Breast Reduction

Introduction

Breast reduction surgery aims to reduce the size of the breasts and involves removal of breast tissue, re-shaping and lifting the breasts. This is often performed for relief of symptoms such as neck pain, back pain and shoulder pain, rash under the breasts, general discomfort and shoulder indentation from bra straps. The surgery may also be for cosmetic purposes.

The benefits are numerous, including symptom relief with better posture and ability to carry out routine daily activities without pain. Patients benefit physically as they are able to increase exercise and sports activities. They may also benefit psychologically from the cosmetic result and the ability to choose and wear clothes comfortably.

Points to consider

• Why do you want breast reduction?
• Are you experiencing symptoms?
• What size would you like to be?
• What size are you to start with?

 

Consultation

During your consultation, you will have the opportunity to discuss the surgical procedure and ask any questions. It is important that you understand the nature of breast reduction surgery, so that you know what to expect.

You must also understand the potential complications as explained below.

Measurements will be taken to assess the degree of reduction required and to help with planning of the surgery.

You may require two or three consultations (at no extra charge) to resolve any queries, to overcome anxieties, and to make the right decision for yourself. It is important to understand fully the limitations and the benefits of breast reduction surgery to achieve a good outcome and realistic expectations. After all, you will be making an important decision that can be life-changing.

Pre-operative photographs will be taken as part of your medical records with your consent. Photographs are not used for publication, but may be used to show other patients, provided you are in agreement.

You will also have the opportunity of meeting with the Breast Care Nurse to discuss the procedure further, see some photographs of previous patients, and ask any questions.

 

Effects of breast reduction surgery

Breast reduction is likely to affect nipple sensation, so this should be expected. Some patients loose nipple sensation and others experience altered sensitivity.

The nipple position is changed, moving upward to a new position for the smaller breast. In so doing, there is a risk to the blood supply of the nipple. This means there is a risk of partial loss or complete loss of the nipple. If this occurs, you may want nipple reconstruction at a later date which means further surgery.

There will be scars on the breast, which will be described to you during your consultation. Usually this is an ‘anchor type’ scar. The healing of scars is variable and depends on skin type. The scar is formed around the areola (dark area around the nipple) and a vertical line down from the areola to the breast fold and a scar along the breast fold. It looks like an anchor or inverted ‘T’.

Breast feeding may not be possible after reduction surgery.

The breasts often feel lumpy after surgery, due to the internal healing of fatty tissue.

 

Potential Complications

Infection

This may occur at the T junction of the scars. It may require antibiotics and regular dressings, depending on severity.

Bleeding

This may be immediate or a few hours after surgery. A drain is usually inserted in the breast which allows any bleeding to drain out and this is monitored carefully.

Blood clots on the legs

Also called, deep vein thrombosis. You will be given compression stockings to wear for 2 weeks to reduce the risk of blood clots.

Wound healing problems

This may occur with infection. Due to stretching of tissues and varied healing, the wound may form a widened scar and may require antibiotics and regular dressings

Nipple problems

Partial or complete loss may occur if the blood supply to the nipple is compromised. Again regular dressings will be required.

Nipple sensation

There will be loss of sensation which may recover over some months. This is due to the incision being made around the areola

Lumpiness

As the fatty tissue in the breast heals, it can form pockets or ‘oil cysts’ which cause lumpiness. If the fat loses blood supply, this results in fat necrosis which is also felt as lumps. This usually settles on its own.

Fluid usually forms as part of the reaction to removal of breast tissue. This can be seen as it appears in the drains placed in the breast at surgery, and may cause swelling after surgery.

Asymmetry

There is usually some asymmetry (imbalance) between the breasts prior to surgery and although we aim to produce equal breasts in breast reduction surgery, there may be some asymmetry afterwards. It is quite natural to have some imbalance of the breast size and shape.

Scarring

In the long term, the wound will heal with scar formation. The scar may be pink or red to start with and should fade with time. It may useful to use Bio-oil on scars to improve healing and fading. Some patients develop hypertrophic (thick scars) or keloid (raised scar) scars which may require treatment, but these are often unpredictable before surgery.

 

Operation

You will be in hospital, usually for one night (or maybe two nights).

The surgery is performed under general anaesthetic.

On the day of your surgery, markings will be drawn on the breasts to plan the surgery.

Pre-operative photographs will be taken with your consent.

You will be required to wear compression stockings to avoid clots in the legs.

You will be given antibiotics to reduce the risk of infection.

The operation takes about 3 or 4 hours, depending on size. You will have a drain placed in each breast to remove any fluid collecting within the breast. The drains are removed after about 24 hours depending on the drainage.

After the operation, you will be given painkillers as required.

 

Post-operation

It is not possible to know the exact size of the bra you will need after surgery. We will aim for the breast size of your choice. Bra size is not guaranteed as different manufacturers vary considerably. However, you are advised to bring a support bra with you and this should be the desired size or one size larger, which allows for any swelling. This swelling should settle within two weeks of your surgery.

It is recommended that you wear a support bra for 2 weeks (24/7) after your operation, and then daily for 6 weeks. You will have dressings applied which allow you to shower or wash and dab dry.

You will have a follow up consultation with the nurse after 1 week for a wound check and you can contact the breast care nurse at any time. You will be seen in the out-patient clinic for post-operative consultation after two weeks.

Gradual increase of activity is advised after the surgery, with light activity for the first two weeks. Internal stitches take time to dissolve whilst the tissues are healing. Usually it takes about 6 weeks to get back to normal activity.

Scar healing can be improved by gentle massage / application of moisturiser or Bio-Oil.

If you have any questions, please do not hesitate to ask your surgeon or breast care nurse.