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. Breast reduction, technically known as reduction mammoplasty, is designed for such women.

If you’re considering breast reduction

Bra straps may leave indentations in the shoulders of women with very large, pendulous breasts. Unusually large breasts can make a woman – or a teenage girl – feel extremely self-conscious.

Breast reduction 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 you smaller, better-shaped breasts in proportion with the rest of your 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 ask 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 for breast reduction

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 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 me. Every patient has a different view of what is a desirable size and shape for breasts and I will tailor your surgery to accommodate your wishes.

Planning your surgery

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

I will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. I will discuss the variables that may affect the procedure, including your age, the size and shape of your breasts, and the condition of your skin. We will 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

I 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 are 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 its 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 can 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.

After your surgery

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 best 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.

You’ll receive 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, 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 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 the chances are that, like most women, you’ll be pleased with the results.
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