Dr. Smiley has recently demonstrated drastic breast reduction surgery on his Snapchat account. The female patient shown in the video complained about the chronic back pain, postural problem, and shoulder discomfort due to the extra weight of her large, pendulous breasts.
In the video, Dr. Smiley has explained the challenges of drastic breast reduction, particularly relating to increased bleeding and loss of nipple sensation. However, the risks can be avoided or at least minimized with meticulous dissection and deep understanding of the breast anatomy, he added.
Dr. Smiley said that large, pendulous breasts have longer blood supply originating from the muscle and therefore there is an increased risk of excessive bleeding and nipple areola loss.
“Nipple areola loss occurs when its skin literally dies,” he said, adding that one way to avoid this complication is to perform free nipple graft in which it is removed entirely from its stalk (main blood supply) and later grafted back into its place after eliminating some of the breast tissue and skin to reduce the “cup size.”
But even the free nipple graft has its own caveat, Dr. Smiley has warned.
“We try to avoid the free nipple graft because it typically causes loss of sensation in the areola. Hence, we only decide if this is warranted during the operation and I will try to avoid it as much as possible,” he said.
During the operation, Dr. Smiley decided not to perform the free nipple graft; hence the areolar complex has remained attached to its stalk or main blood supply. Nonetheless, he was able to lift the drooping nipple by 20 cm from its previous location.
He also reduced the areola so it will look proportionate to the new, smaller breast size.
Meanwhile, Dr. Smiley has ensured that the scar goes precisely around the areola’s border and parallel to the breast fold for optimal scar concealment.
And while the vertical scar between the nipple area and the breast fold is in a more obvious location, Dr. Smiley said it is expected to fade into the background after 6-12 months.