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Beauty Confidence Style & Satisfaction

BREAST REDUCTION INFORMATION

Breast reduction operations are designed to reduce the breast in size. Breast reduction is often requested by patients who are experiencing chronic back and neck pain, or shoulder pain where the bra straps are cutting in. Often, they do not like to participate in exercise or aerobics due to discomfort while exercising and often do not like to take their children swimming due to embarrassment. Many patients also find difficulty in getting clothes to fit or are embarrassed about the size of their breasts in public. A well performed breast reduction will deal with these problems. Breast reduction operations consistently record the highest patient satisfaction score in all plastic surgery procedures.

There has been several different breast reduction operations described in the medical literature. Essentially, all of these operations work by excising the extra breast tissue and reshaping the skin around the new smaller breast with repositioning of the nipple. In addition, they can be used to correct any mild asymmetry that may exist between the two sides.

Before the operation

There is nothing special or complicated to be done by the patient. It is a good idea before the operation to have discussed what size of new breast you wish. Giving the surgeon an estimate beforehand helps in the sculpting of the breast during the operation, although no guarantee of exactly what bra size is possible. If you are on the oral contraceptive pill you should continue to keep taking it, and inform your surgeon and anaesthetist in the hospital. If you smoke it would be advised to stop for a month before and at least two weeks after as this will improve wound healing and your post-operative recovery. It is a good idea to buy a soft sports bra (without wire) about C or D cup and bring it to the hospital with you. In addition, it would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.

The surgery

You will come into the hospital on the morning of surgery. The surgeon will then draw on your breasts with a pen to help with the planning of the procedure. The operation to remove breast tissue is performed under general anaesthetic and takes about 3 hours. The excised breast tissue is routinely sent to pathology for examination under the microscope to exclude any sinister disease - finding any nasty surprises is fortunately rare but cancers are found in approximately 0.5% of tissue removed after breast reduction surgery. The remaining breast tissue and skin are then re-shaped, the nipple repositioned, and the incisions closed with dissolvable stitches. A drain may be placed in each side at the end of surgery.

Post-operative follow-up and after care.

You will need to stay in hospital overnight and possibly for two nights after the operation. The following day the drains will be removed, and a lighter dressing applied. If it is appropriate you can go home with some painkillers. It is import to leave the dressing alone and wear the sports bra day and night. At between 5 and 7 days you will be seen in the clinic and the dressings removed and the wounds checked. After about 2 weeks you will be guided to massage the scars twice a day with simple moisturiser. It is important to rest and take it very easy for at least 2 weeks after the operation. You will be advised to take 2 weeks off work and it is essential to avoid all sexual activity during this period. The sports bra needs to be worn day and night for a month in total as it helps to mould the breast into shape. Vigorous sport such as jogging or the gym should be avoided for 6 weeks. A check up clinic appointment at 3 months after the surgery will be arranged for you.

Possible Complications

All operations carry a risk of complications, although in breast surgery serious complications are rare. It is impossible to perform breast reduction surgery without putting scars on the breast. There are always scars around the new nipple. Depending on which technique is used you may have a scar in the fold under the breast, and a vertical scar connecting this to the nipple scar. Alternatively, you may just have a vertical scar below the nipple. Sometimes the scars on the breast may be red and lumpy for a few months but these usually settle down by themselves. Some patients do get unfavourable scars despite very neat stitching at the time of surgery. We do not fully understand why some patients scar better than others and it is impossible to predict which patients are going to generate poor scars. Fortunately, most scars improve with time and this process of scar maturation may be helped by silicone gel pads.

The risk of infection post-operatively is about 5 %, and usually responds to antibiotics. Such problematic infections are usually related to "fat necrosis" that has occurred deep within the breast tissue when the blood supply to some of the breast tissue has not been sufficient. A haematoma is a collection of blood under the skin and if significant may need to be drained by returning briefly to the operating theatre. This is uncommon (also about 5%) and does not affect the final outcome. Precautions are taken to avoid both these problems developing by giving antibiotics at the time of surgery and by careful surgical technique.

Many patients will notice that they have reduced sensation in the nipple. This is likely to be permanent and is related to small nerves being divided during the operation. Breast reduction surgery usually makes it impossible to breast feed successfully, although this is not always the case in some patients. Patients who are overweight, or smoke heavily, or are diabetic may have problems with slow wound healing. If this occurs, the wounds are left to close on their own, helped by applying regular clean dressings. Very occasionally problems with wound healing may involve the nipple area causing the skin of the nipple to undergo necrosis and rarely total nipple loss.

As discussed under “Asymmetry” in “General Complications”, no two un-operated breasts are truly identical in size and shape. Likewise no two breasts will be truly identical after breast reduction surgery, although great care is taken during the operation to match the size and shape of both breasts. Perfect symmetry is always the aim but never achievable. It is important to remember that due to healing and resolution of post operative swelling, the final appearance of the breasts may take several months to develop and with time the shape continues to improve as a result of internal re-modelling of the breast tissue.

Plastic & Reconstructive Surgery

FACTS AT A GLANCE

SURGERY TIME
3 hours

HOSPITAL STAY
1-2 nights

ANAESTHETIC ASSESSMENT
Possibly

PRE ADMISSION TESTS
Yes

SLEEPING POSITION
Sleeping on back recommended for 2 weeks.

REASONABLY MOBILE
2 day

WASHING
Shower after 1 day. Bath only after 2 weeks.

DRIVING
2-3 weeks

SPORT & EXERCISE
6-8 weeks

SEXUAL ACTIVITY
Restricted after 4 weeks

FULL RECOVERY
6-8 weeks

TIME OFF WORK
2-3 weeks

BRAS & GARMENTS
Sports bra worn for 4 weeks