If you’re considering breast reduction
Bra straps may leave indentations in the shoulders of
women with very large, pendulous breasts. Unusually large breasts
make a woman-or a teenage girl-feel extremely self-conscious.
Breast reduction (reduction mammoplasty) 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.
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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.
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All surgery carries some uncertainty and risk
Breast reduction or reduction mammoplasty 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 anaesthesia.
You can reduce your risks by closely following your surgeon’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 may divide 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 be rebuilt by modern techniques. Occasionally
underlying breast tissue may also necrose and need reconstruction)..
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Planning your surgery
In your initial consultation, it’s important to discuss your expectations
frankly with Mr Murphy. Every patient has a different view of what
is a desirable size and shape for breasts and your surgery will
be tailored to accommodate your wishes.
Heavy breasts can lead to physical discomfort, a variety of medical problems, shoulder indentations due to tight bra straps, and extreme self-consciousness.
Mr Murphy will examine and measure your breasts, and will probably
photograph them for reference during surgery and afterwards. He 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.
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Preparing for your surgery
Mr Murphy 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 medication.
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.
Breast reduction is done in a hospital, as an inpatient procedure under general
anaesthetic. The surgery itself usually takes two to four hours, but may take
longer in some cases. You can expect to remain in the hospital two to three days.
Clinical photographs will be taken before your operation.
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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. Excess glandular tissue, fat, and skin is removed,
and the nipple and areola are moved into their new position.
The skin is then brought 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.
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 it’s new contour.
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 horizontal 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.
Scars around the areola, below it, and in the crease under the breast are permanent, but ban be easily concealed by clothing.
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After your surgery
After surgery, your breasts will be supported with adhesive
tape. A small tube will 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.
You will be able to bathe after a few days and the tapes will be removed after
one week and replaced with a soft bra. It is better to wear the bra around the
clock for several weeks, until the swelling and bruising subside. Absorbable
sutures are used and few if any will need removal.
Your first period 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.
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Getting back to normal
Although you will 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.
Mr Murphy 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 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 the team.
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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.
Every effort will be made to make your scars as inconspicuous as possible. However,
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,
and if you are lucky may fade 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.
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