Surgical Procedure for Breast Reduction
Step 1: Surgical Plan Design
The surgeon begins by assessing the current condition of the breasts, including glandular and soft tissue composition, any abnormal masses, skin structure (laxity, thin or thick skin, excess skin), ribcage anatomy (protrusion or depression), and the inframammary fold (curved, straight, or asymmetric). After that, the surgeon designs the surgical incision, formulates a safe glandular tissue resection plan, and repositions the nipple-areola complex in cases of breast ptosis or significant glandular descent beyond the inframammary fold, accompanied by excessive skin laxity. Care is taken to avoid excessive excision of glandular and soft tissue, which could compromise vascular perfusion, increasing the risk of wound necrosis, nipple-areola complex ischemia, and hypertrophic scarring.
Step 2: Tissue and Gland Resection Using an Ultrasonic Scalpel
The next-generation Ultrasonic Surgical Scalpel is utilized to dissect and release tissue while simultaneously achieving hemostasis through coagulation and sealing. This advanced technique significantly minimizes postoperative serous drainage by ensuring precise dissection with high accuracy. The glandular tissue is resected safely, reducing thermal injury, accelerating wound healing, and minimizing postoperative complications such as serous effusion, hypertrophic scarring, and tissue necrosis.
Step 3: Suturing Technique
Ensuring rapid wound healing and aesthetic outcomes.
Advantages of Using an Ultrasonic Scalpel in Breast Reduction Surgery
According to Dr. Vu, the next-generation Ultrasonic Surgical Scalpel is equipped with an integrated chip that precisely controls the coagulation, sealing, and cutting functions of the scalpel. This technology enhances surgical safety, particularly in breast reduction procedures that require the excision of large volumes of glandular tissue and excess skin, where there is a high risk of bleeding.
Dr. Vu also stated that the application of the next-generation Ultrasonic Surgical Scalpel in breast reduction and breast reshaping for sagging breasts achieves several postoperative benefits, including: a 90% reduction in postoperative pain, same-day discharge, no additional analgesics required after surgery, faster and softer scar maturation compared to electrocautery, and a significant reduction in both early and late surgical complications.
Additionally, the ultrasonic scalpel utilizes high-frequency ultrasound waves to achieve precise tissue dissection, maximizing the protection of surrounding healthy tissue and minimizing unintended damage. This is particularly crucial in female-to-male (FTM) chest masculinization surgery and breast reshaping for sagging breasts, where preserving tissue integrity helps reduce postoperative pain and shortens recovery time.
Potential Risks in Breast Reduction Surgery
Hematoma
Hematoma can occur immediately after breast reduction surgery, primarily due to inadequate hemostasis during the procedure. If the amount of bleeding is minimal, the body can naturally reabsorb it. However, significant bleeding can lead to hematoma formation, requiring further intervention.
The breast is composed of skin, fat, glandular parenchyma, and stromal tissue. Within the stroma lies a complex network of arteries, veins, and lymphatics. The primary arterial supply includes the lateral thoracic artery (from the axilla) and the anterior and posterior intercostal perforators (from the internal thoracic artery). These arterial branches do not strictly follow the ductal system but instead form a vascular plexus within the anterior fatty layer. Consequently, breast reduction surgery typically results in greater bleeding compared to standard breast augmentation procedures.
Hematoma presents with swelling, pain, and bruising and can compromise blood perfusion, increasing the risk of infection and prolonged inflammation. This can negatively impact the viability of the skin flap, delay wound healing and tissue organization, and potentially lead to postoperative breast deformities.
Infection
Infection is one of the early complications following female-to-male (FTM) chest masculinization surgery. It typically presents as localized inflammation and is often manageable with oral antibiotics. However, in cases of persistent infection that cannot be controlled with medical treatment, surgical drainage of a large fluid collection or debridement of the infected area may be required.
Most postoperative infections occur between postoperative days 3 to 7, although some cases may present later. Symptoms of infection include loss of appetite, altered taste perception, fever, pain at the surgical site, erythema, or swelling.
According to Dr. Vu, if any of these symptoms occur, patients should seek early evaluation by a surgeon. If the infection cannot be controlled with antibiotics, surgical intervention may be necessary to clean the infected site, debride infected tissue, eliminate closed spaces and residual pockets within the infected area, and drain accumulated fluid.
Nipple-Areola Necrosis
Nipple-areola necrosis is a potential complication that can easily occur due to compromised blood supply, often resulting from excessive tissue damage around the nipple-areola complex caused by surgical excision and cauterization.
Loss of Sensation in the Breast and Nipple
This is a common complication in breast aesthetic surgeries involving incisions around the nipple-areola complex. For individuals with smaller breasts and minimal glandular tissue, it is advisable to opt for preservative surgical techniques and incision placements to reduce the risk of sensory loss.
In cases of breast ptosis with significant glandular tissue and aging skin, the risk of both early and late complications during wound healing is higher. The use of electrocautery for tissue resection at high temperatures may cause thermal damage, leading to reduced sensitivity, numbness, paresthesia, or even complete loss of sensation in the nipple.
Unfavorable Scarring
Optimal scar aesthetics depend on the surgeon's technique and experience in assessing skin elasticity and the risk of scar formation. A well-planned surgical approach, combined with preventive scar management before, during, and after surgery, helps achieve aesthetic scarring while minimizing the risk of hypertrophic scars, contracture scars, and undesirable scarring. Scarring is inevitable in breast reduction surgery, and its severity depends on the surgical technique, method used, and postoperative care protocol.
A mandatory step in breast reduction surgery is undergoing comprehensive preoperative testing to rule out medical conditions such as coagulation disorders, hypertension, and the need to discontinue anticoagulants and certain herbal medications before surgery. Although rare, anesthesia carries potential health risks, including airway obstruction, cardiac arrhythmias, allergic reactions, brain injury, stroke, and even death.
To minimize surgical risks, patients should choose to undergo breast reduction at licensed hospitals approved by the Ministry of Health, preferably multispecialty hospitals, to ensure safety and prompt medical intervention in case of unexpected complications.
