm bone; and a set distance
from either the midpoint of
the collar-bone or the base of
the neck. This distance varies
with the height of the person.
Once the correct position has
been established, a keyhole
shape pattern is drawn around
this point. Depending on the
width of the lines and the
length determines the amount
of reduction.
Breasts that are unequal or
asymmetrical can be made to
be more equal.
A common misconception is
that the nipple is removed and
replaced. This is usually not
the case. The nipple is kept on
a pedicle of tissue. This allows
inflow of blood and nerve
supply, keeping the nipple
alive and sensate. By keeping
continuity with the nipple
and the breast ducts, breast
feeding may be possible.
Surgery is performed under
general anaesthetic. Local
anaesthetic may also be used
to minimise bleeding and
bruising and reducing the
amount of general anaesthetic
required. The use of drains
or drainage tubes depends
on the surgeon. Surgeons
will also decide on the length
of hospital stay – usually
overnight only. Smaller
reductions may be performed
as day surgery.
The tendency is now
to reduce the amount of
scarring. This is usually the
horizontal portion of the
anchor-shaped scar that may
already be hidden in the
infra-mammary fold. There
is a visible scar around the
areolar and a vertical scar
downwards from the areolar
to the infra-mammary fold.
Larger areolar are usually
reduced. Liposuction of the
lateral parts, under the arm,
may be combined as this
reduces tissue in this area,
the axillary tail, and does
not introduce more scarring.
Scar management, or looking
after the scar, is important.
Each surgeon will guide you
through this to try to optimise
the final scar.
The excised tissue is
with Dr John Kippen
weighed to try to get breasts
as equal as possible but
there will always be minor
differences in size, shape
and projection. Bra size is
used as a guide only, as cup
size varies with different bra
manufacturers. Any tissue
that is removed is sent for
histological examination to
exclude breast cancer or other
breast disease. Benign cysts
are a common finding at the
time of surgery.
Many women tolerate
this procedure very well
and are happy with the
results. As always, careful
consultation with your
surgeon optimises realistic
expectations and ensures a
thorough understanding of
the procedure and steps to full
recovery.
Our columnist Dr John
Kippen is a qualified, fully
certified consultant specialist
in Cosmetic, Plastic and
Reconstructive surgery.
Australian trained, he also
has additional Australian and
International Fellowships.
Dr Kippen works from custom-built
premises in Mona
Vale. He welcomes enquiries
and questions. Please
contact him via johnkippen.
com.au or by email: doctor@
johnkippen.com.au
42 APRIL 2017
Celebrating 25 Years