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      Although large breasts have been accepted throughout the ages as a sign of femininity and a symbol of a woman's nurturing ability; Breasts that were larger than the aesthetic standards of the time caused a number of cosmetic, psychological and functional problems in women, and women sought to reduce these breasts. Breast reduction surgery is one of the most frequently performed plastic surgery procedures. Then, the technique to be used is decided based on the size of the breasts, skin and mammary gland characteristics. If there is breast cancer in the family, the doctor should be informed. Breast reduction is a surgery performed by removing (cutting out) the skin, fatty tissue and gland of the breasts. If the breast is lifted by only removing the breast skin, this is called breast lift (mastopexy) surgery.



        Breast Aesthetics and Breast Reduction Surgery 


     There are some health problems caused by large breasts. For example, most patients experience serious back, neck pain and spine problems. If you imagine that you are living with a load weighing 3–4 kg hanging around your neck, you will have found the source of the problem. Rashes, fungal infections and rashes often occur under large breasts.

       Why Do Breasts Sag? 
      There may be many reasons for this. It should be investigated whether breast growth is due to a hormonal problem. Breastfeeding mothers may also experience sagging breasts. When the breasts are full of milk, they enlarge and are emptied through breastfeeding. This repeated circulation naturally causes sagging in the breasts. Additionally, gravity pulls the breasts downward, causing them to sag. In some cases, sagging begins at a very early age and is caused entirely by the loss of strength of the ligaments that support the breast. 


        It should be questioned whether breast growth continues. It should be investigated whether there is a palpable, painful or painless mass in the breast. It should be questioned whether there is a previous infection or surgical intervention in the breast. Surgical intervention is generally considered for breasts that are not due to a hormonal problem, have stopped growing in the last 6 months, and are desired to be reduced. Breast reduction surgeries are performed after breast development is completed. However, there are some exceptions to this. In young girls who have excessively large breasts during puberty, surgery may be required before the development is completed, in order to avoid affecting normal psychosocial development. In patients over a certain age and with a palpable mass, imaging techniques such as mammography or breast ultrasound are used before the intervention.


        What is the Difference Between Breast Lift and Breast Reduction Surgeries?


       In breast reduction surgery, the breast is shaped by removing tissue and skin. In breast lift, only the skin is removed and the breast is shaped. Prostheses can be used if necessary.

       Can There Be Non-Surgical Solutions?


       There is no known method other than surgery to lift sagging breasts. It is wrong to think that the breasts sag due to weak chest muscles and that they will become firmer with exercise. Both are different compartments. Anatomically, muscle and breast sagging have nothing to do with it.

        Surgery: Cuts and Scars 


     Breast lift and reduction surgery is an operation that gives good results. It is possible to reshape the breast, completely eliminate sagging, and simultaneously enlarge or reduce the breast.  Before the surgery, photographs of the breasts will be taken from many angles and a surgery plan will be made on the breasts. During the surgery, skin, breast and fat tissue will be surgically removed and reshaped in accordance with these drawings.  In this surgery, depending on the technique, there will be an inverted "T" or a straight vertical scar (topitop-shaped) surrounding the nipple area. The scar here remains for life. The width of the scar varies from patient to patient, even with the most ideal techniques.


        Who Should Have This Surgery?


   As a result of these breast surgeries, it can be considered as the transformation of one aesthetic problem (sagging) into another (scar). Therefore, this surgery may not be suitable for everyone. If the sagging of your breasts is moderate or if you think you will be seriously disturbed by the scars, it is not appropriate to have this surgery. But if you have seriously sagging breasts and you think nothing can be worse than this, it would be appropriate for you to have this surgery.



        Can I breastfeed after this surgery? 

     For normal lactation, the presence of functional breast tissue connected to the nipple through milk ducts and the sensitivity of the nipple are required. It is not possible for breastfeeding to be disrupted after a surgical intervention that does not disrupt these anatomical and physiological features. Stimulation of the nipple by the baby leads to contraction of the mammary glands and secretion of milk through a neural and hormonal cycle in which the hormones prolactin and oxytocin also play a role. In order for this sucking reflex to work, it is essential that the nipple has sensitivity. Decreased sensitivity of the nipple may disrupt this cycle and negatively affect milk secretion. However, in controlled studies conducted in recent years, it has been observed that while a decrease in nipple sensitivity is common in the first month after surgery, this situation improves in the following months. It should also be noted that the same studies have shown that the sensitivity of the nipple to vibration and pain is reduced in women with large breasts. If the nipple is separated from the underlying breast tissue and applied as a free patch, breastfeeding is unlikely to occur. Since the nipple is left attached to some breast tissue in almost all breast reduction methods applied today, the breast's ability to breastfeed can be preserved, but its amount may decrease. The factor that determines the amount of milk production is the amount of breast tissue left in place after surgery. Because the majority of the tissue removed in breast reduction surgeries consists of breast tissue and fat tissue. Therefore, as the breast tissue will decrease, the mother will either not be able to breastfeed her baby or the milk she receives may not be sufficient.

        What are the expected benefits from the transaction?

      After breast reduction surgery, there is a decrease in complaints of itching due to diaper rash, redness or fungus formation under the breast. Back pain caused by the size of the breasts is relieved, but it does not go away completely.

        What is the relationship between breast reduction surgery and breast cancer?

     Although breast cancer is very common in women, the rate of breast cancer occurrence after breast reduction surgery varies between 0.06% and 2% according to various clinical series. In addition, in the histopathological examination of the tissues removed after reduction surgery in women who applied due to breast size, 61% of the breast tissue was found to have non-cancerous pathological changes. In light of these findings, it can be said that breast reduction surgery does not increase the risk of breast cancer, and even reduces the possibility of developing breast cancer by reducing the breast tissue and enabling histopathological examination of the removed breast tissue.


       Is it possible to reduce breasts without scars? 

      It is not possible to perform breast reduction surgery without scarring. Alternatively, if the breasts are not sagging at all and there is only size, the breasts can be reduced slightly with liposuction. But this reduction is very limited and causes the breasts to sag a little. 


      How much do scars bother me? 

    Large and sagging breasts cause some physical discomfort. These include neck, shoulder and back pain, uncomfortable grooves created by bras on the shoulders, pain in the breasts, itching and redness under the breast. In young girls, very large breasts also cause some psychosocial problems, which are usually a cause for embarrassment. In some cases, grandiosity is one-sided and can further increase the feeling of shame. Considering that it causes such problems, the scars are acceptable and the final decision should be made by the patient.


      What to Expect After Surgery

    Surgery time varies between 3-5 hours, depending on the technique used. You are allowed to stand up and feed at the 4th hour after surgery. In the first few days, a vacuum bag called a drain is used to collect any blood and serum leaks that may occur in the surgery area. Depending on the amount received, this drain is removed after 1-2 days. It is beneficial to limit arm movements in the first days. There is a tape surrounding the chest in the first week, this is removed between 5-7 days on average and only thin tapes covering the stitch lines are used. You are allowed to take a bath 48 hours after the drains are removed.

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