These are the before pictures of the patientfeatured in our breast reduction tutorial, we are going to be showing today. As you cansee she is slightly asymmetrical with the right nipple lower than the left.So we are going to be performing a breast reduction on our lady today, I just thoughtI would show you the markings, essentially she is larger on the left, so we will starton the right, to get this size correct, and then we can make the other side. Essentiallywe are going to use what is called a wise pattern marking which is a t pattern marking,this is the position that the nipple is going to go to which i have measured with her standingup, so the nipple is going to go from here
to there, This is the vertical line whichis 6 centimeters and I have measured here 12 centimeters, here 12 centimeters and here10 centimeters and here 10 centimeters. So all this tissue is going to be removed, thatpoint is going to be sewn to that pint and that point to that point so 12, 12, 10,10that should all fit together, like that and then we have got 6,6 here, nipple rotatedup and then I can sew the nipple in, so that’s essentially how we do the breast reduction,now the first stage is to put the local anesthetic in all under the breast so it is numb so thepatient will wake up nice and comfortable, and I will show you each stage of the operationas we perform it, the first stage is to take
the skin off this area which allows bloodsupplies coming from here so the blood comes in, to the nipple and out from the nippleso the nipple maintains good blood supply. So what I have done now is I have removedthe skin from around the nipple., I have marked the nipple at the 12 o’clock, 3 o’clock, 6o’clock and 9 o’clock position and then I have removed this breast tissue, so I willjust show you where it is sits obviously we have got the skin there, so that’s the biton the outer bit of the nipple and this is the breast skins, so that’s the skin I haveremoved, I will just show you the fatty side underneath so we will just have that weighedand we do send it off for analysis just to
check there is no little cancers i there andthis is what we are left with, so the pedicle this is the pedicle here with the nerves andthe blood supply in it, keeping the nipple alive, is going to swing up to that positionand then the skin is going to come around to that position so nipple was there, I havecreated a hole so that is going to swing up and then the skin is going to be drawn likethat, our patient wants to be quite small and I can already tell that this is goingto fit together pretty well and we are going to sew it up all with absorbable stitchesand I will show you the finished appearance in a minute so there, nipple up and then bringtogether there.
Yeah I have finished the operation now, allsewn up with absorbable stitches, and an extra layer of glue, you see 6, is against the 6,10 is against the 10, 12 against the 12 so all my lines fit, we have got a lovely pinknipple, which is great I can see if i press the nipple i can see the blood goes whiteand then the blood comes back so thats a nice pink nipple with good blood supply also feelswarm which is great, if you have a problem with the blood going into the nipple, itsnormally very pale and if you have a problem with blood going out of the nipple but okgoing in it goes purpley you know that’s when it is really ingesting too much blood. Soour patient wanted quite small so i have aimed
for getting quite small probably a B, C cupshe wanted to be quite petite and now I need to turn my attention the the left side, thisoperation has taken about an hour to finish the right side and I have done it all myself,and then an hour later we will have the left side finished as well. This is just the endof the operation and I will just show you we have got a very nice symmetrical breastboth nipples lovely and pink, similar size we took more off the left side, and I willjust show you how we stitch the side up, we used to use a lot of stitches, we have progresseda little bit, I use this insorb, which is a type of staple, I will just ping one outthere, so if you can see, a little staple,
Breast Reduction Surgery Surgical Procedure
Hello my name’s Adrian Richards, I’m aplastic surgeon from England and surgical director of Aurora s.uk. I’m goingto be talking today through an operation I did recently on a lady which is a breast reductionoperation. The lady was very big busted, as we see from this picture, and had significantproblems with back, neck and shoulder ache and the left breast is significantly largerthan the right with a very low nipple position. So I’ve done my markings here, essentiallythis is where I’m going to move the nipple up to, this is the area of tissue that I’mgoing to remove. She had a lot of tissue out on the side and I’m going to move the nippleup to that position and bring the skin in
from the side. So my first stage is reallyjust to make the incisions which I’ve done here. My next stage is to remove the top layersof the skin, this is a technique called deepithelialisation, from my bridge of tissue which is going tosupply a blood supply to the nipple, here you can see I’m just completing that. Sothe blood supply will be left intact and this is where the blood supply is going to comethrough and the nerve supply to the nipple through that area of the skin. The rest ofthe tissue I’ve removed now and you can see that’s my pedicle, the nipple is attached,it’s not removed so the nerve and blood supply will be intact and then it’s goingto be moved upwards. That’s me showing where
the nerves come through.This is it with everything sewn up, all with absorbable stitches which will just need tobe trimmed and this is just showing you the tissue that’s been removed. So this areain my right hand, the area around the nipple, most of the tissue is removed from the lowerpart of the breast. I removed more from the left breast in this case as it was larger.So I hope that’s been informative and you’ve enjoyed watching the tutorial. If you’d likeany information about breast surgery, be it reduction, augmentation or uplift, pleasecontact us via our website or by phoning us on a UK number 01844 214362. Thanks for watchingthe tutorial, we look forward to seeing you soon.