Breast Reduction (syn. reduction mammoplasty)
Indications
Breast reduction is indicated for “large” breasts.
What constitutes “large” varies’ the following
complaints are common:
• Neck, shoulder & back pain; shoulder grooving;
sweat rash and poor posture.
• Psychological problems arise because of unwanted
attention from the opposite sex, comments and sexual innuendo.
Clothing is often worn to disguise the breasts.
• Difficulty obtaining fashionable clothes and inability
to participate in active sports.
• Breast reduction may be used to correct breast asymmetry
if one side is much larger than the other
Anaesthetic - General anaesthesia.
Technique
Surgery aims to reduce the size of the breasts and improve
shape by excision of fat and skin. The nipple is reduced
in size and lifted to a higher position. There are many
breast reduction techniques. All involve an incision, and
therefore scar, around the areola; different techniques
uses different additional incisions and thus leave different
scar patterns on the breasts. Before surgery a pattern is
drawn on the breasts corresponding to the incisions used.
The incisions are designed to be hidden by a bra or bikini
top. During surgery a tube is placed in the breast to drain
excess fluid and blood - removed after 24 - 48 hours.
Length
of Operation - 2 - 3 hours
Time
in Hospital - 3 to 5 days
Post-Operative
Discomfort/Limitations
Severe pain is unusual; pain is controlled by the use of
local anaesthetics at the time of surgery and pain relieving
medication as needed. Dressings are usually left in place
for 1 - 2 weeks after which a well-fitting sports bra should
be worn until the swelling settles (4 - 6 weeks). If external
stitches are used; they are remove after 10 - 14 days. Anaemia
is common and is usually treated with iron tablets.
In massive
breasts, significant breast reduction may be needed - this
may be at the expense of increased risk of complications
and a less satisfactory cosmetic result.
Following
breast reduction the breast should not regrow afterwards.
They may increase in size with pregnancy and following weight
gain. If weight is lost the breasts may get smaller. With
time the breast shape will change and some drooping is inevitable.
Permanent scars are left on the breast & usually improve
with time. The final scars usually settle to a white line;
this may be fine or stretched. In some instances the scarring
is unsatisfactory
Time
off Work - 4 - 6 weeks.
Risks
and Complications
General anaesthesia is safe; but in a tiny proportion caries
a very small risk.
General complications: bruising, swelling and bleeding which
may be heavy and need a blood transfusion and a return to
the operating theatre to stop; chest and wound infection,
unsatisfactory scarring , leg vein thrombosis (clot).
Specific
complications: Changes in nipple sensitivity
(increased, decreased or lost); breast numbness; delayed
wound healing; nipple loss; asymmetry in size and shape;
dog-ears (prominent folds of skin which may be formed at
the ends of any scar); fat necrosis (death of small areas
of fat inside the breast which may be noticed as small,
firm, lumps in the breast).
The ability to breast fed may be lost after this operation.
Many of the complications of breast reduction are increased
in smokers and in women who are overweight. Some are more
likely with very large reductions.
Breast reduction produces internal, as well as external
scarring. This internal scar may show on breast X-rays (mammograms)
and give a false appearance of breast cancer. Some surgeons
therefore recommend an X-ray a few months after breast reduction
to provide a baseline for future comparison.
Outcome
- 80 - 90% of patients are satisfied with the outcome of
surgery.
