Breast Reduction

Patients who undergo breast reduction surgery are either seeking relief from physical symptoms caused by excessive weight of large breasts or desire to have smaller, more well proportioned and lifted breasts. Breast reduction surgery usually can solve these problems, making your breasts lighter, more comfortable, and more proportionate; allowing clothes to fit better.

EVALUATION

You may be a good candidate for breast reduction surgery if you have one or more
of the following conditions:

-breasts that are too large in proportion to your body.

-heavy, pendulous breasts with nipples and areolas that point downward.

-one breast is much larger than the other.

-back, neck or shoulder pain caused by the weight of your breasts.

-skin irritation beneath your breasts.

-indentations in your shoulders from tight bra straps.

-restriction of physical activity due to the size and weight of your breast.

-self-consciousness about the large size of your breasts.

Breast reduction can be performed at any age, but plastic surgeons usually recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Many women, however, decide to undergo breast reduction before having children and feel they can address any possible subsequent changes later.

During your consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they realistically can be achieved.

You should come prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. You should tell your plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss.

Your plastic surgeon will examine your breasts, taking measurements and taking photographs. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

INSURANCE COVERAGE

Insurance coverage is sometimes available for breast reduction surgery. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed. A letter of predetermination may be required by your insurance company prior to surgery.

SURGICAL TECHNIQUE

The most common method of reducing the breasts involves three incisions: one around the areola, one that runs vertically from the areola to the bottom of the breast at its crease, and one that runs along the crease.

After the surgeon removes excess breast tissue, fat, and skin, the nipple and areola are shifted to a higher position, and the areola is usually reduced in size. The nipple and areola usually remain attached to the underlying tissue, preserving the sensation. The ability to breast-feed may also be preserved, but this cannot be guaranteed. Liposuction may also be used to improve the contour of the breast near the armpit and side of the chest.

There are many variations to the design of the incisions for breast reduction. The size and shape of your breasts, as well as the desired amount of reduction, are factors that will help your plastic surgeon determine the best technique for you.

RISKS AND COMPLICATIONS

Fortunately, significant complications from breast reduction are infrequent. Every year, many thousands of women undergo successful breast reduction surgery, experience no major problems and are pleased with the results.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. Minor adjustments can be made at a later time, if desired. Permanent loss of sensation in the nipples or breasts may occur rarely. Incisions that have healed poorly may be revised as well. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

PREPARATION FOR SURGERY

Depending on your age, or if you have a history of breast cancer in your family, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast reduction surgery, you will be able to perform breast self-examination. Breast reductions surgery will not increase your risk of developing breast cancer.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and other anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Breast reduction surgery will be performed on an outpatient basis. You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon’s office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon’s office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, you will be taken into a recovery area where you will continue to be closely monitored for about one hour. You will be in a snug compressive elastic wrap. After you are awake and comfortable, you will be discharged by the nurse and allowed to go home or to an aftercare facility.

RECOVERY

On the day of your surgery you should feel fairly comfortable. You should expect only minor discomfort, usually described as pressure. You will be encouraged to get out of bed for short periods of time. The following day you will be seen by your surgeon and placed in a bra. There will be tape over your incisions that will remain until the following week. You will be instructed to avoid straining, bending, and lifting for a few weeks, and to sleep on your back to avoid pressure on your breasts.

There will be no stitches to be removed, but the tape over the incisions will be changed on a regular basis for about four weeks. You may notice that you feel less sensation in the nipple and areola areas. This is usually temporary, but it may take weeks, months, or even a year before normal sensation returns. Your breasts will possibly have some discoloration that may last for a few weeks. It might take some time for the breasts to take a more natural shape. The incisions will initially be pink or red in color, but there appearance will become less conspicuous with time.

After breast reduction surgery, it is possible to return to work within a few days to a week, depending on your job. You may resume normal activities including exercise in a few weeks. You may experience mild discomfort occasionally during this recovery period. Care must be taken to be gentle with your breasts for four to six weeks.

RESULTS

Breast reduction surgery will make your breasts firmer and smaller. The incisions from your surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing, even lo-cut necklines.

Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most women, however, eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure.

Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman’s breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast “lifting” procedure to restore their more youthful contour.

You will return to your plastic surgeon’s office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Once the immediate postoperative follow-up is complete, you will be encouraged to return periodically to observe and discuss long-term results of your surgery.