Breast Reduction

Women with very large, pendulous breasts may experience a variety of problems in addition to concerns about appearance. These include back and neck pain and skin irritation. Bra straps may leave indentations in their shoulders.

Breast reduction (reduction mammoplasty) is designed to reduce breast size and improve shape. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola (the darker skin surrounding the nipple).

The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.

There are many different techniques of breast reduction and the position of the resulting scars may vary. There is always a circular scar around the nipple and a second vertical scar running from the lower most point of the nipple to the fold beneath the breast. In most techniques there is also a horizontal scar in the fold beneath the breasts. The horizontal scar can usually be kept quite short but its length does vary depending on the original size of the breasts. Some techniques of breast reduction avoid the horizontal scar altogether.

Planning your Surgery

At your initial consultation, it is important to discuss your expectations frankly. Every patient has a different view of what is a desirable size and shape for breasts.

The procedure will be explained in detail, its risks and limitations, and the scarring that will result.

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

Preparation for Surgery

You should not take aspirin or non steroidal anti-inflammatory drugs such as Brufen or Nurofen for two weeks before your surgery. These drugs increase the risk of post operative bleeding and have an adverse effect on bruising.

If you smoke, you will need to stop smoking for two weeks before surgery and a week afterwards. Smoking reduces the blood flow to the skin and can prevent healing.

You will need to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

The Risks

As with any surgery, there is always a possibility of complications, including bleeding, infection.

The procedure does leave noticeable, permanent scars, although they will be covered by your bra. (Poor healing and wider scars are more common in smokers.)

The procedure can rarely leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.

Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. The nipple and areola can usually be rebuilt.

The Surgery

The surgery itself usually takes two to three hours. Breast reduction is performed under general anaesthesia.

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Excess glandular tissue, fat, and skin is removed, and the nipple and areola are moved into their new position. The skin from both sides of the breast is brought down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large and pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position.

After your surgery

After surgery, you will have a surgical bra over gauze dressings. A small drain may be placed in each breast to drain off blood and fluids for the first day.

There may be some pain for the first couple of days especially when you move around or cough and some discomfort for a week or more. Wounds are checked one week after surgery, but sutures are generally dissolvable and do not need to be removed.

You will need to wear a support bra for several weeks, until the swelling and bruising subside.

Some loss of feeling in around the nipples and in the breast skin is common. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.