Dr Sumer Yadav's Guide to Breast Reduction Surgery

1. Breast reduction 2015Breast reduction 2015 Dr sumer yadavDr sumer yadav Mch plastic and reonstructive surgeryMch plastic and reonstructive surgery Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

2. Breast is the symbol of femininity .It is aBreast is the symbol of femininity .It is a source of maternal and sexual feelingssource of maternal and sexual feelings and is often the initiating focus of sexualand is often the initiating focus of sexual intimacy. Its feel, sensation andintimacy. Its feel, sensation and appearance, nurture the development ofappearance, nurture the development of warm, interpersonal relationshipwarm, interpersonal relationship Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

3. DefinitionDefinition Surgical reduction of breast volume toSurgical reduction of breast volume to achieve a smaller, aesthetically shapedachieve a smaller, aesthetically shaped breast mound with concomitant relief ofbreast mound with concomitant relief of the potential symptoms of mammarythe potential symptoms of mammary hypertrophyhypertrophy Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

4. Breast EmbryologyBreast Embryology Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

5. Breast AnatomyBreast Anatomy Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

8. Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

9. HistoryHistory Strombeck(1960)-Horizontal bipedicleStrombeck(1960)-Horizontal bipedicle Pitanguy,Weiner(1962)-superior pediclePitanguy,Weiner(1962)-superior pedicle Skoog(1963)-Superolateral pedicleSkoog(1963)-Superolateral pedicle McKissock(1972)-Vertical bipedicleMcKissock(1972)-Vertical bipedicle Courtiss,Goldwyn, Georgiade, Ribiero,Courtiss,Goldwyn, Georgiade, Ribiero, Robbins(1975-1977)- Inferior pedicleRobbins(1975-1977)- Inferior pedicle Orlando(1975)-superomedial pedicleOrlando(1975)-superomedial pedicle Biesenberger(1928),Hester(1985) – centralBiesenberger(1928),Hester(1985) – central moundmound Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

10. Contd.Contd. Vertical and short scar techniquesVertical and short scar techniques Vertical scar -Lassus, Lejour,Vertical scar -Lassus, Lejour, Hammond(SPAIR), Hall Findlay (1970 -Hammond(SPAIR), Hall Findlay (1970 - 1999)1999) Vertical scar with short inframammary scarVertical scar with short inframammary scar –Marchac peixoto(1980-1982)–Marchac peixoto(1980-1982) B or J scar reduction – Regnault &B or J scar reduction – Regnault & Chiari(1970-1974)Chiari(1970-1974) Periareolar reduction –Periareolar reduction – Benelli,Sampao-Goes (1990-1996)Benelli,Sampao-Goes (1990-1996)Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

12. Evaluation Of Breast EnlargementEvaluation Of Breast Enlargement HistoryHistory SymptomsSymptoms Risk factorsRisk factors Scarring tendenciesScarring tendencies Reasons for wanting surgeryReasons for wanting surgery h/o nipple sensationh/o nipple sensation Smoking historySmoking history Type of workType of work General medical conditionGeneral medical condition Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

13. ProblemProblem Macromastia-is developmental increase inMacromastia-is developmental increase in breast volume & weight. Reductionbreast volume & weight. Reduction mammoplasty is indicated for symptomaticmammoplasty is indicated for symptomatic relief as well as aesthetic improvementrelief as well as aesthetic improvement Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

14. EtiologyEtiology MutifactorialMutifactorial -genetic-genetic -obesity-obesity -pregnancy-pregnancy Virginal hypertrophyVirginal hypertrophy GigantomastiaGigantomastia Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

15. Physical ExaminationPhysical Examination Complete general examinationComplete general examination Local breast examinationLocal breast examination -previous breast surgery-previous breast surgery -expected reduction volume-expected reduction volume -nipple-areola size &shape-nipple-areola size &shape -asymmetry-asymmetry -nipple sensation-nipple sensation -right & left nipple to sternal notch-right & left nipple to sternal notch measurementmeasurement -right to left nipple to inframammary fold-right to left nipple to inframammary fold measurementmeasurement Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

16. InvestigationsInvestigations RoutineRoutine SpecificSpecific - Mammography - > 35 yrs.- Mammography - > 35 yrs. -Ultrasound evaluation-Ultrasound evaluation - Psychological evaluation &- Psychological evaluation & counselingcounseling Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

17. Pre-op PhotographsPre-op Photographs Front & lateral viewFront & lateral view Marks at the normal nipple heightMarks at the normal nipple height Nipple in relation to elbowNipple in relation to elbow Shoulder groovesShoulder grooves Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

18. TREATMENT PLANNINGTREATMENT PLANNING Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

19. Indications for surgeryIndications for surgery MajorMajor – very large breast– very large breast shoulder painshoulder pain cervical & upper thoracic paincervical & upper thoracic pain severe embarrassmentsevere embarrassment recurrent intertrigorecurrent intertrigo MinorMinor – inability to exercise due to breast– inability to exercise due to breast discomfortdiscomfort difficulty with breathing during exercisedifficulty with breathing during exercise grooving & hyper pigmentation ofgrooving & hyper pigmentation of shoulder strap areasshoulder strap areasDr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

20. ContraindicationsContraindications Absolute-Absolute-extreme obesityextreme obesity inadequate cardiac, pulmonary,inadequate cardiac, pulmonary, renal reserverenal reserve current or recent lactationcurrent or recent lactation unevaluated breast mass orunevaluated breast mass or mammographic findingsmammographic findings RelativeRelative - current smoking history- current smoking history > 30% ideal body wt. obesity> 30% ideal body wt. obesity inappropriate psychiatric evaluationinappropriate psychiatric evaluation Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

21. Selection of techniqueSelection of technique Depends onDepends on - beast size- beast size - estimated resection volume- estimated resection volume - breast shape- breast shape - more elusive concept of- more elusive concept of appearanceappearance Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

22. Selection of techniqueSelection of technique Breast hypertrophyBreast hypertrophy Mild - (resection < 200gm./ side)Mild - (resection < 200gm./ side) Moderate - (resection 200-500gm./ side)Moderate - (resection 200-500gm./ side) Severe - (resection 500-1500gm./ side)Severe - (resection 500-1500gm./ side) Gigantic - (resection >Gigantic - (resection > 1500gm./ side)1500gm./ side) Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

23. Operative techniqueOperative technique Liposuction- assisted reductionLiposuction- assisted reduction Wise pattern marking designWise pattern marking design McKissock vertical bipedicleMcKissock vertical bipedicle techniquetechnique Petanguy superior pedicle techniquePetanguy superior pedicle technique Inferior pyramidal pedicle techniqueInferior pyramidal pedicle technique Free nipple graft techniqueFree nipple graft technique Central parenchymal pedicleCentral parenchymal pedicle techniquetechniqueDr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

24. Short scar techniqueShort scar technique Vertical MammoplastyVertical Mammoplasty Hall-Findlay Vertical scar MammoplastyHall-Findlay Vertical scar Mammoplasty Vertical reduction with short horizontal scarVertical reduction with short horizontal scar Marchac(1982)Marchac(1982) L-shaped scar reductionL-shaped scar reduction B techniqueB technique Horizontal scar reductionHorizontal scar reduction Periareolar reductionPeriareolar reduction Benelli round block procedureBenelli round block procedure Goes procedureGoes procedure Hammond SPAIR techniqueHammond SPAIR technique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

25. Liposuction- assisted reductionLiposuction- assisted reduction Grazer & Teimourian (1985 )Grazer & Teimourian (1985 ) Matarasso & Courtiss (1991)Matarasso & Courtiss (1991) Selection criteriaSelection criteria – Elastic skin & predominantly fatty breastElastic skin & predominantly fatty breast – Wishing conservative reductionWishing conservative reduction AdvantagesAdvantages – Preserve the glandular tissues, vessels, & nervesPreserve the glandular tissues, vessels, & nerves – If used as adjunct with reduction surgery reducesIf used as adjunct with reduction surgery reduces blood lossblood loss Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

26. Liposuction- assisted reductionLiposuction- assisted reduction Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

27. Wise pattern marking designWise pattern marking design Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

35. McKissock vertical bipedicleMcKissock vertical bipedicle techniquetechnique HistoryHistory – Modification of Strombeck procedure(1972)Modification of Strombeck procedure(1972) AdvantagesAdvantages – Well vascularised pedicleWell vascularised pedicle – Excellent exposureExcellent exposure – Maintenance of superior pole massMaintenance of superior pole mass – Good long term result with breast shapeGood long term result with breast shape – Flexibility in designFlexibility in design DisadvantagesDisadvantages – Sensory return – 65%Sensory return – 65% – Nipple retractionNipple retraction Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

36. McKissock vertical bipedicleMcKissock vertical bipedicle techniquetechnique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

49. Biesenberger reductionBiesenberger reduction Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

50. STROMBECK HORIZONTAL BIPEDICLE TECHSTROMBECK HORIZONTAL BIPEDICLE TECH Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

51. Pitanguy superior pedicle techniquePitanguy superior pedicle technique HistoryHistory – Arie(1957) – first describedArie(1957) – first described – Ivo Petanguy (1967) – modificationIvo Petanguy (1967) – modification AdvantagesAdvantages – Best applied to breast reduction < 500gmBest applied to breast reduction < 500gm – Excellent long term breast shapeExcellent long term breast shape – Well vascularised pedicleWell vascularised pedicle – Preservation of nipple sensationPreservation of nipple sensation – Lack of interference with breast feedingLack of interference with breast feeding Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

52. Pitanguy superior pedicle techniquePitanguy superior pedicle technique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

65. pitanguypitanguy Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

67. Inferior pyramidal pedicle techniqueInferior pyramidal pedicle technique HistoryHistory – Georgiade et al (1979)Georgiade et al (1979) AdvantagesAdvantages – Very versatile – use for reduction from 300-1500gmVery versatile – use for reduction from 300-1500gm – Long lasting result even with ptosis & macromastiaLong lasting result even with ptosis & macromastia – Well vascularised pedicleWell vascularised pedicle – Less chances of nipple retractionLess chances of nipple retraction – Excellent glandular exposureExcellent glandular exposure – Maintenance of nipple sensibilityMaintenance of nipple sensibility CriticismCriticism – Flat breast with inadequate projectionFlat breast with inadequate projection Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

68. Inferior pyramidal pedicle techniqueInferior pyramidal pedicle technique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

83. SUPEROMEDIAL PEDICLE WITH WISE PATTERNSUPEROMEDIAL PEDICLE WITH WISE PATTERN Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

84. Free nipple graft techniqueFree nipple graft technique Procedure of choice in the treatment ofProcedure of choice in the treatment of gigantomastiagigantomastia It is a composite graft of skin, smooth muscle &It is a composite graft of skin, smooth muscle & ductal elementsductal elements AdvantagesAdvantages – Rapid execution with minimal blood lossRapid execution with minimal blood loss – Maintenance of glandular shapeMaintenance of glandular shape DisadvantagesDisadvantages – Loss of nipple sensibilityLoss of nipple sensibility – Loss of lactating abilityLoss of lactating ability Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

85. Free nipple graft techniqueFree nipple graft technique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

99. Schwarzmann techSchwarzmann tech Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

100. Central parenchymal pedicleCentral parenchymal pedicle techniquetechnique HistoryHistory – Hester & associates (1985)Hester & associates (1985) – Modified technique Biesenberger (1928) & WiseModified technique Biesenberger (1928) & Wise (1956,1963)(1956,1963) AdvantagesAdvantages – Well vascularised pedicleWell vascularised pedicle – Minimal difficulty with nipple transpositionMinimal difficulty with nipple transposition – Minimal pre-operative markingsMinimal pre-operative markings – Preservation of breast feeding & lactationPreservation of breast feeding & lactation – Preservation of nipple-areola sensationPreservation of nipple-areola sensation DisadvantagesDisadvantages – Experience is required to perform freehand reductionExperience is required to perform freehand reduction Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

101. Central parenchymal pedicleCentral parenchymal pedicle techniquetechnique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

111. Central mound tech by hesterCentral mound tech by hester Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

112. Vertical MammoplastyVertical Mammoplasty Lassus(1964) emphasizedLassus(1964) emphasized – Use of superior pedicle, inferior pyramidalUse of superior pedicle, inferior pyramidal glandular resection, no skin undermining &glandular resection, no skin undermining & closure with a vertical scar onlyclosure with a vertical scar only Lejour(1999)Lejour(1999) – Modified Lassus techniqueModified Lassus technique – Prior liposuction of the breastPrior liposuction of the breast – Superior pedicle for the nipple-areola complexSuperior pedicle for the nipple-areola complex – Lower pole resectionLower pole resection – New breast mound from suture plication ofNew breast mound from suture plication of lateral pillarslateral pillarsDr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

114. Vertical MammoplastyVertical Mammoplasty Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

129. LISTA TECH……………………LISTA TECH…………………… Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

130. LISTA TECHLISTA TECH Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

132. LISTA TECHLISTA TECH Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

137. Hall-Findlay Vertical scarHall-Findlay Vertical scar MammoplastyMammoplasty Variation of vertical scar themeVariation of vertical scar theme Medial pedicle with inferolateral glandMedial pedicle with inferolateral gland resectionresection Particularly effective for small to moderateParticularly effective for small to moderate reductionreduction Forms a conical, well supported breastForms a conical, well supported breast Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

138. Hall-Findlay Vertical scarHall-Findlay Vertical scar MammoplastyMammoplasty Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

139. Vertical reduction with short horizontalVertical reduction with short horizontal scarscar Marchac (1982)Marchac (1982) Central resection with vertical closureCentral resection with vertical closure having a horizontal component was anhaving a horizontal component was an integral part of the pre-operative skinintegral part of the pre-operative skin resection designresection design Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

140. Marchac(1982)Marchac(1982) Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

141. B & L-shaped scar reductionB & L-shaped scar reduction Regnault (1974) – B techniqueRegnault (1974) – B technique mammoplasty that eliminated the medialmammoplasty that eliminated the medial component of the horizontal scarcomponent of the horizontal scar – Nipple is preserved on superomedial pedicleNipple is preserved on superomedial pedicle – Inferolateral glandular resectionInferolateral glandular resection Born (1994) - modified L scar techniqueBorn (1994) - modified L scar technique – Medial triangular flap interdigitating withMedial triangular flap interdigitating with lateral rectangular flaplateral rectangular flap Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

142. L-shaped scar reductionL-shaped scar reduction Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

143. B techniqueB technique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

144. B techniqueB technique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

145. Horizontal scar reductionHorizontal scar reduction Passot – first surgeon to describePassot – first surgeon to describe horizontal scar reductionhorizontal scar reduction – Inferior wedge resectionInferior wedge resection – Nipple transposition in button hole incisionNipple transposition in button hole incision higher up on the breast moundhigher up on the breast mound Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

147. Periareolar reductionPeriareolar reduction Bennelli (1990) round block procedureBennelli (1990) round block procedure – Minimize scarringMinimize scarring – Skin taken up in purse string mannerSkin taken up in purse string manner – Drawback- flattening of breast inDrawback- flattening of breast in anteroposterior dimension (pancake look)anteroposterior dimension (pancake look) Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

148. Peri-areolar reductionPeri-areolar reduction Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

149. Peri-areolar reductionPeri-areolar reduction Goes procedure (1996) – double skinGoes procedure (1996) – double skin techniquetechnique – Elevation of fairly thin skin flapsElevation of fairly thin skin flaps – Removal of superior horizontal wedge withRemoval of superior horizontal wedge with vertical upper pole wedgevertical upper pole wedge – Exposed central pedicle supported with VicrylExposed central pedicle supported with Vicryl meshmesh Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

154. Hammond SPAIR techniqueHammond SPAIR technique Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

155. SPAIR – HAMMONDSPAIR – HAMMOND SHORT SCAR PERIAREOLAR INFERIOR PEDICLE REDUCTIONSHORT SCAR PERIAREOLAR INFERIOR PEDICLE REDUCTION Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

161. Sculpted pillar vertical reduction mammaplastySculpted pillar vertical reduction mammaplasty Kent K. Higdon and James C. GrottingKent K. Higdon and James C. Grotting Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

169. 00 Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

173. Special topics in breastSpecial topics in breast reductionreduction Secondary breast reductionSecondary breast reduction – Increase in breast volumeIncrease in breast volume – Poor shape or asymmetryPoor shape or asymmetry – Recurrent symptomsRecurrent symptoms Adolescent breast reduction for juvenileAdolescent breast reduction for juvenile hypertrophy – wait until breast growthhypertrophy – wait until breast growth stable for at least 1yrstable for at least 1yr Oncoplastic breast reductionOncoplastic breast reduction – Advocated by Adretsch & CloughAdvocated by Adretsch & Clough Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

174. ComplicationsComplications Hematoma - < 1%Hematoma - < 1% Seroma - 1-5%Seroma - 1-5% Infection - cellulitis or abscessInfection - cellulitis or abscess Skin necrosisSkin necrosis Fat necrosisFat necrosis Nipple lossNipple loss Nipple numbnessNipple numbness Hypertrophic scarsHypertrophic scars Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

175. ComplicationsComplications AsymmetryAsymmetry Inadequate reduction or over reductionInadequate reduction or over reduction Boxy breast deformityBoxy breast deformity Recurrent enlargementRecurrent enlargement Inability to breast feedInability to breast feed Dog – earsDog – ears Inadequate mastopexy resultInadequate mastopexy result Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

184. Thank youThank you Dr sumer yadav - mch plastic surgeon ,Dr sumer yadav - mch plastic surgeon , sumeryadav2004@gmail.comsumeryadav2004@gmail.com

Dr Sumer Yadav's Guide to Breast Reduction Surgery

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Dr Sumer Yadav's Guide to Breast Reduction Surgery