I was conversing with a friend the other day about the importance that our culture places on the form and size of a woman’s breast. And we commented on the latest thing to get that volume that today is perceived as aesthetically pleasing. The opposite, that is to say, the excessively big breast is something more problematic. It is not unusual that our patients come to our office at an early age, sometimes accompanied by their parents who complain about their daughter’s supposed obsession. 

In fact, nobody goes for aesthetic correction because of a problem of more or less just a few centimeters, but for the insecurity that size or form cause (with all its consequences) in the permanent development of a young woman’s life. 

When the breast has grown more than one suffers to accept, some important relationship problems are created: clothes, sports, the bathroom, walking down the street... everything is difficult. And no one other than one who suffers the problem knows how it negatively affects the quality of life. This is the main reason for which adolescents, as early as age fourteen, request the correction. And with the passing of years oversized breasts can cause further, often more serious problems, such as pressure on the lower part of the back that can end up being unbearable.  

Bras (brassieres) do not by themselves solve the problem, but frequently cause greater difficulties, including depression marks from the suspenders, compressions for not very appropriate forms... It is not difficult to find serious back problems in older women. This circumstance, can become a chronic pathology, for a lifetime, because this situation was tolerated.  

Then, when is a breast so excessive as to think about its reduction? Subjectively excessive: when the patient can’t psychologically tolerate its form and volume. This is the aesthetic indication. And objectively: when, although they don't affect the patient personally, their size and circumstances make fear a future pathology. It is the clinical indication. Most of the times both circumstances usually overlap.

Treatment? The surgery.

But what does the intervention consist of?  

Several technical modalities exist, the purpose of all of them is the same: to reduce the breasts’ weight and volume, while achieving an aesthetic form at the same time. The intervention is done with general anesthesia. The intervention is previously planned based on the pictures. The design is made with the patient awake and in vertical position adapting the lines to the real measures of the patient.  

We said that there are several tendencies regarding the surgical techniques, however, there is no procedure that avoids creating a scar. The connecting of flesh is a process of biological repair that depends on the genetic informants peculiar of each individual. There is no reliable laboratory test that tells us how the scar will be. We know nonspecific facts that we use: the direction of the skin’s lines of force, specific instrumental, non-traumatic manipulations, highly inert sutures. In spite of all these techniques, the final result of a skin union is always an imperfectly controlled mystery.  

In the reduction of the breasts we always fight to get scar marks smaller, but hide-and-seek and small, has not arrived at satisfactory results but we should always think of a tribute: THE NON AESTHETIC OVERWEIGHT FOR THE HIDDEN MARKS.

Within the accepted procedures the final scarring is found according to a person’s image:  

Those of typical anchor shape scars are found in people of the Caucasoid countries

Those of an L or typical inverted T scars are found in people of the Latin countries. 

In periareolar incision: 

• Combination of the same ones according to each particular case and the surgeon's knowledge.

• The postoperative stage is very dynamic: The slight cases can be developed in an ambulatory way. The bigger cases should remain hospitalized for at least 24 hours. After that time, the patient can develop her moderate normal activity.

• A bra with an appropriate design of scarring control is indispensable. The nuisances are minimal and the outcome is very satisfactory.

• In short it is a very rewarding surgery for the patient and for the surgeon.