The size of a woman’s breast is determined by genetical factors, body weight and hormonal influence. Some women have overtly large breasts that cause both physical and psychological symptoms. They can present at either end of the age spectrum from adolescence to middle age or even after the menopause. They often complain of backache, neck pain, breast pain and quite often an inability to participate actively in sports. They also have difficulty in finding the correct fit for their clothes and brassiere. Large breasts can also attract unwanted attention, comments and sexual innuendos from the opposite sex with some women experiencing some psychological distress.
Breast reduction surgery aims to decrease the fatty, glandular and skin component of the female breast to a more proportional size to the patient’s overall appearance. The nipple areolar complex (NAC) are also reduced during the surgery and repositioned to a higher level. It is of the utmost important to protect the viability of the NAC during breast reduction surgery to preserve its sensation. Usually women who undergo breast reduction surgery will not be able to breast feed in the future. This is because the nipple areolar complex is separated from the underlying glandular tissue during the surgery. Breast reduction surgery entails surgical scars around the NAC and down the middle of the breasts to the breast crease. In some larger breasts the scars could also go along the breasts crease. The scars will be red and firm initially but will become pale and softer with time.
During the initial consultation, patients will have the opportunity to discuss their goals and desirable results with the plastic surgeon. Every patient is different, therefore a specific treatment regimen is planned to suit an individual’s need.
PROCEDURE
Breast reduction surgery is performed under general anaesthesia and usually takes about 3-4 hours. The surgeon makes incisions based on the planning before the surgery. The incision usually goes around the areolar and down the breast to the breast crease. The size of the areolar is reduced and skin and breast tissue are removed. The nipple areolar complex is then repositioned to a higher level and the remainder of the breast tissue sculpted to the desired size and shape. When the surgeon is satisfied with the proportions, a drain is inserted in the surgical wound and the wounds closed with sutures.
Once the procedure is completed, a light dressing and antibiotic ointment will be applied to the incision site. The wounds will be dressed and the breasts taped to preserve its shape. The drains are usually kept for 1-2 days or until the fluid coming out is minimal. On discharge the surgeon will advise you on how to take care of the wounds at home and you will be given a follow-up appointment.
CANDIDATES
- Generally healthy individuals .
- Concern about overly large breasts.
- Physical symptoms (neck pain, back pain etc) or physical limitations due to the size of the breasts.
- Long and pendulous breasts causing skin stretching and areolar enlargement.
- Skin irritations and rashes in the breasts crease due to overly large and pendulous breasts.
- Unequal size or positioned breasts.
- Non smoker.
RISKS
Although serious complication from breast reduction surgery is uncommon, potential candidates should understand that every procedure comes with it a certain risk and has a recovery period (down time). Preoperative preparation and postoperative care will help to minimize their incidence.
The more common complications from breast reduction surgery are:
- Bleeding (primary or secondary)
- Swelling
- Bruising
- Infection
- Poor wound healing (especially in smokers)
- Loss or decrease sensation of the nipple areolar complex
- Scarring
- Skin discoloration
- Asymmetry and unevenness of skin and breast contour.
- Possibility of loss of nipple areolar complex, skin and breast tissue.
- Revision surgery
- Anaesthesia risks
- Fluid accumulation
These risks mentioned above can be minimized if proper preoperative and postoperative instructions are adhered strictly.
PRE-OPERATIVE PREPARATION
- Stop all non-medical supplements for at least one week before surgery.
- Stop taking any anti-inflammatory pain medications , blood thinning medications (anti-platelets, anti-coagulant), and aspirin one week before the procedure.
- All medical conditions (hypertension, diabetes, etc) need to be optimized prior to surgery.
- Smokers need to stop smoking well in advance.
- Some individuals might require prior blood investigation or further medical assessment.
POST-OPERATIVE
After the surgery, there will be some swelling, bruising, discomfort, numbness and discoloration that can be controlled with oral medications, cold compression and ointments. The swelling and bruising usually last between 2-3 weeks but in some patients, this can last longer. Patients are adviced to wear a support bra for 6 weeks, this will help support the breasts during the healing process. There should not be any intense physical exercise for at least 2 weeks.
Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively. Stitches will be removed about 7-10 days after the surgery. The result of surgery will appear within several weeks, but it may take up to a year for the scar to fully mature.
CARE
- Cold compression with ice pack the first day after surgery.
- Wear sport bra (no underwire bra) for 4-6 weeks after surgery.
- Bed rest with arms elevated to reduce swelling first few days.
- Avoid strenuous arm activities and swimming for at least 2 weeks.
- Regular antibiotic ointment on the surgical wounds.
- Finish taking oral medications prescribed.
