Visão geral da redução de mama

Abstract

Introduction: The extent to which extremely large breasts can negatively impact a woman’s life is often underestimated. For those living with unwanted macromastia and its associated symptoms, the relief from pain and tension that breast reduction can produce is immediately noticeable after surgery. Recovery from surgery leads to additional benefits, and most women enjoy an improved quality of life. Objective: To discuss the overview of breast reduction. Methodology: Literature review from Scielo, PubMed and BVS databases, from April to June 2024, with descriptors “Breast Reduction” and “Overview”. Articles from 2019-2024 (total 59) were included, with exclusion of other criteria and selection of 05 full articles. Results and Discussion: One or more of the following symptoms may prompt the plastic surgeon to recommend breast reduction: The primary indication for breast reduction surgery is chronic pain in the breast, neck, shoulder, or mid-thoracic back, often requiring pain medication for relief. Women may also complain of headaches, which are attributed to constant tension in the neck and shoulders. Women who have underlying spinal disease may have significant worsening of their back pain. Pain, as an indication for surgery, is usually present for several years and is intractable to standard treatments such as physical therapy. Temporary improvement in pain immediately following treatment may occur, but it usually recurs when normal activities are resumed. Other failed treatments such as chiropractic care, massage therapy, and acupuncture also support medical indications for surgery. Significant discomfort that interferes with daily activities and requires behavior modification to obtain relief is another indication for breast reduction. Prior to breast reduction surgery, the patient should be counseled about expectations (appearance and scarring), potential complications, the effects of future weight changes, and the possibility that breastfeeding may not be possible, depending on the type of breast reduction surgery performed. Prior to breast reduction surgery, candidates for breast cancer screening should undergo appropriate testing, if not already done. After breast reduction surgery, candidates for breast cancer screening should resume their regular screening schedule, but mammography should not be performed until six months after surgery. Preoperative breast size and estimated reduction volume are the most important factors influencing selection of breast reduction technique. A history of previous surgery that may have altered the blood supply to the nipple and remaining breast tissue is also important. Conclusion: Breast reduction is performed using a pedicled approach to the nipple-areolar complex (inferior, superomedial, lateral, or superior) or free grafting of the nipple-areolar complex. Liposuction can be used as an adjunct or as a stand-alone technique. Almost any technique will work well for smaller breast reductions (200 to 400 grams per side), but gigantomastia (>1200 grams per side, long pedicle length) is technically challenging and may require free nipple grafting techniques. Common complications of breast reduction are minor and self-limited. They include cellulitis, hematoma/seroma, and minor skin necrosis where the skin incisions meet. Serious bleeding requiring reoperation, if it occurs, usually occurs within the first 12 hours after surgery. More serious complications, such as loss of the nipple-areolar complex or flap necrosis, can occur but are rare with proper planning.