Breast Reduction Surgical Techniques
The purpose of breast reduction surgery is to reduce the volume of the breast. There are many breast reduction surgical techniques, nearly all of which are likely to reduce milk production capability. (1), (2) The surgeries that have resulted in the least negative impact are those in which the areolae and nipples were not completely severed (even though they may have been moved),(3) and the lower portion of the nipple and areola remains intact.(4)
The most common techniques in North America are the pedicle techniques in which the areola and nipple are moved to a higher position while attached to a mound of tissue called a “pedicle” that contains the still-connected ducts, nerves, and blood supply. This technique is called "inferior" or "McKissock," "Robbins," or "Moufarrege" techniques, if the main part that remains attached is below the areola (where the nerves that are important to milk ejection are). It is called "superior" if the main part that remains attached is above the areola. The superior pedicle technique, also known as the "Lejour" and "Lassas" techniques, has been shown in studies to result in less favorable milk production outcome, due to the location of the incision on the lower part of the areola, which severs the primary nerve that affects sensation and milk release.(5) There is also the medial pedicle technique, with the attached portion on the inside side of the areola. The lateral pedicle technique preserves the portion on the outside side of the areola. There are also specialized variations on each of these techniques. Although there is a scar completely around the areola with each of the pedicle techniques, the nipple and areola have not been completely severed.
The Free Nipple Graft technique does severe the nipple and areola completely from the breast. Even with this technique, however, some women have regained nipple sensitivity and some milk production and release capability.(6)
The scars from breast reduction surgery vary widely according to the technique that was used, but can include a scar around the areola; a scar in a vertical line from the areola to the inframammary fold (the fold below the breast); a very small half-inch horizontal scar at the base of the breast; a short horizontal scar of about two inches somewhat above the inframammary fold; or a long horizontal scar along the inframammary fold. Some scars are hidden on the areola, some resemble an inverted T, and others resemble an anchor. It is not possible to know which surgical technique was used from the pattern of the scar.
For more detailed information about breastfeeding after breast reduction surgery, including descriptions of other breast reduction techniques, refer to Defining Your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West, IBCLC (LLLI, 2001).
(1) Widdice, L. The effects of breast reduction and breast augmentation surgery on lactation: an annotated bibliography. J Hum Lact 1993; Sep 9:3 161-7.
(2) Souto, G., Giugliani, E., Giugliani, C. et al. The impact of breast reduction surgery on breastfeeding performance. J Hum Lact 2003; Feb 19:1 43-9; quiz 66-9, 120.
(3) Marshall, D., Callan, P., Nicholson, W. Breastfeeding after reduction mammaplasty. Br J Plast Surg 1994; Apr 47:3 167-9.
(4) Sandsmark, M., Amland, P., Abyholm, F. et al. Reduction mammaplasty. A comparative study of the Orlando and Robbins methods in 292 patients. Scand J Plast Reconstr Surg Hand Surg 1992; 26:203-9.
(5) Tairych, G., Worseg, A., Kuzbari, R., et al. [A comparison of long-term outcome of 6 techniques of breast reduction]. Handchir Mikrochir Plast Chir 2000 May; 32(3):159-65.
(6) Ahmed, O. and Kolhe, P. Comparison of nipple and areolar sensation after breast reduction by free nipple graft and inferior pedicle techniques. Br J Plast Surg 2000 Mar; 53:2 126-9.