Aesthetic Breast Surgery & Correction of Inverted Nipple

 

Reduction mammaplasty

Reduction mammaplasty implies the resection of hyperplastic mammary tissue to decrease the size of breast and achieve cosmetically acceptable appearance. Korean female grows westernized in dietary pattern and life-style so that they tend to have larger breast. Neck pain, back pain, discomfort on breathing, and eczematous skin lesion under the inframammary fold are the indicaions of reduction mammaplasty. Postpartum enlargement and ptosis, asymmetric breast can be improved by this procedure as well.
 

Preoperative considerations

Preoperative conventional work up for the general anesthesia should be performed including CBC, Chest X-ray, and EKG. At least for 2 weeks, patients are prohibited from smoking and taking drugs with bleeding tendency. To rule out the occult carcinoma in the breast, mammogram should be recommended especially on the patient over the age of 35.

 

Surgical techniques

Under general anesthesia, it takes about 3~4 hours for reduction mammaplasty. According to its pedicle and incision, various surgical methods can be tried

 

Postoperative care

Postoperative pain is not severe and even though there happen some pain, analgesic can easily relieve it. Drain can be removed within a few days and stitch out is made around 1 to 2 week after the surgery. Most of the patients go back to the daily activity within a week. Scar grows indistinct and is almost invisible.

 

Complications

Skilled surgeon can minimize the surgical complications. Decrease in sensation of nipple is not infrequent although it recovers as time goes by. Reduction of very large breast may cause some disturbance in breast feeding. Hypertrophic scar along the incision line may occur in some cases and scar revision or steroid injection may be indicated in these cases

 

Augmentation mammaplasty

Patients with underdevelopment of breast, postpartum or senile change of breast may be good cndidate of augmentation mammaplasty.

 

Surgical techniques

Augmentation mammaplasty can be performed under local anesthesia. However, in most cases general anesthesia is preferred. Transaxillary, submammary (inframammary), and periareolar approach are the most widely used techniques and all the methods are acceptable in the aspect of surgical scar.
 

Type of implant

There are largely two types of implant; Saline-filled implant and Silicon-filled implant. Saline implant is safe even when it is ruptured, however it feels less soft and somewhat heavy. Cohesive silicon gel implant was approved a few years ago and now is available. Cohesive silicon gel implant has high cohesiveness so that it has superior tactile sensation and more natural shape than saline implant. However, final decision of which implant had better be inserted should be determined by specialist according to the patients' condition and indication of each implant after the counseling

 

Postoperative care

Drains can be removed within a few days and compressive dressing should be maintained for several days. Stitch out is made within 1 ~ 2 weeks after the surgery. Daily activity is feasible within one week. However severe movement or exercise should be avoided for 2 to 3 weeks. Temporary decrease of nipple sensation may be encountered, but it is restored with almost all cases and there is no disturbance in lactation.

 

Complications

Hardness following the implant insertion due to capsular contracture may occur. Rupture of implant may be another concern. Saline implant is destined to be ruptured about 5% in 10 years. Cohesive gel implant is expected to have less implant rupture rate. In case of rupture, implant can be safely removed and replaced with new one.

 

Inverted nipple

Inverted nipple is the condition that the nipple is buried under or depressed into the the areolar complex. Its incidence is approximately 2~3% and bilateral case is often. It can be congenital or acquired in the developmental stage. Following the adolescent period, breast tissue grows and adjacent skin, gland, and fat component get abundant. If these structures outgrow the ductal structure under the nipple, nipple is pulled down under the skin and cause inverted nipple. Another rare cause includes mammary ductitis and breast cancer.
Inverted nipple looks poor in aesthetic view and induces some poor hygienic problems. It also makes breast feeding difficult.
If manual reduction cannot render the nipple position in situ, surgical intervention should be made. Correction of the inverted nipple should consider the possibility of damage to the duct, complication related to the scarring, recurrence, and planning of breast feeding. Consultation to the plastic surgeon about those considerations should be ahead of the surgery. Since the surgical procedure is relatively simple, operation can be finished in outpatient base or one-day surgery.