【New Era of Breast Reduction and Breast Lift Surgery in Taiwan】

◎Introduction

In Taiwan, large breast is not common but still represents a certain amount of the female population. Dr. Wu performed a lot of "Breast Reduction Surgery" a year and is one of the well-trained breast surgeon in Taiwan. Dr. Wu commonly give lectures in domestic and international conferences regarding breast reduction. The breast is the gift for woman from God. Functionally, it provides breast feeding; aesthetically, a beautiful breast with appropriate size creates appealing appearance, and brings more confidence to women. However, breasts with abnormal size (i.e. too large) or unpleasant shape (e.g. ptosis, deformity) may cause problems like shoulder/neck discomfort, scoliosis, breast skin irritation, breast skin infection, poor self-esteem, etc.

There are three common clinic scenarios in which women are not satisfied with their breasts; they are

1. Large breast with ptosis

2. Large breast without ptosis

3. Post-partum breast atrophy or ptosis

For years, I have been in search of the best answers to the questions. There is a certain solution to a given problem, but it relies on the surgeon to choose the appropriate technique based on his or her training background, experiences, surgical techniques and apprehension of the problems. I was trained at Chang-Gung Memorial Hospital as a plastic surgeon; the institute is one the top plastic surgical training centers in the world. To specialize in breast surgery, I went abroad frequently to learn from other masters of breast surgery.

◎Three Major Skin Incision Types for Breast Reduction, Breast Lift and Reduction Mammoplasty Surgery 

There are three major incisions for breast reduction surgery: they are Inverted-T, Vertical and Circumareolar incisions.

1. Inverted-T incision breast reduction or breast lift is for gigantomastia
2. Vertical scar breast reduction or breast lift is for moderate to large breast reduction

3. Circumareolar breast reduction or breast lift is only for very mild breast lift

◎ Inverted-T breast reduction, breast lift and reduction mammoplasty

This oldest and traditional breast reduction surgery is still the popular method nowadays. This method incorporates an “ADIDAS” like excision of breast, lifts the nipple, reduces the areola and closes the incisions in an inverted-T shape. It is easy to perform, can create predictable results and can reduce significant breast volumes. But it also produces predictable and significant scars. Besides, this method pulls down the breast skin when closing the incisions and causes the breast to become a little bit flat. It is especially suitable for patients with the following conditions.

1. Patients with very poor breast skin tone

2. Patients with gigantomastia

◎Vertical scar breast reduction, breast lift and reduction mammoplasty

Comparing to inverted-T incision, the vertical scar breast reduction or breast lift surgery is a newer technique. There are several variations of pedicle patterns, but the incision of this method is definitely vertical (without adding a long transverse scar); the one I used most common is Dr. Hall-Findlay’s methods. Dr. Hall-Findlay is a plastic surgeon in Alberta, Canada; she invented a vertical breast reduction technique which was named as Hall-Findlay’s breast reduction. Dr. Wu has the chance to learn from her several times. Basically, this kind of reduction mammoplasty method incorporates a “Snowman” skin excision, a "C-shape" breast glandular removal, a nipple lift and a wound closure as "Lollipop". The resultant scar is only located at the lower half of breast. The major advantages are a a shorter scar and more projected breast shape; the major disadvantages are more time consuming in shaping the breast；It is especially suitable for patients with the following conditions.

1. Breasts with not too bad skin tone

2. No need for too much breast reduction

3. A desire for shorter scar

4. A desire for more projected breasts

This method is also the preferred technique of Dr. Wu. Using this method, the largest breast reduction is 2200g per each breast.

Removed breast tissue by Hall-Findlay's breast reduction method

Hall-Findlay's Vertical Mammoplasty

◎Circumareolar  breast reduction, breast lift and reduction mammoplasty

Using this method, the breast will be pull into center after surgery. However, a breast is a tear drop shape, not a bowl shape. So the result of this technique is quite unpleasing. This method is only suitable for cases with very mild breast lift, but not for reduction. I have seen some cases done with this methods by other surgeons and the results are quite un-nature. So I definitely will not recommend this technique.

◎ Newest Paper Regarding Breast Reduction

Complications After Reduction Mammaplasty: A Comparison of Wise Pattern/Inferior Pedicle and Vertical Scar/Superomedial Pedicle.
Ogunleye AA1, Leroux O, Morrison N, Preminger AB.
Ann Plast Surg. 2017 Jul;79(1):13-16

Abstract
Reduction mammaplasty is a commonly-performed procedure among plastic surgeons. Although several methods exist, the Wise pattern/inferior pedicle (IP) technique is the most widely used. The vertical scar/superomedial pedicle (SP) technique has gained acceptance for its shorter scar and more durable projection results, but some hesitation remains with its use in larger volume reductions.The incidence of complications in 124 consecutively performed breast reductions (246 breasts) at a single institution using either the Wise pattern/IP technique or vertical scar/SP technique, as well as risk factors associated with them, was determined. Patient demographics, comorbidities, intraoperative details, and major and minor complications were assessed.Ninety (72.6%) patients underwent SP, and 39 patients had IP reductions. Minor infections and wound dehiscence were the most common complications (11 each [8.9%]), followed by minor nonoperative hematomas, 10 (8.1%) and fat necrosis, 7 (5.6%). The mean weight of resected tissue per breast was 692 g. No nipple loss, major complications or reexplorations occurred. Obese, diabetic patients were more likely to undergo IP compared with SP reductions. After adjustment in a multivariate analysis, there was no significant difference in complication rates between the 2 methods (IP vs SP: odds ratio, 2.65; 95% confidence interval, 0.85-8.27; P = 0.09). The results were similar after the analysis was restricted to patients with mean weight of resected tissue per breast greater than 1000 g.There was no significant difference in complications between IP and SP reduction, suggesting that the SP method is a safe alternative to the IP technique, even in macromastia patients undergoing large-volume reductions.

Surgical Conditions for Breast Reduction

• Procedure name：vertical or inverted-T breast reduction
• Candidate: patients with breast hypterophy
• Anesthesia: IV sedation
• Surgical duration: 4 hours
• Post-op: no sweating for 3 days, limited arm lifting for 7 days, sports bra for 4 weeks, avoiding strenunous exercise for 4 weeks
• Hospitalization: 1 day
• Recovery: 7-10 days
• Price quote: email to drcwwu88@gmail.com
• Possible complications and risks: hematoma <1%, infection < 1%, unsightly scar , asymmetry, areolar distortion, nipple inversion, etc

◎ Case Studies of Breast Reduction 

◎ International Presentations of Dr. Wu

Dr. Wu gave a presentation at the Japanese Society of Reconstructive Microsurgery (Saitama, Japan, 2015)

Dr. Wu gave a presentation at the Oriental Society of Aesthetic Plastic Surgery (Taipei, Taiwan, 2016)

Dr. Wu gave a presentation at the World Society of Reconstructive Microsurgery(Seoul, Korea, 2017)

◎ Related Articles

• 【Dr. Wu's Curriculum Vitae】
• 【Case Study of Breast Reduction】
• 【Liposuction for breast reduction】

Dr. Wu's Clinic 

A. Vendome Aesthetic Clinic, Taipei, Taiwan

• Tel: +886-2-27038858
• 3F, 149, Sec. 3, Xinyi Rd, Da'an Dist., Taipei, Taiwan
• 台北市大安區信義路三段149號3F

B. Vendome Aesthetic Clinic, Hsinchu, T

• Tel: +886-3-5508362
• 39, Sec. 1, Wenxing Rd, Zhubei City, Hsinchu County, Taiwan
• 新竹縣竹北市文興路一段39號