2016’s Academy Awards were punctuated with the usual Red Carpet gowns and the statement is clear, small breasts are de rigueur where haute couture is concerned. Particularly fetching were Alicia Vikander in Louis Vuitton, Charlize Theron in Dior, Rachel McAdams in August Getty Atelier, Priyanka Chopra in Zuhair Murad. Controlling for design elements, fabric choice, drapery, color, etc. the overwhelming impression conveyed by these beautiful women was elegance, health, timeless proportion. Contrast these images with celebrities Chrissie Teigan in Marchesa, Patricia Arquette in Marina Rinaldi or Mindy Kaling in Elizabeth Kennedy and the attention definitely fixates on the fusion of breast and abdomen.

Breasts change throughout a woman’s lifetime. Under the influence of hormonal variation, weight fluctuations & aging, maximal expansion and stress occurring during puberty, pregnancy and menopause. The female breast is a specialized sweat gland and subserves lactation and is subject to disease states ranging from mastalgia (breast pain) to breast cancer. By contrast, a woman’s breast has much broader connotations: sexuality, femininity, maternity, among them. The 21st century beauty bias is undeniable and cosmetic breast procedures have become more widely accepted and sought.

The profile of the breast reduction patient is bimodal: 1) young women (late teens to early 20s) whose breasts developed early and excessively; 2) postmenopausal women. The younger cohort is frequently concerned about preserving the ability to lactate, however are adamant not to wait until they have completed their families. The young breast reduction patient is willing to accept scars for improved functionality: enhanced ability to exercise, enabling them to wear “age appropriate” clothes, including “Victoria’s Secret” bras, defiance of being “stereotyped” because of the weight and position of their breasts. Not infrequently, large breasted teens have been subject to harassment from males and demeaning comments from their peers. Today’s public personalities like Queen Latifa, Ariel Winters, Jennifer Connelly are open about their motivations and in so doing have empowered a generation of young women who reject appearing prematurely “matronly”. Knowing that they may experience “regrowth” of their breasts, many request significant reduction.

 

By contrast, the postmenopausal reduction patient who has lived with large breasts and also has a higher Body Mass Index, usually elects a more “proportionate” reduction. The boundaries of the breast can be redefined with liposuction of the dorsal rolls and accessory axillary breast. As the composition is more fatty, shaping the breast is more challenging than in a younger, predominantly fibroglandular breast. Balancing the breasts with the hips is almost as crucial as relieving the musculoskeletal load and dermatological rashes. Preop mammograms are recommended for older reduction mammoplasty patients, to exclude occult tumors and postop mammograms should be scheduled at least 12 months later. Ultimately, all breast tissue resected will be sent for Pathology analysis. The recent surge in popularity of breast lifts and reductions supports the notion that “size does matter” as long as it’s in the correct position, proportion, i.e “double DD/high” definitely trumps “F long”.

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