Breast Reduction

Overview

Breast reduction surgery (or reduction mammoplasty) is a procedure to reduce the size of the breasts. The surgery is usually performed on women with overly large, pendulous breasts who suffer from back or neck pain, shoulder grooving from bra straps, or irritation or rashes under the breasts. Overly large breasts can also interfere with sports and exercise, as well as bring about feelings of self- consciousness. Breast reduction surgery can alleviate these and other problems by removing portions of the breast skin, glands, and fat; making them smaller, lighter and firmer. It can also reduce the size of the areola, the darker skin around the nipple. The goal is to give the woman smaller, better shaped breasts in proportion with the rest of her body. Multiple scars will remain after the procedure. Though the results of this surgery are partially cosmetic, the procedure can help women pursue many activities they were previously unable to perform. Of all types of plastic surgery, women who have breast reduction are usually the most satisfied with the outcome.

According to the American Society of Plastic Surgeons, over 113,000 women underwent breast reduction surgery in 2003. It has become one of the fastest growing areas of breast reconstruction; less than 40,000 women opted for the surgery in 1992. Those most likely to undergo the procedure are women between the ages 19 to 50. Though the procedure is usually performed on women whose breasts have fully developed, occasionally teenage girls undergo breast reduction if their breasts are causing severe physical discomfort. Many women will wait to have the surgery until after they have had children, as breasts tend to shrink after pregnancy and nursing. Breast reduction surgery may also interfere with a woman’s ability to breast-feed.

Breast reduction is not a simple operation, but it is normally safe when performed by a qualified plastic surgeon. As with any surgery, there is the possibility of complications; including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery that can be usually be controlled with antibiotic creams. You can reduce your risk for complications by closely following your physician’s advice both before and after surgery.

The surgery does leave noticeable, permanent scars, although your bra or bathing suit easily covers them. (Poor healing and wider scars are common in smokers.) Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola area may lose their blood supply and the tissue will die (Again, this can happen as a by-product of smoking).

At your initial consultation, it is important to discuss your expectations frankly with your plastic surgeon, and listen to his or her opinion. Every patient, as well as, every plastic surgeon, has a different view of what is a desirable size and shape for the breasts. Your plastic surgeon will examine and measure your breasts, and will probably take pictures of them for reference during surgery and afterwards. He will discuss some of the variables that may affect the procedure, such as your age, the size and shape of your breasts, and the condition of your skin. He will also discuss the repositioning of the nipple and areola, because they will move higher during the surgery.

Breast reduction is performed under general anesthesia. You will be asleep throughout the entire surgery. The techniques for this surgery vary, but all include an incision and scar around the areola. One of the most common procedures involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes glandular tissue, fat and skin, and moves the nipple and areola into their new position. Then, the skin from both sides of the breast is brought down and around the areola, shaping the new contour of the breast. In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted to a higher position. Grafting always results in the loss of sensation in the nipple and areola area.

After the surgery, you will wear a sports bra over gauze dressings. A small tube attached to a fluid collector may be placed to the side of each breast to drain off blood and fluids for the first several days. The bandages will be removed a day or two after the surgery, but you will continue to wear a sports bra around the clock for several weeks, until the swelling and bruising subside. Sometimes the stitches will dissolve; at other times your stitches will be removed in one to three weeks. It is normal to have a small amount of drainage and crusting at the suture lines for several weeks.

You may feel some pain for the first few days, especially when you move around or cough, and some discomfort for a week or more. Your surgeon will discuss pain management with you. Although you may be up and about after several days, your breasts may ache for a couple of weeks. You should not lift or push anything over 5 pounds for three to four weeks. There is also the likelihood of fatigue and a loss of stamina in the first few weeks after surgery. It important to rest in order to allow your body to heal. Your surgeon will give you detailed instructions for resuming your normal activities. As a guideline: most women can return to work (if it is not too strenuous) and social activities in about two weeks. You should limit your exercises to stretching, bending and swimming until your energy returns. It is also very important you wear a supportive sports bra.

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, they may fluctuate in response to your hormonal shifts, weight changes, or pregnancy.

Your plastic surgeon will make every effort to make your scars as inconspicuous as possible. However, it is important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you are able to wear even low-cut tops.

A final thought: as much as you have desired these new changes in your breasts and body image, it is important to remember you will need time to adjust to your new shape - your family and friends will be adjusting as well. Be patient with yourself, and with them. Keep in mind why you had this surgery, and allow emotions to settle down. Chances are that, like most women, you will be pleased with the results.