About Breast Reduction
Breast reduction, also known as reduction mammaplasty.
Breast reduction surgery is designed to reshape and reduce your breast size so that they are more proportionate to the rest of your body and will no longer cause you emotional or physical discomfort.
Breast reduction surgery can help alleviate some of the chronic pain that is often caused by overly large breasts. This pain is usually felt in the head, neck, shoulders and back. Breast reduction surgery can also help with other health problems that may occur, such as poor blood circulation, impaired breathing and chafing of the skin on the chest and the lower breast areas.
How is it performed?
A breast reduction surgery usually tends to take between 3 to 5 hours, and an overnight stay is not usually required. During the surgery itself your surgeon will make three incisions into the breast to remove any excess breast tissue, fat and skin. Then, the areola and nipple will be reduced in size, if requested, and moved to a higher position on the breast. Any skin that was located above the nipple is brought down and together so that the breast can be reshaped and some liposuction may be performed to under the arm to improve the contour. Below you can find some of the most commonly used incision patterns:
- For breasts that are not sagging and mainly fibrous rather than fatty, liposuction is used to decrease breast size. Micro or small incisions made into the breast allow the liposuction cannula (tube) to enter the breast.
- A donut incision or periareolar incision is one made around the perimeter of the areolas.
- A keyhole incision, sometimes also known as a lollipop incision, is one made around the border of the areolas, with a further incision made vertically from the areolas down to the breast crease.
- The most common technique used by surgeosn is called an anchor incision and involves three distinct cuts. The first is made around the border of the areolas, the second vertically down from the areolas to the breast crease and a third along the breast crease. Using this, your surgeon will remove any excess fat, breast skin and tissues with either a cautery instrument or scalpel in order to create the breast size and shape you desire. If your breasts are uneven (asymmetrical) your surgeon will remove more tissue from one breast than the other, reshaping the remaining skin and fat to create a matching breast shape and move the areola and nipple to a higher position.
In most cases your surgeon will place drains in the breasts to collect any excess fluid after your surgery before closing the incisions with sutures from the deep tissue to the surface layers of the skin.
What are my options?
The shape and size of your breasts, as well as your medical history and anatomy are all factors that your plastic surgeon will use to determine the best method for you. If your breasts are extremely large, your surgeon may have to completely detach the nipples and areolas so that they can be shifted to a higher level. If this is the case, your surgeon will ask you to decide whether you are happy to sacrifice the chances of breast feeding and sensation in your nipples to achieve your desired breast size.
What will my breast reduction incisions and scars be like?
You scars will vary according to type of incision your cosmetic surgeon decides is best for you. They will do their best to conceal the incision lines within the natural contours of your breast but some will still be visible on the surface of the breast. These are permanent in most cases but they will significantly improve over time. Your surgeon will make every effort to minimize scar visibility by using special tissue handling and suture techniques.
Is it right for me?
There are several reasons you may consider breast reduction surgery:
- If your breasts are too large for your body frame and create neck back or shoulder pain.
- If you have heavy breasts with nipples and areolas (pigmented skin surrounding the nipples) that point downward.
- If one breast is much larger than the other.
- You have back aches, neck aches or skin irritation under your breasts.
- You have difficulty breathing and notice grooves in your shoulders from your bra straps.
- You have poor posture or numbness in parts of your breasts and upper chest from excessive breast weight.
- You are in good health with no active diseases or pre-existing medical conditions.
- You have realistic expectations of the outcome of your surgery.
- You are old enough so that your breast development has stopped.
- You have finished having children and breast-feeding because this can have significant and unpredictable effects on the size and shape of your breasts.
If you are planning on breast-feeding in the future you should discuss this with your physician.
Contraindications for breast reduction surgery could include:
- A history of irregular mammograms undiagnosed lumps or other types of masses
- Severe obesity
- Wound healing disorders
- Current breast-feeding
- Clotting disorders or a family history of them
- Heart or circulatory disorders
If you are in good health generally, have realistic expectations and a positive attitude then you will probably be a good candidate for a breast reduction. Try to be as open as possible during your discussion with your aesthetic surgeon so he can give you the best advice and you can understand what can realistically be achieved.
What result can I expect?
Your breasts will remain a consistent size unless you gain or lose a significant amount of weight or become pregnant. You should remember that gravity and the effects of aging will still always eventually cause your breasts to sag and loosen over time. For safety, as well as the most beautiful and healthy outcome, you should maintain a good relationship with your plastic surgeon and return for follow-up evaluation at prescribed times or whenever you notice any changes. Do not hesitate to contact your surgeon if you have any questions or concerns.
- Your breasts will be in better proportion with your body and will feel firmer.
- Surgery will alleviate neck, back and shoulder pain and make it easier to breathe and exercise.
- You may have decreased sensation in some areas including the nipples and areolas.
- Some women complain that their breasts and nipples look slightly uneven.
- Breast-feeding may be a problem.
You might notice a change in breast size, but at this point you will have significant swelling. In most cases, this swelling will remain for weeks or even months. When the anaesthesia wears off you may have some pain. If the pain is extreme or long-lasting contact your physician. You will also have some redness and swelling after the surgery. Contact your surgeon to find out if your pain, redness and swelling are normal or are signs of a problem.
It is essential you follow all patient care instructions given to you by your physician. This will usually include information about which compression garments to wear, how to take care of your drains, how to take any antibiotics or painkillers, if prescribed and the level of activity that is safe for you to undertake. Your surgeon will also provide detailed instructions about the normal symptoms and how to spot any signs of complications. It is important to realize everyone’s body is different and so the amount of time it takes to recover varies between individuals.
Here is a general idea of what you can anticipate:
- Drains – Your drains will more than likely be removed at your first follow-up appointment which is usually within the first week after surgery.
- Monitoring your temperature – While you are healing from breast reduction, take your temperature regularly. An elevated temperature could mean an infection.
- Soreness and pain – You will feel tender, stiff and sore for a few days and will more than likely not want to move too much. This will subside. Be sure to take your required medications and follow the precise instructions provided by your surgeon. Swelling – As with all surgeries, swelling will be an issue. You may be swollen for up to three to four months although this could be very slight and only noticed by you. Your breasts of course will be smaller than they were before and higher so you may not notice swelling too much. Treatment for prolonged swelling includes increasing your fluid intake (preferably water), having normal to low sodium intake and movement such as light walking.
- Bruising – Bruises may or may not be present after your surgery. This depends entirely on the patient, the technique used and the effectiveness of the epinephrine that was administered during surgery. Other common side effects during recovery include numbness or changes in nipple sensitivity, itching around incision sites and increased firmness or fullness in the breast tissue. These side effects should subside over the next few weeks with some residual effects lasting up to three months after surgery.
- Sleeping – It is important to sleep with at least two or three fluffy pillows under your upper back and head or on a wedge pillow or a recliner chair to keep your torso elevated. This helps relieve pressure on your treatment area reducing swelling and pain. Bathing – You may be asked to take sponge baths until your incisions are completely closed and your sutures are no longer in place.
- Activity – Even though you may not feel like it, your surgeon will probably advise you to walk and move around as soon as you can to prevent blood clots and swelling. You will be instructed not to exercise or engage in strenuous activities for at least three to four weeks. Don’t lift anything over five pounds and try not to raise anything over your head until your surgeon releases you for activity. Take your time in healing so that you give yourself the best healing environment possible. Your full range of motion should return between six to ten weeks depending on how well you have healed.
Limits & Risks
Fortunately, serious risks of breast reduction surgeries are rare and the satisfaction rate with these procedures is high. The overall complication rate is low, when the operation is performed by an experienced plastic surgeon operating in an accredited facility. Despite this, all surgical procedures carry some degree of risk.
Some potential complications of all surgeries are:
- Adverse reaction to anaesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
- Blood clots in your legs or lungs
You can minimize the risk to you by carefully following the instructions and advice of your plastic surgeon before and after your cosmetic surgery procedure.