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
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.
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
carry a risk of complications, although in breast surgery serious complications
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
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.
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.
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