"The Learning Channel" (TLC) television channel broadcasts a show called
"The Operation".  Tonight's episode was breast reduction surgery.  It
was a graphic (viewer discretion advised) hour-long presentation of an
actual surgery, with commentary provided by the (woman) surgeon as she
operated.  We watched from marking the skin to cutting skin to removal
of tissue to recontour and closure.  Fascinating!  I didn't get to see
the first 30 minutes, but will definitely be looking for a rerun.  Here
are teaching points presented in the second half of the show.

The medical and psychological reasons for breast reduction include:
- back and shoulder strain
- possible degenerative arthritis
- "irreversible grooves" in the shoulders (not explained - bra straps?)
- rashes under and between breasts
- difficulty breathing
- problems with hygiene
- limited career and lifestyle choices
- difficulty finding clothes that fit properly

Goals of the surgery include:
- protecting nerve supply to the nipple and areola
- preserve ability to lactate
- improve body image
- result in breast symmetry regardless of original asymmetry
- minimize scarring

About the surgery itself:
- a total of about 1100g (2.5 pounds) of tissue was removed during the
procedure
- the patient's bra size was reduced from F to C cup
- surgery of this scope is the most common breast reduction procedure
- the final incision was a circle around the areola, then leading
straight down to the base of the breast, then horizontal under the
breast (like a circle atop an upside down "T"), although wedges of
tissue had been removed all around the breast
- staples are used to temporarily close the incisions (like basting
stitches)
- after stapling, the (unconscious) patient is sat up to compare
symmetry
- when contour is acceptable to the surgeon, staples are replaced with
subcutaneous sutures

The surgeon, a Dr. Feldman (I didn't hear where), had done "a couple
hundred" such procedures.  She said that although the surgery should
preserve lactation, the ability to completely breastfeed may be lost, so
if it is important to the patient to breastfeed w/o supplementation, she
should probably postpone the surgery.  Her ongoing discussion of breast
anatomy was interesting (blood vessels, nerve supply, fat deposits, milk
ducts, etc).

Miscellaneous facts:
- about 80% of women have a clinically noticeable difference in size
from one breast to the other
- "last year" (1996? in the US or worldwide?), 37,000 women had breast
reduction surgery (!!!)
- surgery removing 200-300g of tissue (total of 2 breasts) is generally
considered a cosmetic "breast lift" and usually not covered by insurance
- surgery removing 500g or more of tissue (total of 2 breasts) is
generally covered as a medical procedure (although there will be
cosmetic benefits as well)

The patient, a young Olympic athlete (volleyball) from the USA, was
interviewed (while trying on swimsuits!) six weeks after the surgery.
She was delighted with all aspects, and pleased with the minimal
scarring.

If you don't mind watching blood and casual handling of body parts, this
is a great show!

~~ Nancy Penney
[log in to unmask]