Since 25 years ago, Felicio,Y [1-3]. published at 1993 in the La   Revue  de Chirurgie Esthétic de Langue Française: “ Plastie mammaire de reduction sans cicatrice mammaire, avec radio-chirurgie” and  at 1997, Felicio,Y. published: “ Axillary reduction  Mammaplasty” in Aesthetic  Plastic Surgery Journal ( ISAPS), that prove  when it is used this technique is preserved  de Central Breast. Until today a few colleagues they know this technique [4].

In spite the author showed in different Congress in all Continents of the world, but not is popular yet, it is necessary to divulge more.

D’Artigue in 1924, registred in literature: “Axillary Breast Reduction” but, a few colleagues and a few patients knows that it is possible to reduce the breast avoiding scar on breast [5].

Many women don’t submit the breast reduction because the extension of the scar.

The author believe that now it is a new moment about breast reduction, she believe it is the final era, about big breast, because it is beginning to appear publications about cancer after to use breast silicone implants.

During 1960, the Twigg model influenced many women to have little breast, in my service in this time,   the most number of the surgery was : breast reduction, but , after 1990, approximately 30 years after , strong midia , change,  principally in USA, the patients wants more and more, big breasts….. Many, many: breast silicone implant, are made in the world, not only for plastic surgeons, but, for differents doctors, sometimes not qualified to do it.

Nowaday, it is appearing many problems: capsula, assimetry, infections, desconfortbal, artificial results, sometimes needs to change the implant, etc, until cancer……

In my prived service, we are receiving patients that they want midle breast, no more: little, no more: big, in great majority, personal experience.  

During  since March 1993 until March 2016, 514  breast operated, were registred, Felicio,Y. by axillary reduction mammaplasty technique, in your ebook (www.get-morebooks.com  code:  978 - 613-0-16890-2)  being: 66,14%: were breast  hypertrophy, 14,98%: ptose, 9,72%: assimetry, 7,79%: mastopexy associated breast silicone implant, and 1%: tumor and aberrant ginecomasty. The age varied between 16 – 58 years old . The quantity of breast tissue resected, varied between 50 – 1500g. The greater percentage was: 36,77%, between 200 – 300g. Two decades ago we removed more quantity, about 500-1000g.  Complications: It was registred 3,30%, low, when compared with the others techniques. In 514 breast operated, where 17 complications, 6 keloids, 6 hypertrophy scars with seroma, 3 hematomas, with short dehiscence, 2 hypersensibility of the arm, that disappeared after 30 days with physiotherapy [6].

Surgical Procedure

The procedure is performed under local and/or peridural anesthesia and sedation. The patient remain   lay down, not to sitted, and the   arms are abducted position.

It is marked with one fusiforme incision contourning all the axilla

F1 - Preoperative Drawing.

F2 – Removing Fusiform Skin in all Axilla.

F3 - Detachment by Hegar Valve.

not superficial and not down, approximately 4cm since skin until sub-cutaneo tissue, and after five minutes all the gland  It will be free,  with  a few trauma and a few blooding,  exactly inter mammary gland, and begin remove the breast tissue.

F4 – Using Radio wave Surgery Removing Breast Tissue Little By Little.

little by little until  there is no more breast tissue up the muscle, this moment finish the remotion, about  breast and fat tissue if is necessary to remove.

It is used radiowave surgery because cut and coagulation the same time and the blooding is more low and reducing the time surgery.

It is necessary to put one drain in lateral and inferior breast position and maintaining during 48 hours.

The sutures are only four sutures for the both breasts: one vicryl 3 zeros, two mononylon 4 zeros and one mononylon 5 zeros. The sutures are will be made in three planes: in gland, in sub-cutaneo and in the skin, continue suture and separated sutures in the skin.

F5 – Final Suture and Drain.

The compressive dressing in axilla during 24 hours and the patient begin use the bras immediately finish the surgery, it is necessary to use the bras, during three month. 

The sutures only are removed after 15 days, because the axilla it is a region that has many mobility.

Beginning open the arms very slowly.

See the links:

https://youtu.be/K42Zgp-_u6E

https://youtu.be/NcsBMYz0EKE

Table-1: March 1993-March 2016.

Table-2: March 1993-March 2016.

Table-3: March 1993-March 2016.

Amount of the breast tissue resected in 514 breast operated

Table-4: March 1993-March 2016.

Complications (3, 30%)

This patient has 25 years old, with assimetry, was removed 375g of the left breast and 325g of the right breast, the result after six months later.

Pacient with 22 years old, was removed 500g for each breast, in total 1000g for the both breast, post operative after one year later.

The same patient, the result after 20 years later

The philosophy based in the axillary breast reduction it is very different the others techniques to do breast reduction, because axillary approach it is closed procedure and the others are open.

Only after one year the final result it is the best in axillary via, the others in three months are good, but after one year  the gland has one bascule, how the superior pole is removed, it will be concavo, in the axillary approach  the superior polo, will be maintained, or full,  the breast tissue it is removed around the central part (CAM: complex areole-mamilar), more in lateral and inferior quadrants, the great majority of the women they will be want, convex the superior pole.

Ritwik Grover described in  Advances in Plastic & Reconstructive – APRS: “ Why supercharging a  Wise-Parttern Might Be Wise in a select group of large Breast Reduction” and it is cited the big problem about T – junction in inverted T technique,  described by Pitanguy,I. more popular technique used in the world during five decades. The author during two decades use axillary approach with more than 500 cases operated in different   types of the breast: glandular, fat breast and mixed breast, being the best results are in glandular breast [7,8].

It is proved that is possible to reduce larges breasts, removing 1500g or more, avoiding the problem from T – junction ischemia. The result it will be conform the type of the breast, not depend of the technique, personal experience [9-11].

This procedure it is more economic than the others, use only four sutures in the both breast, the others use ten or more sutures. The performed time it is approximately 1.h and 45` or two hours in axillary approach, from skin to skin, and the others techniques it is necessary to lost more time, in my hands.

 It is necessary to break paradigms and to divulge that is possible to reduce the breast with only one scar hidden in axillary pleats, avoiding any scar on breast.

Many women they will like to do reduction in yours breast, but they avoid because the size of the scars [12].

The surgeons in the world they do breast reduction with one, two or three scars on breast, yet,  it is necessary to find one more high level of the satisfaction  of the part of the patients  and it is a good way is avoiding  scar on breast……   

Dear colleague when you to cut one breast, remember that the mamma it is sexual symbol  of the woman, if you need to cut the breast of the  your  daughter, of the your spouse or your girlfriend, to do one   reflection,  what the scar it will be???

The best impediment in breast surgery it is the scar……

During five decades all the plastic surgeons in the world made breast reduction with one, two or three scars on breast, yet, but the great majority of the women they want to reduce, to up the breast but they don’t want scar on breast…..

It is possible, to do it by axilla and to avoid scar on breast, only one  scar it will be remain inside axilla pleats and it is more ease to do corrections when has bad scar in axilla than on breast.

It is economic procedure and with a few trauma, more than the others, it is possible to do it by local and peridural anesthesia.

This procedure reduce the parenchyma, preserve the sensitivity, up the breast, but maintain the original shape, does not change.

Depend of the quality of tissue for each patient and has good retraction of the skin, add more elevation of the breast.

The principal advantage remain only one scar in axilla, avoiding any scar on breast.

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