Breast Reduction (Reduction Mammaplasty)
Breast reduction is a surgical procedure performed to reduce the size of the breasts, enhance their shape, volume and projection by removing as well as reshaping the breast tissue and re-positioning the nipples higher on the breast. In contrary to widespread and often inconsiderate perceptions, large breasts can affect woman’s health, well-being, self-image, and lifestyle in a very negative way. Neck, back and shoulder ache, skin irritation and rush, social embarrassment, difficulties with clothing and exercises are only few to mention. Thankfully, the breast reduction leads to predictably satisfying results, excellent long term outcome and hugely improved self-esteem in vast majority of patients. The operation is often regarded by experts as a reconstructive procedure which favourably affects overall quality of life, rather then just a cosmetic appearance.
The operation should not be performed until a woman’s breasts are fully developed, from late teens onwards. Only occasionally, marked breast growth can occur in early puberty, when reduction might be justified earlier. For women who have not yet completed their families and are contemplating breast reduction surgery, it is important to understand that breastfeeding will almost certainly be impossible after breast reduction has been performed. This may be a reason to defer surgery until the family is complete.
At the initial consultation, it is important to establish needs and wishes and whether operation can realistically achieve what you expect. It is important to hear about your past and current medical history, in particular problems like breast lumps, nipple discharge, breast pain, breast cancer and/or previous breast surgery. Smoking is not allowed in the period immediately before and after surgery because of significantly increased complication rates in patients who smoke. You should be off all cigarettes and nicotine patches at least 3 weeks before the operation.
Please note that absolute cup size and perfect symmetry of the breasts cannot be guaranteed after operation although, naturally, I do my best to meet preoperative objectives as accurately as possible.
An operation is performed under general anaesthetic and takes between 2-3 hours. The typical scar extends around the nipple, vertically down towards the breast crease on the chest and sometimes, also along that crease. For small reductions it is often possible to avoid a horizontal component of the scar. The exact technique and amount of breast tissue removed is usually determined and discussed with the patient in advance. It is based on a degree of agreed reduction and individual anatomical considerations. At the end of the procedure, surgical drains are inserted on each side and these are removed few hours before your discharge from the hospital (1-2 days). The wounds are most commonly closed with dissolvable sutures, (so there will be no need for their removal later) and covered with a surgical tape and light, shower proof dressings.
You should expect to spend 1-2 nights in hospital and will go home with oral painkillers wearing a sports bra. I will advise you on adequate types of bras at the time of consultation so that you can bring one with you on the day of surgery and we can put it on straight away. My personal preference is that patient wears a well supporting, comforting soft bra up to 6 weeks after surgery at day and night most of the time. Wired bra should be only used after this time period. After discharge from hospital, patient should be involved in light normal daily activities and gradually and sensibly return to usual activities over a period of 2-3 weeks, once the wounds have healed satisfactorily.
It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:
- Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand. I would strongly advise you to stop smoking prior to surgery as this can badly affect the outcome of surgery and increase complication rates.
- Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery.
- Plan your time off school / work / sports.
- Allow at least few weeks after surgery before considering a holiday.
Potential risks and complications
Unfortunately, complications can occur following any surgery and patients need to be fully aware of this. I always tend to carry out surgery in a safe manner and take all sensible, precautionary measures to minimise risks and complication rate. Please note below the commonest complications associated with breast reduction:
- Bleeding and haematoma (including need to return to theatre to evacuate large blood clot in approximately 3-4% of patients)
- Infection (3% of patients)
- Delayed wound healing
- Widened or hypertrophic scars
- Fat necrosis
- Skin numbness
- Nipple necrosis
- Alteration in nipple sensation, size and position (minor adjustments can be made at a later time)
- Asymmetry (minor adjustments can be made at a later time)
- Clots in the legs/lungs
The scars are initially pink, can be a bit lumpy and/or itchy, but over the course of 6 months, they mature nicely and become hardly noticeable white lines. Although scars are permanent, in my experience they rarely pose problems in the long term – with time, fine lines simply blend beautifully with surrounding skin and horizontal ones remain hidden within the breast crease (Picture 1). Postoperative infections can however, delay healing process and prolong remodelling of the scar tissue. It can take several months (up to 2-3) for swelling to disappear, scars visibly fade and soften and breast finally settle. Naturally, breast size can still change postoperatively either in response to ongoing gravity, hormonal changes or fluctuations in body weight.
In general, breast reduction leads to significant improvement in physical appearance, psychological wellbeing and predictably satisfied patients. Essential to that, however are realistic expectations, thorough honest consultation, surgical expertise and above all, mutual trust between patient and surgeon.
Examples on the right illustrate what can be realistically achieved. If you wish, I would be happy to show you more illustrations of pre/post operative results during our consultation. This leaflet provides only basic and generic information. Full details and explanations are provided at the consultation as no two patients are the same and personal circumstances are highly individual. Patients will be provided with detailed leaflet, comprehensive informed consent on risks and complications associated with this operation, few of which are mentioned above.
If you have any concerns following your surgery please contact:
- Hospital where you were operated:
Ashtead 01372 221 442; St Anthony’s 020 8337 6691; Parkside 020 8971 8000
- Your GP practice
- My secretary on 0845 026 7776 (Monday – Friday, 9.30 – 18.00)
|Hospital stay||1-2 nights|
|Surgery time||2-2.5 hours|
|Wound healing||2 weeks|
|Shower / Bath||from week 1|
|Time off work||average 2-3 weeks; those involved in manual activities might need more then 4 weeks|
|Sports and exercise||from week 4; jogging/hopping based workout from week 12|
|Full recovery||6 weeks|
scars at 3 weeks