Reduction Mammaplasty Or Breastfeeding ?

Reduction mammaplasty is one of the most frequently performed operations in plastic surgery. In addition to the functional aspects of reducing the size of hypertrophic breasts to relieve patients of the adverse effects of macromastia on the musculoskeletal system, the psychological aspects of this operation have become increasingly important. Along with continuous technical advances in the performance of reduction mammaplasty that have contributed to increased safety, reliability, and aesthetic outcome, the expectations of patients have changed accordingly. Whereas older women who have experienced chronic back pain, inframammary intertrigo, and impaired physical activity for many years are often reluctant to accept the visible squeal of surgery, younger women are often more apprehensive of the prospect of trading large breasts without scars for smaller breasts with visible and sometimes unsightly scars. The psychological impact of operation scars should not be underestimated.

Another main object in reduction mammaplasty is the creation of a symmetric and youthful breast shape that remains stable for many years. A considerable proportion of the women who undergo this procedure are of fertile age. Consequently, a number of studies have been conducted to investigate the effects of this surgical procedure on breastfeeding potential. Some authors state that the sculpture of flaps during mammaplasty may impair breastfeeding potential, depending on the surgical technique adopted.

The breast of a woman contains 15 to 20 lobules. The milk is produced in the alveoli and collected in the lobules, then flows through the milk ductules and ducts to be collected in the milk reservoirs beneath the areola, from which it is secreted through the nipple. The key to preserving breastfeeding potential after a reduction mammaplasty is preparation of breast flaps sparing as many lobules and connected lactiferous ducts as possible and maintenance of adequate nipple–areola complex sensitivity.

Some studies investigating the effects of a reduction mammaplasty procedure on breastfeeding potential considered the superior, inferior, and horizontal pedicle techniques, or compared these three different techniques. The findings suggested that breastfeeding potential can be maintained, although to varying degrees. Basic dilemma may be which breast function is preserved after a reduction mammaplasty in different techniques?

The minimum number of lobules required for breastfeeding is not known. The success rates in superior pedicle breast reduction 60-71 %, inferior pedicle breast reduction 43-77 %, medial pedicle breast reduction 48 %, and lateral pedicle breast reduction 55 % are similar in the literature. The rate for failure to breastfeed in some studies cannot be attributed exclusively to an inappropriate surgical technique. Indeed, exte
al factors such as socioeconomic problems, working demands, inadequate information on the benefits of breastfeeding, fear of ptosis or deformity as a result of previous breast surgery, psychological refusal, and postpartum depression plays an important role. Moreover, many women complained that they had received little encouragement and support to breastfeed from the nursing and medical doctor staff.

Finally, the ability to breastfeed after breast reduction surgery is adequately preserved by surgical techniques that spare the essential connections between the lobule and milk ducts and the vital nipple–areola complex. Some studies demonstrate that by adopting conservative mammaplasty reduction techniques, the ability to breastfeed can be preserved in a remarkably large number of patients. Among one of the most popular techniques the superior pedicle breast reduction allowed to spare a sufficiently large proportion of the lobules and ducts connected to the nipple–areola complex to allow breastfeeding. Nonetheless, medical and paramedical staff also play an essential role by educating women who have undergone breast surgery about the benefits of breastfeeding and encouraging them to do so. The plastic surgeon should offer advice and explanations regarding the possibility of breastfeeding, thereby erasing any doubts of both the patients and the perinatal staff.