OUR BREAST REDUCTION AND LIFT SURGERY IN SYDNEY
Let’s start at the beginning. The brassiere was deconstructed by Robert Wise ( Fig 1). Hence the Wise pattern breast reduction. Whilst this was a leap forward it did have some basic flaws as it later emerged. This is a purely skin envelope-based deconstruction and therefore reduction and lift. This means that in its most basic form it relied on the skin envelope to hold the breast form. Immediately we can see the problem, skin is elastic it stretches and relaxes so this means that an inferior pedicled, Wise pattern reduction is in its best form on the day of surgery on the table. Ageing and descending from that moment forward.
Figure 1 ( Farhadieh RD, Bulstrode NW, Cugno S: Plastic & Reconstructive Surgery: Approaches & Techniques, Elizabeth Hall-Findlay Wiley 2015).
BREAST REDUCTION: BASIC PRINCIPLES
So we need to think a little differently. This involves an understanding of the inferior wedge principle. The inferior ptotic (sagging) gland needs to be removed in a breast reduction. It can be separated and moved up to the centre of the breast (BUT not the upper pole) with a mastopexy (lift). If we want to fill the upper pole then this will require either an implant or the addition of tissue (eg fat injections). The inferior wedge is that tissue below the Wise pattern.
Dr Elizabeth Hall-Findlay has demonstrated that somewhat counterintuitively the upper pole position of the breast is more reliable than the much-venerated Inferior Mammary Fold (IMF). There are lots of formula and measurements suggested, they all rely on the goal of symmetry. For example, in an ideal C cup size, the nipple should be 10 cm from the upper pole of the breast and 10 cm from the midline. There is normally a vertical distance of flat chest wall (this can vary from about 9 cm to 16 cm in an average height patient) between the clavicles (collar bone) and the upper breast border.
SYDNEY’S CUSTOM BREAST LIFT OR REDUCTION SURGERY
So what to do? The breast foot print as it is called determines the boundaries in which most naturally a lift, reduction, augmentation or reconstruction can be performed. So these anatomical borders are outlined as part of the examination and preoperative markings in the sitting position with the arm by the side. There are many different ways to determine the ideal position of the nipple after a breast reduction and a lift. Being familiar with these principles allows us to use the best technique applicable to body shape of each Sydney patient, customizing the design and the final shape of the breast. The sagging lower pole of the breast, along with the upper border is marked. So now we have all the main requirements for the breast reduction and lift surgery in our Sydney or Canberra clinic. The upper pole of the breast, the ideal nipple position and the wedge of inferior tissues that are sagging.
With this in mind we can turn our attention to the pedicle of the breast. This determines which part is preserved and carries the circulation of the nipple areolar complex. Superior, medial, lateral, inferior and supero-medial pedicles can all be safely designed. One good way to think about the breast is in quadrants. Upper inner, upper outer, lower inner and lower outer. Arguably from an aesthetic perspective fullness in the upper inner is amongst the most important principles. This is in part why most experienced surgeons choose, a medial, superior or supero-medial pedicle.