Breast Reduction

 

Introduction

Breast Reduction surgery is an operation for women with very large and pendulous breasts. Beside the aesthetic nuisance of the condition, there may be moderate to severe physical symptoms. This may range from back, neck pain, skin irritation, poor posture, poor esteem etc. The surgery involves removal of fatty, glandular, and skin tissue along with a breast lift and areolar reduction. This usually involves a scar around the areola which then goes downwards vertically to join a horizontal scar in the breast crease (inverted T manner). The goal is to achieve a proportional breast size to the body.

The scars are concealed with clothing and do not show with low cut dresses.

Of all the plastic surgery procedures, breast reduction has been shown to be the most gratifying because of immediate relief of symptoms (backache, feeling of heaviness etc).

 

Candidates for surgery

Breast reduction surgery, typically, is not considered an operation done purely for cosmetic benefit. The main indication is the physical discomfort and restrictions that patients suffer.

Ideally the operation should be done when a patient has achieved and maintained her weight consistently. Similarly the family should be complete. Although breast feeding is possible after the operation, there can be engorgement. Also, any significant change in body weight may alter the relative size of the breast in relation to the body frame. This is because the proportion and distribution of breast fat and glandular tissue is changed during the operation. The breasts react differently to weight gain and loss after surgery than before it.

There should be a realistic expectation about the cosmetic benefits from this operation.

 

Consultation

A general health questionnaire will be filled and discussed. Family history of breast disease will be taken. In the consultation the breasts will be examined, measured and photographed for reference before and after the procedure. An approximation of the final reduced breast size and position of the breasts will be given.

A time of two weeks will be given to consider and reflect on the discussion prior to commitment for surgery. Opportunity for further discussions will also be offered.

 

Preparation for surgery

You will be asked specifically to stop smoking. Smoking results in poor outcomes to any surgery. There are higher risks of wound infections poor healing and skin necrosis. The anaesthesia risks and postoperative chest infections are higher.

All non-steroidal (Brufen, Nurofen, Voltarol etc) anti-inflammatory drugs including aspirin will, preferably, be required to stop at least a week before surgery. They cause a higher risk of bleeding, bruising, during and after surgery.

The procedure is done as an in-patient and may be a requirement to stay at least 2 days.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

 

The Operation

This involves making an incision around the areola (and in process reducing its size as well) continuing downwards and joining a horizontal incision on the breast crease. Skin flaps of breast tissue are mobilized and excess breast tissue is removed from within the breast.

The position of the breast is elevated (breast lift) and fixed in position. All excess skin is removed and wounds closed.

The whole operation takes about 2-3 hours. There is moderate blood loss and rarely a blood transfusion may also be required.

The excised breast tissue is routinely sent for histology to check for any unsuspected tumours.

 

Anaesthesia

The operation is done under a general anaesthetic.

 

Postoperative care

After surgery, the breasts will be supported with adhesive tape. A small tube will be placed in each breast to drain off blood and fluids for the first day or two.

You may feel some pain for the first couple of days, especially when you move around or cough; and some discomfort for a week or more. You will be prescribed medication to lessen the pain.

You will be able to shower after a few days and the tapes will be removed after one week and replaced with a soft bra. It is best to wear the bra around the clock for several weeks, until the swelling and bruising subside. Absorbable sutures are used and few if any will need removal.

Normally patients can return to work in two weeks. Strenous work and exercise should be avoided for about 6 weeks to avoid bringing on discomfort.

As the scars are extensive there may be mild ongoing crusting and oozing for a couple of weeks.

It takes about 6 months to a year before the scars and breasts completely settle to their final appearance.

There may be some temporary loss of sensation to the nipple and skin of the breast. This improves over the next few months. In some patients, it may take longer, and occasionally may be permanent.

 

Scars

Every effort is made to make scars as inconspicuous as possible. However, it’s important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious. Fortunately, where the scars are located, you can wear even low-cut tops.

 

Risks

Breast reduction is not a simple operation, but it’s normally safe. . As with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anaesthesia.

The procedure does leave noticeable, permanent scars, although they’ll be covered by the bra or a low cut dress. Poor healing and wider scars are more common in smokers.

There can be a slight mismatch between the breasts or the position of the nipples. Breast feeding may not be possible because of division of many of the milk ducts.

There may be a temporary, occasionally a permanent loss of nipple sensation. Rarely, because of disruption to the blood supply to the nipple there may be distortion or complete loss of the nipple.  Even more rarely, the underlying breast tissue may also necrose.

Because a lot of scars will be introduced inside the breast tissue there may a small risk of reduced sensitivity of mammograms to pick up breast cancers in the future.

 

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