Breast Reduction

Breast reduction surgery is a commonly sought cosmetic surgery procedure. Women may wish for a breast reduction for a variety of reasons.

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Large breasts may be a hereditary condition that may cause embarrassment in some cases or pain and discomfort, especially around the neck and shoulder areas. In some cases following childbirth, the breasts may become droopy and women may wish to reduce the size of their breasts and reshape them at the same time. If all that is required is a ‘lifting’ of the breasts whilst maintaining the size of the breasts, then a different procedure called a ‘mastopexy’ is indicated. Both breast reduction, as well as mastopexy, lift the breasts with the nipples placed in a more youthful position. I will discuss with you in detail which procedure would be most suitable, taking into consideration what your expectations and desired outcomes are.

Your breast reduction journey

Possible Complications

Other Information

Consultation

During the consultation, I will explore the reasons for you requesting a breast reduction. We will discuss what you expect from the surgery and the ideal size and shape you are hoping to get. Please wear a bra you feel fits you most comfortably. I will examine you and take some measurements that will guide me in giving the correct advice. Things to discuss:

Size

Breasts vary in cup size depending on where you were measured for your bra. Therefore the existing bra size is noteworthy but not entirely indicative of where you are currently. We can aim to achieve a certain size, but I cannot promise a specific bra cup size following surgery.

Shape

The Procedure

Breast reduction surgery inevitably involves scars. The position of scars will depend on the type of reduction you will be having. For small reductions, it is sometimes possible to have a scar that runs around the nipple-areola complex (NAC) and down the breast (vertical scar technique). However, for the majority of breast reductions, I use the ‘Wise pattern’ technique, which runs around the NAC, down the front of the breast in a vertical fashion, and across the bottom of the breast in the breast crease. The overall appearance is therefore that of an anchor. However, over time, the only scar that will be visible from the front should be the vertical scar and even this fades with time.

Aftercare

Sutures

The incision is closed using absorbable sutures. The incision is then covered with a state-of-the-art waterproof dressing which will come off after about 3 weeks.

Garments

You will be placed into the post-surgical bra before you wake up from the general anaesthetic. I will provide a breast ‘band’ which wraps around your chest providing additional compression on your breasts. I would advise wearing the support bras (nothing under-wired) 24 hours a day for 6 weeks, and the breast band for 2 weeks. The bra may be taken off for showering, which can be done after the first 48 hours. I advise all my patients to wear a support bra all the time, even at night. This is the best way to maintain the shape of the breasts and delay age related drooping.

Medications

I will see you immediately after surgery to discuss how things went and to check that all is well. I will make sure you are comfortable before you go home. In the vast majority of cases, patients undergoing breast reduction are able to go home the same day. You will be given adequate pain relief. Please avoid taking any aspirin or blood thinning medication such as aspirin. You will also be given a 5 day course of oral antibiotics to reduce the chances of infection. Finally, you will be given a 3 day course of a medication that reduces the chances of bleeding.

Recovery

Scar management

After 3 weeks, wounds have generally healed. You are advised to gently massage the scars as tolerated as this helps to soften, flatten and desensitise them. I would advise massaging the entire breast as well as the scar. You may use any lotion of your choosing, such as E45 or bio-oil. 5 minutes morning and evening for about a year. Make this part of your ‘routine’. Secondly, scars tan faster than normal skin. Therefore avoid exposing the scars to the sun, but if you have to, then apply factor 50 sun block daily, for a year. It takes about a year for a scar to fully mature and caring for your scars in this manner will ensure optimal healing. In some cases, I may advise using silicone gel (such as Kelocote), to be smeared onto the scar daily for a year.

First 48 hours

For the first 48 hours following surgery, please minimise the activities you are undertaking. Any activity that increases your blood pressure may trigger bleeding. You may return to light duties after a week and back to work within 2 weeks. I strongly advise against any heavy lifting (including children) for 4 weeks as this may be uncomfortable.

Eat well and stay well hydrated by drinking lots of fluids. Abstain from alcohol for at least a week as this can cause dehydration. Smoking or use of any nicotine replacement product is to be avoided for at least 6 weeks before and 6 weeks after surgery to allow the body to heal as quickly as possible.

You may return to driving after 2 weeks if you feel comfortable and able to maintain full control of the vehicle. You may fly ideally after 6 weeks, but make sure you drink plenty of fluids (not alcohol) and wear compression stockings on your calves.

Possible Complications

General anaesthesia

Any operation involving a general anaesthetic carries a risk of developing blood clots in the calves (deep vein thrombosis – DVT), which could break off and move to the lungs causing a pulmonary embolism (PE). Early mobilisation and keeping hydrated will reduce this risk, as will avoiding smoking before and after surgery for at least 6 weeks. There is a risk of allergy to the drugs for anaesthetic and antibiotics/pain relief, and a very small but theoretical risk of major life-threatening complication/death related to the anaesthetic (1 in 100,000 risk).

Drains

Bleeding and haematoma

This is rare and precautions are taken during surgery to minimise the risk of this. You will also be given medication to reduce the change of bleeding after surgery. However, in the rare instance that significant bleeding occurs, one breast may swell quite obviously and become painful. The nipple may change colour and become dusky (purple and dark). This will require a return to theatre and stop the bleeding. After 48 hours, it is extremely uncommon for such bleeding to occur.

Infection

Many precautions are undertaken during surgery to minimise the chances of infection, including giving you antibiotics after surgery for 5 days. Unfortunately infections can occur and this may be very superficial to the incision site, and easily treated with antibiotics. Sometimes, some of the fat within the breast may die (fat necrosis) and either become infected, become hard (calcified) or burst and become an oil cyst. This can happen occasionally.

Scar

Asymmetry

Nipple sensation

Swelling

Fat necrosis

As the breast tissue is released and manipulated into a new position, some of the fat within the breast tissue may not survive if the blood supply to the fat is interrupted. It is impossible to predict when this will happen, but the techniques that I use are safe and minimise the likelihood of this happening. Fat necrosis presents as a hard lump within the breast. If this occurs more than 3 months after surgery, you must have a mammogram to investigate whether the lump may be anything more sinister, such as breast cancer. Fat necrosis may resolve if small, but larger areas of fat necrosis may need surgical excision, which will result in a small dent in the breast.

Nipple loss

Other Information

Age related changes

With time, skin loses its elasticity. This age related change can be made worse by chronic sun exposure and smoking. Inevitably, breasts will droop over time, and uplifted and reduced breasts are no different. Weight gain, subsequent pregnancies and age related changed will all affect the size and shape of the breasts over time. Wearing a support bra consistently is the best way to slow down this age-related drooping.

Breast feeding

Mammography (breast screening):

Past the age of 47, you may be invited for breast screening. This special X-ray of your breasts is important to identify early signs of breast cancer. Having breast reduction surgery will not interfere with the mammogram. The risk of developing breast cancer is the same and perhaps even smaller as there will be less breast tissue present following surgery. All breast tissue removed is sent for histological analysis (biopsy) to make sure there was no cancer present in the tissue.

The outcome of all cosmetic surgery is highly subjective. Whilst your surgeon will try to give you a realistic expectation, the satisfaction which you feel about your result depends on many things.

Most people are delighted with their outcome. If there are elements of your surgery which fall short of what you had hoped for, you MUST feel free to discuss them with me, as the majority of issues are easily resolved.

Infection

Scar