Breast Reduction - From G to D - Plastic Surgery - Dr. Juris Bunkis
Dr. Bunkis: Hi. This is Dr. Bunkis from Orange County Plastic Surgery. This morning, we are doing a breast reduction on this 19-year-old female. You can see that her breasts are disproportionately large for her frame. Her nipples are way below where they should be. What we're going to do is decrease the size of her [inaudible], move the nipple up where it should be, and decrease the size of her breasts. She says that she's a G size and she'd like to be a small D.
Here, we are in the OR, going to reduce her breasts. We've drawn the Wise-pattern on her chest. Basically, her nipple will be moved up into here, we'll take out some of the excess skin, and we'll take out a lot of the tissue. She's a G size right now. She wants to be a D. We start by injecting some local anesthetic which causes the blood vessels to constrict and we have less blood loss during the procedure.
First thing we do is we make a cut around the areolas, and we will be leaving her areolas attached to her breast tissue. We don't detach the areolas, but we're going to be moving it upward and just removing a lot of the volume from the breast. Now, we're going to remove the excess skin along the bottom part of the breast and make a spot up top for the areolas to go. This is just removing the excess skin.
We have taken off the skin that we're going to remove. Now, we're going to develop a little pedicle underneath the areolas that will have intact ducts underneath and so forth. If she wishes to breastfeed, she'll be able to, but it's that little pedicle of tissue underneath the areolas that will allow it to stay alive and keep all its sensation going and so forth. We're going to make it based on the medial side.
Okay. We've finished developing this pedicle. As you can see where the areolas is, she's got a very healthy piece of breast tissue underneath. That's what's going to keep the areolas alive and enough ducts going in there so she can breastfeed and so forth. That will be tucked up into here where the nipple goes. This is the excess tissue at the bottom that we're going to be resecting and sending to the lab.
I'm doing the last of the excess breast tissue. When this comes off, you'll be able to see how we put her back together again. Kind of like Humpty Dumpty. You can see this is going to spin underneath here, and then these parts will come together like this. That's what her breast is going to look like. We approximate everything temporarily with [inaudible] clips. It allows us to make sure that the shape is adequate, that everything's going to work the way we expected it to. Okay. This is going to be the hole for the new areolas.
We're taking out the skin to make room for the areolas. Here, you can see it sitting underneath the surface. This is where we're going to put it. Now, replacing these clamps with some [deep] sutures to hold the breast together. Here, you can see everything's been approximated, and now, we're just running a suture just underneath the skin that'll hold everything together. That way, she won't have any little crosshatches from the external sutures and she'll have a nicer scar in the long run.
We're just putting a little glue on the incisions. Now, you can see what this breast looks like when it's done. Initially, it looks very flattened at the bottom and kind of bulging at the top. In about four months, this will be concave and this will round out. She's going to have a very, very nice result. This is how we do breast reductions at Orange County Plastic Surgery.
This is an example of a similar patient. She was a little older. She was about 30, but you can see that she has very large droopy breasts of similar shape to that 19-year-old we just saw. Here, you can see her before and a year after I did a similar type of a breast reduction.