Breast Reduction

Large breasts can cause problems in many aspects of a woman's life. In some cases, it may even be difficult to find a properly fitting bra. Often, women with large breasts feel very self-conscious. The actual weight and bulk of the breasts may cause physical problems and symptoms that compound the feeling of unattractiveness. There can be a feeling of uncomfortable fullness, neck or back pain, and shoulder grooving. These symptoms may contribute to limited performance in certain occupations and in sports. Finally, large breasts can also be difficult to assess for lumps or masses, thus making cancer detection more difficult for the patient or for her physician.

The goal of breast reduction is to reduce, re-contour and reshape the breasts. The breasts are made smaller. The nipple areola complex is repositioned upward, and if indicated, reduced in size. Excess skin and breast tissue is removed primarily from the lower and outer portions of the breast.

In some cases, patients choose to have some of the saggy breast tissue that has been removed replaced with breast implants. This operation helps to provide better fullness in the upper breast. While it may seem strange that a patient who is having surgery to remove breast volume would choose to consider an implant, the combination can work well in patients whose primary concern is sagging related to excess volume. When considering this operation, patients should carefully read the information on breast augmentation as well as this information. Patients who have extremely large breasts or require reduction for improvement of symptoms such as pain related to their large breasts are typically not good candidates for simultaneous placement of implants.

A preoperative plan is made which allows both the surgeon and the patient to share in the decision as to the proposed size of the breast after surgery. The surgeon will attempt to make the breasts as identical as possible, but some asymmetry may remain. Furthermore, it is not possible to predict exactly how large the breast will finally be after surgery. Healing results in some progressive change in breast size since some swelling may be present for several months following surgery.

Procedure

The procedure is typically performed under general anesthesia in an outpatient surgery center. Thus, you can go home after the procedure and follow up the next day. Incisions are made in the lower breast resulting in three scars: one around the nipple, which usually heals very nicely; a vertical incision from the nipple to beneath the breast, which remains visible; and finally, an incision in the fold beneath the breast.

Breast tissue is sculpted using a combination of sharp dissection and occasional liposuction. The nipple remains attached to the deeper breast tissue. The remaining breast is folded around the nipple and its attachments and the incisions are closed with dissolvable sutures. The breasts are dressed with cloth tape and a compression garment.

Recovery

Your breasts will be bruised, swollen, and you may experience some mild discomfort for a couple of days. The pain is generally well controlled with oral pain medication. In the recovery stage, it is important to wear the bra at all times until otherwise directed.

Patients follow up on post operative day one for general re-evaluation and then at one week. At that post operative visit, the cloth tape is removed and replaced with flesh colored dressing tape which falls off on its own with in the following week. Your incisions will be noticeable immediately following surgery but they will gradually fade and flatten for up to a year after surgery. If your skin has a lot of stretch marks or is extremely thin, this is a sign of poor skin elasticity. Patients with poor skin elasticity may be more prone to widening of the scar after surgery. A small percentage of patients will require a scar revision to improve the appearance of the scars. Your skin will also be firm and numb at the outset. It will soften and normal sensation will return gradually over the following weeks to months.

Recovery is generally one to two weeks. It is important to limit lifting weight and lifting your arms above your shoulders as much as possible the first two weeks. Patients usually return to light activity within two to three days after surgery. Full activity is resumed within two or three weeks but no vigorous bouncing type activities (jogging or horseback riding) are recommended for 6 weeks. Although the breasts usually look good almost immediately after surgery, there is an improvement in the shape over the following several months. Breast reductions can cause a “boxy” look to the breast for the first couple months. With patience, the breasts will eventually round out at the inferior pole giving a natural look.

Possible Complications

There are potential complications associated with having any surgery including bleeding, prolonged bruising and swelling, infection, temporary or permanent numbness, weakness and unfavorable scarring as previously mentioned. Other possible complications are asymmetry of the breasts or nipples.

Infection or collections of blood or fluid in the wound may delay recovery and could result in skin loss, fat wasting or pronounced scarring. This could result in the need for additional corrective surgery. The blood supply to the skin may be compromised or damaged as a result of the surgery which could lead to wound breakdown or skin or nipple loss. If this happens and the wound does not heal favorably on its own, a scar revision or skin graft may be needed.

Although these complications are relatively rare, wound problems are much more likely with patients who smoke, especially wound breakdown and nipple loss. Therefore, we require patients who use tobacco products to completely quit for a minimum of four-to-six weeks before and after breast lift surgery.

Because some milk ducts are disrupted during the surgery you may not be able to breastfeed following the surgery. Some women successfully breastfeed after having the surgery but this is difficult. For best results, follow your physician’s advice both before and after surgery.

Breast reduction is an operation that is enjoying a rapid increase in popularity. For the proper patient, it is a very gratifying procedure. Not only can it help patients to improve self-esteem, it can be of significant benefit is the treatment of neck, back and shoulder pain related to large heavy breasts.