- Having a second breast reduction is termed a "re-reduction," and this is a procedure I have performed numerous times.
- The key with this operation is blood supply to the nipple areolar complex
- I perform all of my primary breast reductions with a superior-medial pedicle. "Pedicle" is the medical term for the tissue that has a nerve and blood supply in it. In this case the pedicle supplies the nipple and areola.
-When performing a breast re-reduction, the concern is making sure that the blood supply to the nipple and areola are not compromised.
-If you have an operative report showing that a superior or superior-medial pedicle was performed when you had your first breast reduction, then you could show that to your plastic surgeon so he/she will know more about blood supply issues that could affect your nipple/areola, BUT it is unlikely that you have that operative report, AND that's just fine!
-When I perform breast re-reductions, I just assume that the old fashioned, or more popular, way of performing breast reductions in the past was likely used, whereby an inferior pedicle was used. The issue here is: that is exactly in the area of your breast where tissue needs to be removed.
-Of course removing that tissue also removes the dominant blood supply to your nipple and areola.
-Therefore, for patients like you, I remove all of that excess inferior (lower) breast tissue and skin, and de-epithelialize (remove the top layer of skin) around the areola, and allow the nipple and areola to be nourished by a random pattern blood supply. The key here is not moving the nipple and areola too much higher, but it can certainly be raised several centimeters very safely.
-The other option would be to try to re-create the old inferior pedicle, but that is purely guesswork as the old pedicle can not be readily identified, and it can take a long turn to the side under the skin before reaching the nipple and areola, so I never try that technique.
-Lastly, a free nipple graft is an option, but loss of sensation and some loss of pigment accompanies that method. And healing time takes longer.
-The above is very technical, but important! The key is this: meet with a board certified plastic surgeon (ASPS Member) who has a lot of experience with breast re-reductions!
-Best of luck to you, and thanks for sharing!
