Breast Reduction

Heavy breasts can lead to physical discomfort, a variety of medical problems, shoulder indentations due to tight bra straps, and extreme self-consciousness.

Incisions outline the area of skin, breast tissue, and fat to be removed and the new position for the nipple.

Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast its new contour.

Scars around the areola, below it, and in the crease under the breast are permanent, but can be easily concealed by clothing.

With smaller, better proportioned breasts, you’ll feel more comfortable and your clothes will fit better.

If You’re Considering Breast Reduction…

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.

Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

If you’re considering breast reduction, this will give you a basic understanding of the procedure- when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don’t understand.

The Best Candidates for Breast Reduction

Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.

In most cases, breast reduction isn’t performed until a woman’s breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.

All Surgery Carries Some Uncertainty and Risk

Breast reduction is not a simple operation, but it’s normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician’s advice both before and after surgery.

The procedure does leave noticeable, permanent scars, although they’ll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.

Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)

Planning Your Surgery

In your initial consultation, it’s important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient-and every physician, as well-has a different view of what is a desirable size and shape for breasts.

The surgeon will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He or she will discuss the variables that may affect the procedure-such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they’ll be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.

Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it’s medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have your surgeon write a predetermination letter if required.)

Preparing For Your Surgery

Your surgeon may require you to have a mammogram (breast x-ray) before surgery. You’ll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation.

Breast reduction doesn’t usually require a blood transfusion. However, if a large amount of breast tissue will be removed, your physician may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Where Your Surgery Will Be Performed

Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes two to four hours, but may take longer in some cases.

Type of Anesthesia

Breast reduction is nearly always performed under general anesthesia. You’ll be asleep through the entire operation.

The Surgery

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.

After Your Surgery

After surgery, you’ll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.

You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain.

The bandages will be removed a day or two after surgery, though you’ll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.

Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting Back to Normal

Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.

Your surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it’s not too strenuous) and social activities in about two weeks. But you’ll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You’ll also need a good athletic bra for support.

You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.

A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don’t hesitate to call your doctor.

Your New Look

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You’ll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.

However, as much as you may have desired these changes, you’ll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you’ll be pleased with the results.

FAQ

How long is my recovery?

Some patients spend one night in the hospital following this procedure. You may have bruising on or near your breasts lasting a week or two. Swelling of the breasts may persist for several weeks. You should be able to resume normal activity within a day or two of surgery. Strenuous exercise and heavy lifting should be avoided for 3-4 weeks following surgery.

How long will I be in pain?

You will be sore for a few days. However, most patients do not experience much discomfort. You will be given a prescription for pain medication to use immediately post-op, and can switch to Ibuprofen or other over the counter medication after a few days.

How often will I need to come to the office for follow-up visits?

Your first post-op visit will typically be within three days after surgery. We will then monitor your recovery and progress on a weekly basis for a few weeks.

When can I go back to work?

Within one week, you should be able to return to work. If your job requires physical labor, you should consider taking 2-3 weeks of leave or return to work with lifting restrictions.

When can I drive?

You can drive as soon as you are off of the narcotic pain medication and feel alert enough and physically able to do so.

What medications will I be on after surgery?

You will be given prescriptions for pain medication—usually Percocet and Vicodin.You may take one or the other to control your pain. A prescription for Zofran is also given; you can have this filled if you need to. This can be used to control post-operative nausea and vomiting that some patients experience after anesthesia. We do not routinely prescribe antibiotics, but will prescribe them if we suspect you have an infection.

Can I go home the same day?

Generally, patients who have this procedure spend one night in the hospital. However, some patients feel more comfortable recovering at home. You might be able to go home the same day as surgery if you are doing well. Someone will have to drive you home and stay with you the first night.

When can I have sex?

You may have sex when you feel comfortable enough. However, anything other than gentle manipulation of the breasts immediately post-op could harm the incision.

Will I have scars?

Yes. The most common scar pattern is an incision around your areola, down your breast and under your breast.

Will I have drains?

Drains are usually necessary to help collect fluid that accumulates in your breasts following surgery. You will need to empty and measure the output of the drains at least twice daily. The nurse will show you how before you leave the hospital. Most frequently, the drains are removed within a few days following surgery. They are concealed pretty well when secured under loose garments.

When can I shower?

If you have drains, sponge bathe until you are seen for your first post-operative visit. If you do not have drains, you may shower the day following surgery. You will have Dermabond, an adhesive glue covering your incisions. Your incisions can get wet. Do not apply any ointment or scar products until discussed with our office.

Will I have to wear a special garment?

We recommended wearing a sports bra after surgery for two weeks. Choose a sports bra with no under-wire that fastens in the front. We suggest getting at least two. You will need to bring one with you to the hospital on the day of surgery. These can be found at a department store, Target, Wal-Mart, or a sports store. Ask the nurse what size you should buy.

When will I see the final result?

You will immediately notice the results. However, you can expect about 10-20% of swelling. The swelling should diminish over 3-6 weeks.

Will I be able to breast feed after surgery?

There are different techniques used for breast reduction surgery. Most frequently, the nipple is left intact, and should not interfere with breast feeding. Extremely large or pendulous breasts might require a more aggressive procedure, requiring the nipple to be removed and replaced as a graft. If this procedure is used, you will not be able to breast feed following surgery.

Will I lose sensation in my nipples?

Loss of nipple sensation is common following surgery. Usually, sensation gradually returns. However, permanent loss of nipple sensation is a risk of breast reduction surgery.

What happens if I gain weight?

If you gain weight, your breasts may get larger. That is why it is important to maintain a stable weight. Your breast size will also increase during pregnancy, and may interfere with your surgical result.

How do I prevent constipation?

Narcotic pain medication can cause constipation. We recommend taking Colace or Pericolace. This medication is available over the counter at the pharmacy. You should begin taking this medication when you get home, and continue as long as you are on the narcotic pain medication. Increasing your fiber intake, eating fruits and vegetables, and drinking plenty of fluids also help. If constipation becomes a serious problem, we suggest either a Dulcolax suppository or drinking Milk-of-Magnesia.

What if I cannot urinate?

Following anesthesia, some patients have difficulty urinating. If you go home and are unable to urinate within six hours, you might need to be catheterized. Go to the Emergency Room—either Georgetown or one that is closer to your home. Patients are usually able to urinate after the medication leaves their system.

How can I reach someone, after office hours if I have a problem?

If you have a problem and the office is closed, you may contact the Plastic Surgery fellow or chief resident. You will be given their pager number after surgery.

Do my sutures need to be removed?

Dr. Spear usually uses dissolvable sutures. They are not noticeable, and are absorbed by the body.

When can I travel?

You may travel within a few days, as long as you feel comfortable. We like to see you within a couple of days follow surgery, and once the following week to monitor your recovery.