Firm Sagging Breast Naturally
The most serious complication of breast reduction surgery is nipple-areola complex (NAC) or breast necrosis. Very large breasts and or significant breast ptosis are the main reasons for such a disastrous complication, particularly in inexperienced hands. However, partial or total necrosis of the NAC can still occur in patients with high risk factors such as smoking, diabetes, or chronic corticosteroid therapy. Free nipple techniques in breast reduction are a viable alternative option for patients with large or ptotic breasts and should be considered and discussed early. Viability of the NAC depends more on adequate venous return than arterial input, with most cases of NAC necrosis being secondary to venous congestion. Methods to avoid later venous congestion include choosing
The arterial blood supply is relatively constant with a major vessel from the internal thoracic (mammary) system. Taylor has demonstrated that this vessel originates from the second or third interspace 4 and runs obliquely downward toward the nipple. The angle taken by this vessel will depend on the degree of breast ptosis. It enters the breast at the level of the breast meridian but will be located more medially the greater the distance cephaled to the nipple. It is because this vessel is very superficial and can always be found about 1 cm deep to the skin surface that the superior pedicle can be quite radically thinned. In fact, trying to inset a full-thickness superior pedicle can compromise nipple-areola circulation secondary to compression.
In patients who have simple breast ptosis or who require only a small reduction of 400 to 500 g or less, the vertical mammaplasty can provide an excellent aesthetic result. Addition of an aggressive vertical skin resection is particularly helpful in cases of pseudop-tosis, where the lower pole of the breast is excessively prominent. As in any other breast reduction techniques, vertical scar mammaplasty works most easily in moderate-sized breasts with good tissues and elastic skin in young nonsmokers. A patient with normal and stable weight is preferable to an obese patient whose weight is constantly fluctuating. Juvenile patients are more prone unpredictable and often hyper-trophic scar formation, and all efforts should be undertaken to keep scars as short as possible.