Patient with heavy breasts often live with constant neck and back discomfort and bra strap pain. It can be a source of embarrassment and make buying comfortable clothing quite difficult. An inability to exercise and skin irritation under the breasts can further add to the daily distress.
Breast reduction is an operation designed to reduce the size of the breasts and lift them up on the chest wall to improve the shape and support. If the ‘success' of an operation is to be measured by patient satisfaction, then this procedure consistently rates amongst the best of all surgical procedures (cosmetic and non-cosmetic) that are performed today. For some patients it is unquestionably a life-changing procedure.
Modern techniques are designed to maintain sensation to the central breast (although this may change in the short term) and can allow for future breast-feeding. Also whilst it is not easy to guarantee the final size of the breasts, it is possible to a large degree to tailor the final result to your wishes.
There are a number of different techniques for breast reduction and lifting (also referred to as mastopexy when performed by itself without a reduction). The position of the scars can vary slightly between techniques and generally I would use a minimal scar technique where possible. Broadly speaking the scars on each breast are around the aereola (the pigmented skin around the nipple), running vertically down to beneath the breast, and may extend under the inframammary fold (crease under the breast). Breast reduction surgery requires an artistic ability to ‘sculpt’ a new breast shape and the aim is to individualize the operation to the patient. I aim to use the minimum number of incisions necessary to achieve the goal of smaller, more attractive, and well-supported breasts.
The surgery to the breasts is often combined with some liposuction under the armpit areas to obtain an aesthetic and natural transition from the breast to the chest wall and remove the excess tissue that is often present in this area in women with large breasts.
The sutures around the aereola are removed in 7 to 10 days. I routinely use dissolving sutures for the main incisions to minimise postoperative discomfort and obtain the finest possible scar in the long term.
Preparation for Surgery
It is advisable to stop taking Aspirin and other non-steroidal anti-inflammatory medications (such as Voltaren, Brufen, or Neurofen) two weeks prior to surgery as these mediations can all increase bleeding and bruising following surgery. Paracetamol is absolutely safe to take should you need it prior to surgery.
A number of nutritional supplements such as garlic, fish oils, and Vitamin E can also increase bleeding and should be stopped. The oral contraceptive pill should also ideally be stopped prior to surgery. Needless to say, smoking does increase the potential for several complications such as wound infection and healing problems and should ideally be stopped at least 4 weeks prior to and 2 weeks after surgery.
It is advisable to purchase a pair of supportive elasticated ‘sports’ bras pre-operatively for use after the surgery. My practice nurse will advise you regarding what sort of bra to buy.
The Operation and Postoperative Care
Breast reduction is performed under general anaesthesia and takes 2-3 hours. A 24-hour hospital stay is generally advisable although the surgery can be performed as a day-case operation in some cases. Surgical drains (if required) are removed the morning after surgery.
Postoperative progress is usually straightforward and accompanied generally by surprisingly little discomfort. Often little more than paracetamol is required for pain relief after the first day. The breasts are supported by well-padded and supportive dressings after surgery, and these remain in place for one week. Most of the swelling and bruising will have settled by 10-14 days, and you will be able to get back to work after this period.
I will advise you about wearing a supportive well fitting bra night and day for six weeks after surgery to support the breasts as healing is completed and the breasts take on their new shape. Underwire bras should be avoided for this period so as to not irritate the scars. Massaging the scars as well as paper tape (Micropore) will help you achieve the best possible scars in the long-term. It takes approximately 3 months for the breasts to attain their final stable shape.
Breastfeeding After Breast Reduction
Modern breast surgery techniques aim to preserve a good proportion of the breast ducts and nerve supply to the nipples. It is therefore possible to breastfeed after surgery although the actual success rate is variable from individual to individual.
It is worthy of note that in many instances women with very large breasts are unable to establish satisfactory breastfeeding for a variety of reasons. The size of the breasts (small or large) certainly has little influence on the amount of milk production.
Complications following breast reduction are fortunately uncommon but, as with all types of surgery, not unknown. Most represent a temporary nuisance rather than a long-term problem. Infection and haematoma can occur as can minor delays in wound healing. The treatment is usually simple provided that they are treated early and should not have any significant effect on the long-term outcome. Very occasionally (<1%) we may need to return to theatre post-operatively to drain a haematoma if this is particularly large in size.
Sensation over the central breast usually returns to normal after 2-3 months, although in the short-term they may become more or less sensitive. The final size is also impossible to guarantee as previously mentioned but it is a certainly possible to give you a good idea of what size you might expect post-operatively. The scars are generally of excellent quality but again this does depend to some extent on your genetics and biochemical tendency to scar production.
Deep venous thrombosis (DVT) is a potential complication and much care is taken to reduce this risk. The risk is heightened if you have a previous history of clotting, are taking oral contraceptive pills, or smoke. The risk is significantly reduced with the use of calf compression devices during surgery, as well as early mobilization following surgery.
Very rarely there may be loss of a small amount of the skin margin of the areola or the nipple. This usually only occurs in very large breast reductions or in patients who are heavy smokers or diabetic. No specific treatment is required but healing may take longer in these situations that originally anticipated.
Provided that patients are properly prepared and selected for surgery, I would say that breast reduction is amongst the most reliable and successful of all plastic surgery operations. The ‘downside' of scars is felt by most to be a small price to pay for the improvement in comfort and body image that usually follows this procedure?
Procedure Time 2-3 hours
Anaesthetic General anaesthesia
Nights in Hospital 1 night
Time off Work 10-14 days
Time to daily activities including driving 10-14 days
Time to sport and exercise 4-6 weeks