Breast Reduction

Incisions for breast reductionWomen who undergo breast reduction surgery are frequently seeking relief from physical symptoms caused by the excessive weight of large breasts. Breast reduction usually can solve these problems as well as improve the size and shape of your breasts. Following breast reduction, your breasts will be more proportional to the rest of your body, and clothes may fit you better.

It is advisable that you first discuss this procedure with your General Practitioner (GP), who may then refer you to the Consultant Plastic Surgeon of your choice. Sharing your expectations with your GP and surgeon is the best way to increase the possibility of achieving your desired outcomes.

Additional Information

Reasons for breast reduction surgery include:

  1. Large size of breasts
  2. Neck, shoulder, and back problems that may be perceived to caused by the weight of large breasts
  3. Marked breast asymmetry (size difference)
  4. Dissatisfaction with the breasts’ appearance
  5. Skin problems around the breast area
  6. Limited options for clothes
  7. Psychological issues leading to social inhibitions

Breast reduction is a major surgical procedure, performed under general anaesthetic, on an in-patient basis in hospital. The operation will:

  1. Reduce the size (volume) of the breasts
  2. Reshape and reposition the breasts (breast lift)
  3. Reposition the nipple
  4. Possibly correct asymmetry, if present.

Most patients report a signifi cant improvement in symptoms of back pain. However this is an indirect benefi t of the surgery, possibly due to better posture and lighter breasts. No guarantee can be given that back pain can be cured or improved, as the cause of the back pain may be quite separate to the breast problem.

It is important to realize that all women have varying degrees of asymmetry (differences between their breasts) with respect to:

  1. Breast volume
  2. Breast shape
  3. Chest wall placement of each breast
  4. Nipple-areolar size and shape
  5. Nipple-areolar placement on the breast mound

Some degree of breast asymmetry will persist after your surgery no matter how carefully the surgery is performed, despite precise measurements and excision of the redundant tissue.

Patients seeking solely a breast lift (mastopexy) procedure are generally satisfied by the absolute volume (size) of their breast tissue. When supported in a good quality bra the size of the breast is acceptable. In their case, it is the shape of the natural unsupported breast that is displeasing. Breast reshaping techniques based on surgical principles described below, can be used to create a more aesthetically pleasing breast shape. In some cases, women who seek breast reshaping also desire more breast volume and undergo a breast lift and augmentation (either simultaneously or as a staged procedure).

The Consultant Plastic Surgeon shall discuss in detail your medical history and expectations to determine if it is safe and wise to proceed with the operation.

Reasons the Surgeon would consider not proceeding with the surgery include:

  1. Multiple surgical procedures on the breasts in the past
  2. Undiagnosed breast lump(s) or known breast cancer
  3. Obesity
  4. Likely or planned future pregnancy
  5. Medical conditions prohibiting elective surgery
  6. Unrealistic expectations
  7. Smoking: This is known to cause a 300% increase in complications

As breast reduction is an invasive operation there are a number of consequences that most patients shall experience.

  1. Scars
  2. Swelling
  3. Sensory changes / loss over the breast
  4. Possible restrictions with breastfeeding
  5. Bruising at the incision sites and weeping at the incision sites for a few days

The scars vary depending on the technique used. The technique varies depending on the shape of the breast and the surgeon’s preference. The traditional and most common scar is the ‘anchor’ shape. But in recent years, more minimal scar techniques have been developed such as the ‘vertical’ scar or ‘purse string’ (nipple) scar. These last two types are made more useful in patients undergoing a small or moderate reduction and are not usually suitable for the larger or more droopy breast.

There is no relationship between breast reduction and the development of breast cancer. Undergoing breast reduction surgery neither increases the risk of breast cancer nor does it prevent it.

It is generally recommended that the patient waits about 6 months following surgery before a mammogram is performed as it may be painful and disrupt the result. If a lump does develop requiring investigation an ultrasound is usually the first investigation of choice. If the patient is over 40 years of age and has not had a mammogram for over 2 years it is useful to have one pre-operatively.

Breast ScaringBreast reduction surgery will not have a negative impact on a future pregnancy. But a pregnancy may well cause an increase in breast size and stretching of the breast skin. After the pregnancy the breasts may sag and undo some of the benefits of the surgery. Women of child bearing age should give careful consideration to the possibility of pregnancy and, in some cases, may wish to defer breast reduction until a family is complete.

It is likely that breast reduction will reduce the ability to breastfeed. This can depend on the amount of reduction and the surgical technique employed in addition to the patient’s own natural ability. If a patient wants to preserve the possibility of breastfeeding she should consider deferring surgery until her family is complete.

The following is a list of important guidelines for patients to follow prior to their procedure.

  1. Maintain an appropriate stable weight for 9-12 months prior to the date of surgery
  2. Abstain from alcohol for 7 days prior to surgery
  3. Stop smoking 2-3 months prior to surgery
  4. Not take anti inflammatory medicines for 14 days prior to surgery due to the increased risk of increased blood loss during surgery, e.g. Aspirin™
  5. Inform your Consultant Plastic Surgeon of all medicines you are taking and for what condition
  6. Stop taking the oral contraceptive pill, if relevant, at least 6 weeks prior to surgery and use alternative means of contraception.

The Consultant Plastic Surgeon shall prepare for the operation by marking with a special pen the relevant dimensions and surgical plan for incisions on the patient’s breasts.

A technique to move the nipple-areolar complex (nipple area) needs to be determined. There are two basic choices:

  1. To move the nipple and areola as a free tissue graft (rarely used)
  2. To leave the nipple and areola attached to a dermoglandular pedicle of tissue (through which circulation is maintained).

The Consultant Plastic Surgeon shall decide the most optimum approach based on the patient’s characteristics. The most commonly used Wise or “keyhole” pattern of skin incision allows Consultant Plastic Surgeons to adequately remove the redundant skin in both the vertical and horizontal dimensions. This leaves a resulting anchor type scar with the lower scar often hidden in the fold below the breast.

Once the nipple and areola have been isolated, the excess skin and breast tissue is removed. Bleeding is controlled. The breast is then re-assembled by suturing the medial and lateral components to each other and to the chest wall. The nipple and areolar complex are then inset and the skin incisions are closed. Difficulties in breast-feeding have been reported with some approaches where all glandular breast attachments have been separated from the nipple.

A mastopexy or breast lift is carried out in much the same fashion but the nipple and areola are always left attached to the breast substance, and only excess skin is removed. The skin incisions may vary (periareolar) and no glandular breast is removed. It is simply reshaped and anchored (using pillar techniques and in some case fascial slings) to the chest wall muscles.

Most patients stay in hospital for 2-3 nights after surgery. The typical recovery time for a patient who has undergone breast reduction surgery is 3-4 weeks. A supportive bra (without an under wire) usually should be worn during the recovery period. Swelling is usually present as is the case after most surgical operations but will usually subside after 2 -3 weeks. There may be some pain initially and in some cases prescriptive medicines may be required for a short period.

It is advisable that patients do not return to or start work for 2-3 weeks after their first operation while exercise and house work should be kept to a minimum during the first 7 days of recovery. Generally for most patients sports or more strenuous activities can be resumed after 3 months. Driving depends on the individual: a seat belt must be worn and the woman should be comfortable and fully mobile if she is to be in control of the car.

It will typically take 6-9 months for the scars to begin to fade in colour and become less pronounced. The sensation of the skin around the breast will have been altered and can take 9-12 months to return to its pre-operation feeling. It is important to realise that achieving the final breast shape is not a quick process and may take months.

The following are some of the potential local and systemic complications.

Local Surgical Complications may include: wound infection, hematoma(blood collection), seroma (fluid collection), changes in the nipple-areolar complex sensitivity and loss of portion or all of nipple and areolar complex due to inadequate blood supply and fat necrosis which may feel like a ‘breast lump’ after surgery.

Distant Systemic Complications may include: Respiratory problems, circulatory system collapse, disturbances of the blood clotting mechanism leading potentially to excessive bleeding and excessive clot formation.

For most patients the final results of the procedure will not be apparent for up to 12 months after the procedure. It is recommended that during the total recovery time the scars are not exposed to excessive sun light, which could lead to darkening and increased visibility of the scar tissue. It is critical that you follow the advice of your Consultant Plastic Surgeon to ensure an optimum recovery and outcome.

Please note: that with all procedures there is a possibility of patient dissatisfaction with the outcome.

Allergic reaction to anaesthetic 
In very rare cases anaesthetics can cause allergic reactions. The best current estimate is that a life-threatening allergic reaction (also known as anaphylaxis) happens during one in 10,000 to one in 20,000 anaesthetics. Your anaesthetist will choose the drugs for your anaesthetic by taking into account many different factors, in particular, the type of operation, your physical condition, and whether you are allergic to anything.

Most people make a full recovery from anaphylaxis. It isn’t known how many anaphylactic reactions during anaesthesia lead to death or permanent disability. One review article suggests that one in 20 serious reactions can lead to death. This in effect implies that the chance of dying as a result of an anaphylactic reaction during anaesthesia is between one in 200,000 and one in 400,000 anaesthetic procedures.

For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.