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Okay, so the first step is to do our infiltration with our local anesthetic. We're going to do this with a deep, deep sedation but not general anesthesia, no breathing tube, and we're going to choose an inferior pedicle for her. She's young with possibility of breast feeding; sensation more likely to be maintained with this than a superior pedicle, which could add more fullness but she's got lots of fullness up here and we can add some of this up to there.

First step is just making things go numb. She's deeply sedated so she doesn't feel any of this, but it's going to make...so we can lighten the sedation and not have to have a general anesthesia to be able to accomplish the surgery.

And we're going to just infiltrate all of the incisions and all the area that we're going to be working at, and we'll do that on both sides and then we'll prep and be ready to start. We're going to de-epithelialize this part, this is what we call the pedicle which is up here around the nipple.

We're going to take the top layer of skin off underneath here so we can all come up and under, and here, the breast tissue is removed with these corners and underneath these little flaps and that nipple comes up into this circle, if you can see it from that angle.

And this is the de-epithelialization, just taking this top layer of skin off,
kind of like this, and we leave the nipple obviously, right where it's at.
And just the skin around it gets taken off just like that. And there's very
little bleeding because of the fresh epinephrine that gets mixed into the
stuff that I injected at the beginning and all that makes it so her - you
can hear her snoring, her level of sedation is right there, she's breathing
on her own, no breathing tube, she's just comfortable and this is all numb
so it doesn't hurt a bit even if she were awake, but we'll let her sleep
through it. We'll take this skin off all the way down to the bottom of the
fold there and we take the rest of the skin off.

So here's our pedicle, all the top layer of skin is taken off of it and
we've started to make the incisions here and here and we're going to make
it all the way around the pedicle here, and the pedicle is the blood supply
to this nipple and also through that go the nerves for sensation to that
nipple and if breast feeding in the future is issue, some of the milk
ducts and nerves have to be cut just to be able to do this, but for the
most part, breastfeeding and sensation are not terribly affected like
this. So we're going to make all these incisions. So now we've got all
the skin incisions made, we're just going to take off this little triangle
of skin here and go and get the breast tissue underneath it afterwards, and this one here.

What do we have here? [Inaudible 04:22] fingertips right here. And
now we're going to make the pedicle, so here's the pedicle and I'm just
going to keep the blood supply attached to it and make a little incision
down here all the way down to the muscle. I'm just going to open it again
see. It's not bleeding at all even though we're just cutting with a blade, because this has been already injected. It has a lot of epinephrine in there and
so the vessels are all constricted so they don't bleed.

Alright, that's her pedicle. That's the blood supply to it, we'll thin it out in
just a bit. Okay, so now it's the reduction of the breast tissue. I prefer to use
these heavy scissors, it just makes a nice, smooth cut. With all this dense
breast tissue, it goes through relatively quickly and painlessly. Give a little string.

Yeah, not a whole lot of bleeding with this, just fat doesn't bleed a lot
anyway, generally. Okay, let's get a little direction. Because of her youth,
this is pretty dense breast tissue to get a hold of, it's becoming less fibrous and
quicker and easier to get rid of. A little less snipping, just kind of peels
away a little easier, it's pretty dense right through here.

Okay. So we've developed the pedicle which is here, has the blood supply
to it. We've elevated up just above the level of the muscle here. There's
the collar bone right there, so we can put this up another degree more of
fullness. We've taken the breast tissue underneath these little flaps of
skin here and here, and we've reduced 487 grams in mass, so it's about
500 so about right there, we're going to go to the other side.

Alright so both sides are done, we got both skin flaps, both pedicles,
we did the same thing to this side that we did to the other, and we got
that little place for this pedicle to come up in there to give us that fullness,
and we've got 500 off here and 650 here which we're going to temporary
close and make sure they're even, and then we'll close them up….


What Does Breast Reduction Surgery Look Like?

Dr. York Jay Yates walks us through a typical breast reduction surgery.

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