Breast Reduction

This is most beneficial for women in good physical and mental health, who have reasonable expectations of surgery that will decrease the size of their breasts 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.

There is a theoretical increased risk that breast feeding may not be possible. 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.

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. 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. This is rare and more likely, in larger reductions. 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.

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.

Cancer screening may be more complicated after reduction surgery, however, if women over 35yrs have a base-line mammography before surgery and then again after their breast lift has settled (around 6 months later) there is unlikely to be a problem.

I will take a full medical history, including any breast disease, surgery, or family history. If you have had mammograms, please bring along the results. We will discuss your desired breast size and shape and anything else related that you feel is important.

You will have a full examination with the focus on your breasts to assess their size, symmetry and shape and the quality of their surrounding skin. I will take photographs to plan your surgery and measure you for a sports-type bra, which will be used as a comfortable dressing over your surgical dressings after your operation.

Feel free to 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.

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 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.

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

On the evening prior or the morning of your operation I will review what we have discussed, and we will both sign your operation consent forms. I will then measure and draw guidance marks for surgery on your chest and breasts.

The operation usually takes around 3 hours depending on the technique used and is performed under General Anaesthetic so you will be asleep. After surgery, you will awake in a recovery area and soon afterwards be taken to your room. 

A drain is placed under the incision in each breast to remove normal healing fluid. These are usually removed after a day or two and you can then shower normally. 

Most patients go home a day or two after surgery on simple pain-relieving medications and a short course of antibiotics.

You will feel tired and sore for a week or two, but you will be able to move around and function relatively normally. You won’t need stitches removed as these will dissolve.

You can usually return to work after 3 – 4 weeks, however if your work involves heavy lifting/ is strenuous, then 6 – 8 weeks might be realistic. So long as you can do so carefully, 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.

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 alone.

They should be protected from sunlight for 2 years to avoid them pigmenting differently to the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed to any sun. Your scars will continue to mature for up to a year.

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

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