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Breast Reduction

Breast reduction

Base-line information you need to know about breasts in order to make the informed choices if you are considering cosmetic surgery to your breasts

It is important to realise several facts:

  • Most women have one breast larger than the other.
  • Most women have one breast that sits lower on the chest wall than the other.
  • Breasts are composed of a mixture of fat and glandular tissue. The glandular tissue (the part which secretes breast milk) weighs more than the fat so the larger the proportion of glandular tissue your breasts have the heavier they are and the more they will droop without support.
  • Breast fat increases and decreases in tandem with variations in body fat generally.
  • Breast glandular tissue increases and decreases in tandem with variations in female hormones (for instance before and after menstruation and pregnancy).

Armed with these pieces of information, you will find it much easier to decide whether this operation is for you, and which variant of this operation will suit you best.

Breast reduction

Breast reduction is an operation in which breast tissue (mixture of fat and glandular tissue) and excess breast and areolar skin are removed from the breast mounds to leave you with smaller, firmer breasts.

Commonly asked questions about breast reduction

  • Am I a good candidate for breast reduction surgery?
  • Will I be able to breast feed after having my breasts reduced?
  • Can surgery affect my nipples?
  • Will breast reduction affect my risk of getting breast cancer?
  • Will breast reduction affect me when I need to participate in breast screening?
  • What should I expect from my consultation?
  • How is the surgery performed?
  • What does my operation involve?
  • What about my recovery and return to normal activities?

Am I a good candidate for breast reduction surgery?

This is best decided during a consultation, but generally speaking this operation is beneficial for women in good physical and mental health, who have reasonable expectations of surgery that will decrease the size of their breasts in order to try and improve various problems, which may include:

  • Aching in your upper back and neck
  • bra strap grooves in the skin of your shoulders
  • inability to exercise due to the weight and size of your breasts
  • embarrassment during day-to-day social interactions (comments; leering; men talking to your breasts rather than you)
  • an inability to find clothing that fits you
  • having one breast which is markedly larger than the other

Will I be able to breast feed after having my breasts reduced?

After breast reduction surgery there is at least a theoretically-increased risk that breast feeding may not be possible. Whether or not there is an increased incidence of women becoming unable to breast feed after breast reduction surgery is contentious. Several studies suggest the ability to breast feed after reduction surgery is equivalent to an age-matched population of women who have not had surgery. The techniques I use should maximise your ability to breast feed, if your breasts were going to be able to feed anyway. I always advise that you should expect not to be able to, but that you may well be pleasantly surprised. If the ability to breast feed is vital to you, you should complete your family before having surgery.

Can surgery affect my nipples?

Nipple sensation may decrease (in up to 10% and most likely with large reductions) or transiently increase and become extra sensitive (again, paradoxically more likely in larger reductions for different reasons).

Altered nipple sensation results from nerve damage. Decreased sensation occurs when nerves that travel through the breast are damaged. Techniques used for reduction endeavour to avoid this, but in a proportion of cases this is an unpredictable outcome. Nipple sensation may increase in patients who had very little sensation before their surgery and this may be because the nerves transmitting sensory information to the brain had been overly stretched by the weight of heavy breasts and recover after reduction and then “over signal” to the brain for a while until they adjust.

The blood supply to the nipple and areolar skin may be compromised and part or all of one or both nipple-areolar complexes may die as a rare complication of breast reduction surgery. Complete or partial loss of one or both nipple-areolar complexes is a rare complication. It is more likely, in larger reductions and so in those at risk, the decision is usually taken to surgically remove the area and re-place it as a graft, which paradoxically this gives the nipple-areolar complex a better chance of complete survival in patients undergoing large reductions.

Nipple-areolar complex loss is also more likely in people who smoke or have disease affecting the small blood vessels to the skin

Finally, the colour of nipple-areolar complexes may lighten or darken after surgery: this is more likely in dark skinned races or after infection.

Will breast reduction affect my risk of getting breast cancer?

No. It has been suggested that smaller breasts have less glandular tissue and therefore, fewer cells which might mutate to form a cancer. There is no good science to back the suggestion. For women with a genetic tendency towards breast cancer (carriers of the BRCA1 & 2 genes), then skin-sparing mastectomy may be indicated rather than breast reduction.

Will breast reduction affect me when I need to participate in breast screening?

Cancer screening may be more complicated after reduction surgery in so far as damage to fat and alteration of the breasts’ architecture may make interpreting mammograms harder. Generally, if women over 35-years-old have base-line mammography before surgery and then again after their breast reduction has settled at say, 6 months after the operation, to give a Radiologists the potential for comparison later, there is unlikely to be a problem.

What should I expect from my consultation?

During your consultation, I will take a full medical history. I will ask you specifically about any breast disease you have suffered, as well as any previous surgery you may have undergone and about your family’s history of breast diseases such as cancer. If you have had mammograms, I will need to know the results. I will also ask about your desired breast size and shape and anything else related to the appearance of your breasts that you feel is important.

I will examine you completely, then focus on your breasts to assess their size, symmetry and shape and the quality of their skin envelope. I will then take standardised photographs in order to help plan and discuss your operation. Finally I will measure you for a sports-type bra which you will choose and bring with you to be used as a comfortable dressing over your surgical dressings in the days immediately after your surgery.

By all means bring pictures from magazines to show me examples of women who seem to have breasts of a size that equate with your desired breast size – these will be useful in discussion.

How is the surgery performed?

All the techniques I use for breast reduction have aspects in common and these are:

  • Removal of both excess breast tissue and excess breast and areolar skin
  • Moving the nipple and remaining areolar skin to a new position on the breast.

The common aim of all techniques is to produce as predictable, stable and aesthetic a breast shape for you as possible.

The aspects of these techniques that I vary depending on your breasts’ size, shape, symmetry, skin tone and degree of ptosis (droop) are:

  • Incisions – which I will make as minimal as is compatible with providing you with a predictable stable and aesthetic a breast shape.
  • Nipple -areolar attachment – I will always endeavour to maintain the nipple and areolar skin attached to breast tissue beneath it but on occasions (for instance when very large volume reduction is necessary or very droopy breasts are being reduced) it may be necessary to surgically remove the nipple and areolar skin and re-attach it as a skin graft (which generally results in lost nipple sensation).
  • On occasion I may use liposuction to remove fat from the armpit area.

What does my operation involve?

Before surgery, you will meet and be assessed by your anaesthetist who will prescribe medications for your comfort and to lessen anxiety if need be.

On the evening before, or the morning of your operation I will review what we have discussed and planned previously and we will both sign your operative consent forms. Then I will measure and draw guidance marks for surgery on your chest and breasts with you sitting upright.

The operation is performed under General Anaesthesia – you will be asleep. The operation usually takes 3 hours or so, depending on the technique used. After surgery, you will awake in a recovery area and soon afterwards you will be returned to your room. A drain is placed under the incision in each breast to remove the normal healing fluid that the body produces and stop it accumulating within your reduced breasts. These drains will be removed when the drainage is minimal – usually after a day or two and once they have been removed you can shower normally. Most patients go home a day or two after surgery on simple pain relieving medications and a short course of antibiotics.

What about my recovery and return to normal activities?

You will feel tired and somewhat sore for a week or two following your surgery, but you will be able to move around and function relatively normally.

You will have buried, soluble stitching which will dissolve and doesn’t need to be taken out.

Generally, you can return to work if your occupation is sedentary, after 3 – 4 weeks, but if your work involves heavy lifting or is strenuous in other ways, for instance women police officers, 6 – 8 weeks might be a more realistic period off work. So long as you can do so with due care and attention, you can begin driving 3 – 4 weeks after surgery.

You should restrict yourself to light exercise for 2 – 3 weeks – avoiding lifting anything over 5Kg and aerobic exercise for at least 3 weeks.

Your breasts will be swollen for at least 6 – 8 weeks, but at that stage your new breasts will have attained almost their final appearance. Your final operative result will continue to mature for 3-6 months and your scars will continue to mature for up to a year.

New scars benefit from friction-free massage (using vaseline, for instance, to lubricate the massaging process). Beginning to massage scars two to three weeks after surgery, will help them mature, soften and flatten faster than if left to their own devices. New scars should be protected from sunlight for 2 years to avoid them pigmenting differently from the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed – even to a British winter sun.

In the longer term, final size, shape, symmetry and aesthetic result of breasts after reduction surgery will vary according to individual factors which are due to genes, life style, life events and gravity. After surgery, lack of support, alterations in weight or hormonal variation may alter your breasts’ appearance and symmetry markedly.