Cosmetic Breast Surgery - Breast Reduction

Who is a good candidate for breast reduction? 

Ideally you should be of normal weight for height, not overweight, when the operation is done. Any woman with large breasts may be a candidate for the operation. If your breasts are so large that they are causing symptoms, then a breast reduction operation may help you. Possible symptoms include:

• Neck, back and/or shoulder ache
• A feeling of heaviness in the breasts
• Bra strap grooves in the shoulders
• Rashes underneath the breasts
• Pins and needles in the hands
• Striae (lines) or dilated veins on the breast
• Enlarged areolae

Heavy breasts can lead to physical discomfort, a variety of medical problems, shoulder indentations due to tight bra straps, and extreme self-consciousness.

A breast reduction operation can improve your self-image, self-confidence and self-esteem. It can liberate you and allow you to perform exercise, and wear clothing such as bathing costumes and T-shirts that you previously could not.

Usually the operation is not performed until a woman’s breasts are fully developed, in other words, from late teens onwards. The best candidates are those who are mature enough to fully understand the procedure and those who have realistic expectations about the results. Occasionally, marked breast growth can occur in early puberty warranting the performance of the operation in the teens.

What are the risks?

When performed by a qualified plastic surgeon, breast reduction is normally safe and the results predictable. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anaesthesia. Some patients develop small sores along the lines of the incisions after surgery; these generally heal of their own accord or may require the removal of a suture.

The procedure does leave permanent scars, although your bra or bathing suit will cover these. The usual scar circles the nipple-areola complex, extends vertically down to a scar underneath the breast, similar in shape to an anchor. For smaller reductions Mr Soldin uses a vertical scar technique where the scar goes around the nipple, and vertically downwards only. This resembles the shape of a lollipop, and has the benefit of less overall scarring when compared with the anchor scar. Poor healing and wider scars are more common in smokers. The procedure can also leave you with slightly mismatched breasts, unevenly positioned nipples or some breast asymmetry. Future breast-feeding may be difficult, since the surgery removes many of the milk ducts leading to the nipples.

Some patients may experience numbness in their nipples or breasts. In most patients this resolves within a few months of surgery although sometimes it may last for up to two years and can, rarely, be permanent. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)

Up to 50 % of women will have one or other minor complication. In the long term however 95% of women are delighted with the results.

What can be expected at the initial consultation?

At the initial consultation you will be assessed as to whether you are a good candidate for the operation. Your fitness for the procedure will be evaluated and potential problems sought. Your breasts will be examined.

It is important to bring to your surgeon’s attention any previous breast problems that you may have had. Such problems would include breast lumps,
nipple discharge, breast pain, breast cancer and any surgery you might have had on the breasts. You should also inform your surgeon as to whether you have any family history of breast cancer, particularly in your mother or sisters. If you are on any chronic medication, if you have any allergies, if you have a tendency to bleed or bruise easily, if you have had any previous surgery, if you have had any previous problems with local or general anaesthesia and if you have any chronic medical ailments, tell your surgeon. You should also discuss what your goals and expectations are. Clearly, these should be realistic.

How should one prepare for the operation? 

Ideally the operation is done when you are at your normal weight and no specific diet or exercise program is required prior to surgery. In general you should be healthy and medically fit to have the procedure. If you gain weight after the operation, your breasts may enlarge slightly, but not to their former, pre-operative size. Exercise will be easier after the operation.

It is advisable to stop smoking at least 6 weeks prior to surgery and not to smoke till the wounds have healed - about two weeks after the operation. It is well known that there is a higher frequency of complications in women who continue to smoke. Best of all stop smoking altogether.
On the day of surgery, you should be feeling fine and not have flu, a cold or any other illness. It is wise to shower or bath and wash well the morning of surgery.

Prior to the operation, Mr Soldin will take photographs for your medical records, and put pen marks on your breasts. These help obtain a symmetrical shape and size during surgery. The new nipple and areolar position will be determined and the amount of breast tissue to be removed decided. It is not possible to guarantee a particular cup size, especially as cup sizes vary amongst different bra manufacturers.

The anaesthetist will also consult with you and discuss the anaesthetic options. Breast reduction operations are done under general anaesthesia.

How is the operation performed?

The operation takes between two and three hours. Once asleep, you will be prepped (skin cleaned ) and draped. A mixture of local anaesthetic (which will help with post-operative pain relief) and vasoconstrictor (which diminishes the amount of bleeding during surgery) will then be injected into the breasts. 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 breast tissue is excised via these incisions, and the nipples moved upward to their new position. A drain is often left in each breast and allows the removal of excess blood or fluid and will be removed a day or two after the operation. The wounds are then stitched with dissolving stitches and drains are placed near the armpit. A waterproof dressing is then applied.

What can be expected after the operation?

As you wake up, you should experience minimal pain. The prescribed analgesics will ease any discomfort. You will be allowed to eat once you are awake. On the first day after surgery, you will be encouraged to get out of bed into a chair and to walk around. A shower on the first day, and daily thereafter also makes for a quick recovery.

You will be discharged from hospital on the first, or second day after surgery. Although you may be up and about in a day or two, your breasts may still ache for a couple of weeks. Sedentary or office workers are usually given 3-4 weeks off from work, although this is adjusted for individual needs. If your work is more active you may need longer off work. Sex and driving can be resumed two weeks after surgery and athletics and sport 6 weeks after the operation. You will probably find that you have much less stamina for several weeks after the operation and you should limit your exercises to stretching, bending and walking until your energy level returns. You should avoid lifting or pushing anything heavy for four weeks.

You can expect some loss of feeling in your nipples and breast skin, caused by damage to many small nerves during surgery. This numbness is not a complication, but a normal consequence of making cuts in the skin and breast tissue. 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.

A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, do not hesitate to call me.

What can go wrong?

In general, breast reduction is associated with a high degree of patient satisfaction and the vast majority of women are very pleased with the result. Nevertheless, as with all surgery, there can be complications. The serious complications are very rare and include anaesthetic problems, blood loss, drug reactions, leg clots and lung or heart problems. Most complications are minor and resolve without the need for further surgery. More commonly, breast-related problems may occur which include the following:

• Sensory problems in the breast
• Scarring and dog ears
• Size, shape or symmetry problems
• Infection and wound breakdown
• Skin, nipple, areolar loss
• Bleeding, haematoma, seroma
• Problems with breast feeding
• Lumps or cysts in the breasts
• Psycho-sexual problems

1. Sensory Problems

Almost all patients experience early sensory problems, usually diminished sensation, sometimes heightened sensation. By 6 months after the operation, 80% of patients have regained most sensation and usually you can expect an improvement for 2 years after the operation. Some patients have a permanent, either complete or partial, sensory loss. There is no treatment available for sensory loss, but fortunately it is a rare occurrence and mostly not a concern to my patients. Most women are happy to exchange some sensation for smaller, more comfortable breasts.

2. Scarring and dog-ears

All patients will have scars and these must be expected after the operation. In the majority of patients by a year after surgery the scars settle down to thin lines, which are soft and not very noticeable. They are never invisible though. If you have other scars on your body from previous surgery or trauma, these may give an indication as to the quality of scar you can expect. To minimise scarring, taping of the scars fro some months may be helpful. Massage and sun avoidance also help. Occasionally scars may become abnormally large or even form a keloid, which may require further treatment.
Dog-ears may occur at the ends of the scars and may require a small operation (which can be done under local anaesthetic) to correct them. If they require correction, this is usually done six months to a year after the original surgery.

3. Size, shape and symmetry problems

Every attempt will be made to make the breasts symmetrical. Tissue removed from breast is weighed separately and the weights are compared. It must be understood, however, that no patient is exactly symmetrical to start with. By making the breasts smaller, asymmetries can become more obvious. Additionally the 2 breasts may heal differently and this can cause asymmetry. Because of this, if there is any asymmetry between the 2 sides, it is best to wait for at least 1 year before correcting this.

4. Skin, nipple or areolar loss

Because the blood supply to the nipple and areolar may be interfered with, there is a small risk of partial or complete nipple-areolar loss or loss of skin, especially near the bottom of the breast. The risk of nipple-areolar loss is very small (less than 1%), but it can occur. Should nipple-areolar loss occur, reconstructive procedures can be done.

Skin loss, especially underneath the breast may be associated with infection. Small skin losses often heal very well with dressings, although this can take some time. Occasionally a small operation or even a skin graft is required to treat the problem.

5. Bleeding and seroma

Occasionally, after the operation, a vessel may start to bleed in the operated breast. This can result in a collection of blood. This is called a haematoma. The commonest time for this to occur is early after the operation and if the amount of blood is excessive, a small operation will be required to control the bleeding.
A seroma is a collection of inflammatory fluid within the breast. Sometimes a seroma requires repeated drainage with a needle and syringe. This is usually relatively painless and is done in the rooms. Bruising of the breast is the norm and can be expected to last for 2-3 weeks after operation.

6. Breast Feeding

Although most women have the ability to breast-feed subsequent children, often the amount of milk produced is reduced and the child requires supplementary bottle-feeding.

7. Cysts and lumps

Various kinds of cysts can result as well as a condition called fat necrosis. Although this does not cause major problems, it can show up as a lump in the breast, which may require a biopsy. Some resolve on their own, others require a small operation to remove them.

8. Psycho-sexual Problems

Some women experience persistent pain after the operation despite having a good cosmetic result. The cause for this is unknown and usually the pain settles down. Some women can experience sexual problems after the operation - they may not like the breasts being touched. A few women suffer post-operative depression that can be treated.

How satisfied can one expect to be with the procedure?

Because this is a common plastic surgery procedure, the results are predictable. After the operation, you should feel better, you should be able to wear attractive clothes, exercise, and have greater self-esteem and self-confidence.

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy. Although every effort will be made to ensure that your scars are as inconspicuous as possible, it is important to remember that breast reduction scars are extensive and permanent. They may remain red and slightly prominent for months, before fading to thin pale lines.

Breast reduction results in a marked change in your body and your body image. You will look better proportioned, and clothes will fit you better. Often self-esteem and self-confidence improve and patients find that they can now exercise. As a consequence, patients frequently lose weight after the procedure. Studies show that over 97% of women are very happy with the procedure and that if they were in the same situation again, they would opt for the operation. Most complications are minor and resolve without the need for further surgery. Breast reduction patients are amongst the happiest in any Plastic Surgeon's practice.

What to bring with you to Hospital

• Your normal “overnight” toiletries, pyjamas, dressing gown etc.
• Some of all the medication you are on.
• A sports bra to give good postoperative support.

REMEMBER

• No smoking for 1 week preoperatively
• No aspirin for 2 weeks preoperatively
• Get a good night’s sleep preoperatively
• If on oral contraceptives stop the cycle before you come in but use an alternative form of contraception!