Breast Reduction

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

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 use 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 and removed after 24-48 hours.

Length of Operation

2 – 3 hours

Time in Hospital

3 to 5 days

No posts found.

Postoperative Discomfort/Limitations

Severe pain is unusual and pain is controlled by the use of local anesthetics 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 removed after 10-14 days.

Anemia is common and is usually treated with iron tablets. In massive breasts, significant breast reduction may be needed which may post 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 and usually improve with time. The final scars usually settle to a white line which may be fine or stretched. In some instances the scarring is unsatisfactory.

Time off Work

4 – 6 weeks.

Risks and Complications

General complications:
Bruising, swelling and bleeding which may be heavy and need a blood transfusion and a return to the operating room to stop. There may be chest and wound infection, unsatisfactory scarring and 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.