>Can someone explain how much breast tissue is taken out when they do what
>is called a "breast tuck"? Do they remove the nipple like they do in
>reduction surgery? I am working with a young mom who had large implants
>removed, and smaller ones put in. She said they had to do a breast tuck to
>take up the slack when they put in the smaller implant. She has scars all
>the way around her areola and then the vertical one from the nipple down
>to the chest wall (under the breast). Looks exactly like reduction scars.

This type of surgery is called "mastopexy."  It is similar to reduction
mammoplasty in that tissue is removed, however far less tissue is removed
in this type of surgery; the objective is more to lift and reshape the
breast.  Typically, more dermal tissue is removed than adipose or
parenchymal tissue.  Because the technique is similar to reduction
mammoplasty with periareolar incisions to reduce the size of the areola, it
carries the same risk of impacting lactation.  However, because less tissue
is removed and disrupted, the impact may not be as severe.  Specifically,
innervation through the fourth intercostal nerve may be affected, but fewer
ducts are likely to be removed or severed.

There is some overlap between the two types of surgery.  According to
"Surgery of the Breast:  Principles and Art," ed. S. Spear,
Lippincott-Raven, 1998, p. 684:  "Where the extent of the breast reduction
is modest (less than 100 g) the operation often resembles a mastpexy rather
than a breast reduction.  Small reductions can be performed using a
periareolar technique as well as an inverted-T pattern."

Mastopexy is also occasionally used in conjunction with augmentation to
improve the shape of the breasts.  Excess dermal and adipose tissue are
removed from areas that detract from the cosmetic appearance of the breast
and implants are added selectively.

As with reduction mammoplasty, there are several techniques that vary in
their impact upon lactation.  For example, the concentric (or doughnut)
technique, wherein a periareolar incision is made and (presumably) adipose
tissue is excised deeply in a doughnut pattern around the circumference of
the areola, is a popular technique for minimal scarring, however it is more
likely to sever lactiferous sinuses (if indeed such "sinuses" exist) than
an inverted-T type surgery, which would similar to the inferior pedicle
reduction mammoplasty.

So, yes, the nipple/areolar complex is usually, although not always, moved
in a mastopexy.  It is not typically completely severed, though, as it is
in the reduction mammoplasty free-nipple graft technique.  In mothers who
have had mastopexies, it would seem reasonable to expect that there would
some negative impact upon lactation,.  However, in most cases it should not
be as severe as the impact from reduction mammoplasty.

Diana West
http://www.bfar.org

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