Breast Reduction

Description

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight - from neck and back pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. Unusually large breasts can make a woman - or a teenage girl - feel extremely self-conscious. Breast reduction 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 to the rest of her body.

Breast reduction is usually performed for physical relief rather than simply for 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 is not 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 breastfeed.

Surgical Procedure

Breast reduction is done in a hospital as an inpatient procedure. The surgery itself usually takes 2 to 4 hours, but may take longer in some cases. The patient remains in the hospital 2 to 3 days.

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.

Recovery

After surgery, the breasts are wrapped in an elastic bandage or placed in 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.

Some pain may be experienced for the first couple of days, and some discomfort for a week or more. The bandages will be removed a day or two after the surgery, though the patient will continue to wear the surgical bra around-the-clock for several weeks, until the bruising and swelling subside.

The stitches will be removed in one to three weeks. The breasts may occasionally ache for a couple of weeks and the patient should avoid lifting or pushing anything heavy for three to four weeks.

Most women can return to work (if it is not too strenuous) and social activities in about two weeks. Sex should be avoided for a week or more, since sexual arousal can cause the incisions to swell, and anything but gentle contact with the breasts should be avoided for about six weeks. A small amount of fluid draining from the surgical wound, or some crusting, is normal.

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before the breasts settle into their new shape. Even then, their shape may fluctuate in response to hormonal shifts, weight changes, and pregnancy.

It is 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 usually can be placed so that the patient can wear even low-cut tops. Of all plastic surgery procedures, breast reduction results in the quickest body-image changes.

Questions to Ask Your Doctor

Do you recommend breast reduction?

What can be expected in terms of reduction? Can you express this in bra size?

Do you have "before and after" photographs of patients?

Will the procedure clear up the problems such as skin irritation and shoulder pain?

How will the surgery be performed?

What are the risks and possible complications?

Will a blood transfusion be needed?

How long will recovery take?