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If you're considering breast reduction...
Women with very large, pendulous breasts may experience a
variety of medical problems caused by the excessive weight-from
back and neck pain and skin irritation to skeletal deformities
and breathing problems. Bra straps may leave indentations
in their shoulders. And unusually large breasts can make a
woman-or a teenage girl-feel extremely self-conscious.
Breast reduction, technically known as reduction
mammaplasty, is designed for such women. The procedure removes
fat, glandular tissue, and skin from the breasts, making them
smaller, lighter, and firmer. It can also reduce the size
of the areola, the darker skin surrounding the nipple. The
goal is to give the woman smaller, better-shaped breasts in
proportion with the rest of her body.
If you're considering breast reduction, this
will give you a basic understanding of the procedure- when
it can help, how it's performed, and what results you can
expect. It can't answer all of your questions, since a lot
depends on your individual circumstances. Please be sure to
ask your doctor if there is anything about the procedure you
don't understand.
THE BEST CANDIDATES FOR BREAST REDUCTION
Breast reduction is usually performed for physical relief
rather than simply cosmetic improvement. Most women who have
the surgery are troubled by very large, sagging breasts that
restrict their activities and cause them physical discomfort.
In most cases, breast reduction isn't performed
until a woman's breasts are fully developed; however, it can
be done earlier if large breasts are causing serious physical
discomfort. The best candidates are those who are mature enough
to fully understand the procedure and have realistic expectations
about the results. Breast reduction is not recommended for
women who intend to breast-feed.
ALL SURGERY CARRIES SOME UNCERTAINTY
AND RISK
Breast reduction is not a simple operation, but it's normally
safe when performed by a qualified plastic surgeon. Nevertheless,
as with any surgery, there is always a possibility of complications,
including bleeding, infection, or reaction to the anesthesia.
Some patients develop small sores around their nipples after
surgery; these can be treated with antibiotic creams. You
can reduce your risks by closely following your physician's
advice both before and after surgery.
The procedure does leave noticeable, permanent
scars, although they'll be covered by your bra or bathing
suit. (Poor healing and wider scars are more common in smokers.)
The procedure can also leave you with slightly mismatched
breasts or unevenly positioned nipples. Future breast-feeding
may not be possible, since the surgery removes many of the
milk ducts leading to the nipples.
Some patients may experience a permanent loss
of feeling in their nipples or breasts. Rarely, the nipple
and areola may lose their blood supply and the tissue will
die. (The nipple and areola can usually be rebuilt, however,
using skin grafts from elsewhere on the body.)
PLANNING YOUR SURGERY
In your initial consultation, it's important to discuss your
expectations frankly with your surgeon, and to listen to his
or her opinion. Every patient-and every physician, as well-has
a different view of what is a desirable size and shape for
breasts.
The surgeon will examine and measure your breasts,
and will probably photograph them for reference during surgery
and afterwards. (The photographs may also be used in the processing
of your insurance coverage.) He or she will discuss the variables
that may affect the procedure-such as your age, the size and
shape of your breasts, and the condition of your skin. You
should also discuss where the nipple and areola will be positioned;
they'll be moved higher during the procedure, and should be
approximately even with the crease beneath your breasts.
Your surgeon should describe the procedure
in detail, explaining its risks and limitations and making
sure you understand the scarring that will result. The surgeon
should also explain the anesthesia he or she will use, the
facility where the surgery will be performed, and the costs.
(Some insurance companies will pay for breast reduction if
it's medically necessary; however, they may require that a
certain amount of breast tissue be removed. Check your policy,
and have your surgeon write a "predetermination letter"
if required.)
PREPARING FOR YOUR SURGERY
Your surgeon may require you to have a mammogram (breast x-ray)
before surgery. You'll also get specific instructions on how
to prepare for surgery, including guidelines on eating and
drinking, smoking, and taking or avoiding certain vitamins
and medications. Some surgeons suggest that their patients
diet before the operation.
Breast reduction doesn't usually require a
blood transfusion. However, if a large amount of breast tissue
will be removed, your physician may advise you to have a unit
of blood drawn ahead of time. That way, if a transfusion should
be needed, your own blood can be used.
While you're making preparations, be sure to
arrange for someone to drive you home after your surgery and
to help you out for a few days if needed.
WHERE YOUR SURGERY WILL BE PERFORMED
Breast reduction surgery may be performed in a hospital, an
outpatient surgery center or an office-based surgical suite.
If you are admitted to the hospital, your stay will be a short
one. The surgery itself usually takes two to four hours, but
may take longer in some cases.
TYPE OF ANESTHESIA
Breast reduction is nearly always performed under general
anesthesia. You'll be asleep through the entire operation.
THE SURGERY
Techniques for breast reduction vary, but the most common
procedure 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 excess
glandular tissue, fat, and skin, and moves the nipple and
areola into their new position. He or she then brings the
skin from both sides of the breast down and around the areola,
shaping the new contour of the breast. Liposuction may be
used to remove excess fat from the armpit area.
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 into a higher position.
(This will result in a loss of sensation in the nipple and
areolar tissue.)
Stitches are usually located around the areola,
in a vertical line extending downward, and along the lower
crease of the breast. In some cases, techniques can be used
that eliminate the vertical part of the scar. And occasionally,
when only fat needs to be removed, liposuction alone can be
used to reduce breast size, leaving minimal scars.
AFTER YOUR SURGERY
After surgery, you'll be wrapped in an elastic bandage or
a surgical bra over gauze dressings. A small tube may be placed
in each breast to drain off blood and fluids for the first
day or two.
You may feel some pain for the first couple
of days-especially when you move around or cough-and some
discomfort for a week or more. Your surgeon will prescribe
medication to lessen the pain.
The bandages will be removed a day or two after
surgery, though you'll continue wearing the surgical bra around
the clock for several weeks, until the swelling and bruising
subside. Your stitches will be removed in one to three weeks.
If your breast skin is very dry following surgery,
you can apply a moisturizer several times a day, but be sure
to keep the suture area dry.
Your first menstruation following surgery may
cause your breasts to swell and hurt. You may also experience
random, shooting pains for a few months. You can expect some
loss of feeling in your nipples and breast skin, caused by
the swelling after surgery. This usually fades over the next
six weeks or so. In some patients, however, it may last a
year or more, and occasionally it may be permanent.
GETTING BACK TO NORMAL
Although you may be up and about in a day or two, your breasts
may still ache occasionally for a couple of weeks. You should
avoid lifting or pushing anything heavy for three or four
weeks.
Your surgeon will give you detailed instructions
for resuming your normal activities. Most women can return
to work (if it's not too strenuous) and social activities
in about two weeks. But you'll have much less stamina for
several weeks, and should limit your exercises to stretching,
bending, and swimming until your energy level returns. You'll
also need a good athletic bra for support.
You may be instructed to avoid sex for a week
or more, since sexual arousal can cause your incisions to
swell, and to avoid anything but gentle contact with your
breasts for about six weeks.
A small amount of fluid draining from your
surgical wound, or some crusting, is normal. If you have any
unusual symptoms, such as bleeding or severe pain, don't hesitate
to call your doctor.
YOUR NEW LOOK
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, their
shape may fluctuate in response to your hormonal shifts, weight
changes, and pregnancy.
Your surgeon will make every effort to make
your scars as inconspicuous as possible. Still, it's 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 can wear even low-cut tops.
Of all plastic surgery procedures, breast reduction
results in the quickest body-image changes. You'll be rid
of the physical discomfort of large breasts, your body will
look better proportioned, and clothes will fit you better.
However, as much as you may have desired these
changes, you'll need time to adjust to your new image-as will
your family and friends. Be patient with yourself, and with
them. Keep in mind why you had this surgery, and chances are
that, like most women, you'll be pleased with the results.
Back to Procedures
Information provided by American
Society of Plastic Surgeons. |
