Breast Reduction - Enlarged Breasts

Enlarged Breasts

Etiology

A woman develops large breasts usually during thelarche (the pubertal breast-development stage), but large breasts can also develop postpartum, after gaining weight, at menopause, and at any age. Whereas macromastia usually develops in consequence to the hypertrophy (overdevelopment) of adipose fat, rather than to milk-gland hypertrophy. Moreover, many women are genetically predisposed to developing large breasts, the size and weight of which often are increased either by pregnancy or by weight gain, or by both conditions; there also exist iatrogenic (physician-caused) conditions such as post–mastectomy and post–lumpectomy asymmetry. Nonetheless, it is statistically rare for a young woman to experience virginal mammary hypertrophy that results in massive, oversized breasts, and recurrent breast hypertrophy.

The abnormal enlargement of the breast tissues to a volume in excess of the normal bust-to-body proportions can be caused either by the overdevelopment of the milk glands or of the adipose tissue, or by a combination of both occurrences of hypertrophy. The resultant breast-volume increases can range from the mild (>300 gm) to the moderate (ca. 300–800 gm) to the severe (<800 gm). Macromastia can be manifested either as a unilateral condition or as a bilateral condition (single-breasted enlargement or double-breasted enlargement) that can occur in combination with sagging, breast ptosis that is determined by the degree to which the nipple has descended below the inframammary fold (IMF).

Therapeutic approaches

Medical

Breast hypertrophy (macromastia and gigantomastia) does not respond to medical therapy; yet a weight-reduction regimen for the over-weight woman can alleviate some of the excessive size and volume of her abnormally enlarged breasts. Physical therapy provides some relief for sufferers of neck, back, or shoulder pain. Skin care will diminish breast crease inflammation and lessen the symptoms caused by moisture, such as irritation, chafing, infection, and bleeding.

Surgical

Reduction mammoplasty, surgery or lipectomy, is the technically reliable method for diminishing the size and volume of the enlarged breast. The traditional, surgical techniques for breast reduction remodel the breast mound using a skin and glandular (breast tissue) pedicle (inferior, superior, central), and then trim and re-drape the skin envelope into a new breast of natural size, shape, and contour; yet it produces long surgical scars upon the breast hemisphere. In response, L. Benelli, in 1990, presented the round block mammoplasty, a minimal-scar periareolar incision technique that produces only a periareolar scar — around the nipple-areola complex (NAC), where the dark-to-light skin-color transition hides the surgical scar.