Mr Neil Toft

Consultant Plastic Surgeon

BSc MBChB MD FRCS (Plast)

 

0845 094 5657

 

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BREAST REDUCTION INFORMATION

General Background

Breast reduction operations are designed to reduce the breast in size. There have been several different breast reduction operations described in the medical literature. Essentially, all these operations work by excising the extra breast tissue and reshaping the skin around the new smaller breast with repositioning of the nipple. In addition, they can be used to correct any mild asymmetry that may exist between the two sides.
Breast reduction is often requested by patients who are experiencing chronic back and neck pain, or shoulder pain where the bra straps are cutting in. Many patients also find difficulty in getting clothes to fit or are embarrassed about the size of their breasts in public. A well performed breast reduction will deal with these problems. Breast reduction operations consistently record the highest patient satisfaction score in all plastic surgery procedures.

Before the operation

There is nothing special or complicated to be done by the patient. It is a good ideal before the operation to have discussed what size of new breast you wish. Obviously, no guarantee of exactly what bra size is possible, but by giving the surgeon a rough estimate beforehand helps in the sculpting of the breast during the operation. If you are on the oral contraceptive pill you should continue to keep taking it, and inform the surgeon or anaesthetist in the hospital. If you smoke it would be advised to stop for a month before and least two weeks after as this will improve wound healing and your post-operative recovery. It is a good idea to buy a soft sports bra (without wire) about C or D cup - i.e. approximately 3 sizes smaller than your natural breast size - and bring it to the hospital on your day of surgery. In addition, it would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.

The operation itself

You will come into the hospital on the morning of surgery. The surgeon will then draw markings your breasts with a pen to help with the planning of the procedure. The operation is performed under general anaesthetic and takes about 3 hours. The excised breast tissue is routinely sent to pathology for examination under the microscope to exclude any sinister disease - finding any nasty surprises are fortunately very rare. The remaining breast tissue and skin are then re-draped, the nipple repositioned, and the incisions stitched. There will be a bulky dressing over the breasts and a drain in each side at the end.


Post-operative follow-up and after care.

You need to stay in hospital overnight after the operation. The following day the drains will be removed, and a lighter dressing applied. All being well you can go home with some painkillers. It is import to leave the dressing alone and wear the sports bra day and night. At between 5 and 7 days you will be seen in the clinic and the dressings removed and the wounds checked. At two weeks after the operation the stitches will be removed (this is not painful). At this point it is important to massage the scars twice a day with simple moisturiser (e.g E45 cream). It is important to rest and take it very easy for at least 2 weeks after the operation. You wound be advised to take 2 weeks off work and it is essential to avoid all sexual activity during this period. The sports bra needs to be worn day and night for a month in total as it helps to mould the breast into shape. Vigorous sport such as jogging or the gym should be avoided for 6 weeks. A check up clinic appointment at 3 months after the surgery will be arranged for you.


Complications

All operations carry a risk of complications, although in breast surgery serious complications are rare.
It is impossible to perform breast reduction surgery without putting scars on the breast. There are always scars around the new nipple, a scar in the fold under the breast, and one connecting the two. The scars therefore appear in the shape of an anchor. Sometimes the scars on the breast may be red and lumpy for a few months but these usually settle down by themselves. Some patients do get unfavourable scars despite very neat stitching at the time of surgery. As doctors we do not fully understand why some patients scar better than others and it is impossible to predict which patients are going to generate poor scars. Fortunately, most scars improve with time and this process of scar maturation may be helped by silicone gel pads.
The risk of infection post-operatively is about 5 %, and responds to antibiotics. Such problematic infections are usually related to "fat necrosis" that has occurred deep with in the breast tissue. A haematoma is a collection of blood under the skin and if significant may need to be drained. This is rare (also about 5%) and does not affect the final outcome. Precautions are taken to avoid both these problems developing by giving antibiotics at the time of surgery and by careful operating.
Many patients will notice that they have reduced sensation in the nipple. This is likely to be permanent and is related to small nerves being divided during the operation. Breast reduction surgery usually makes it impossible to breast feed successfully, although this is not always the case in some patients. Patients who are overweight, or smoke heavily, or are diabetic many have problems with slow wound healing. If this occurs, the wounds are left to close on their own, helped by applying regular clean dressings. Very, very occasionally problems with wound healing may involve the nipple area causing the skin of the nipple to undergo necrosis.
No two un-operated breasts are truly identical in size and shape. Hence, no two breasts that have had breast reduction operations are truly identical also. Although great care is taken during the operation to match both sides in terms of volume and size, very minor imperfections may exist. Perfect symmetry is always the aim but may not always possible.

Summary

Breast reduction surgery involves one overnight stay in hospital, and about 2 weeks off work. The complication rate is low, and patients are usually very happy with the results, which often lead to a dramatic change of lifestyle.


Operation Time 3 hours
Anaesthetic General
Nights in hospital 1
Time off work

2 weeks

Return to normality/exercise 4 - 6 weeks