Breast Reduction

Breast reduction surgery has been performed on patients for more than 20 years but was not popularized until about 6 to 8 years ago. The rising popularity of breast reduction surgery is probably related to the growing trend for women to be more active and athletic socially, thus desiring less bulky breasts that might limit physical activity. In addition, identifying symptoms associated with breast reduction, such as upper back and neck pain and shoulder grooving, has resulted in insurance companies often covering this surgery. Modern breast reduction surgery has become among the top 6 reconstructive cosmetic surgery operations.

You may be a good candidate for breast reduction if you have/experience:

• breasts that are too large in proportion to your body
• breasts that are not the same size
• back, neck, or shoulder pain as a result of your breast size
• pendulous breasts with nipples and areolas pointing downward
• skin irritation under your breasts
• inability to participate in various physical activities as a result of your breast size
• dissatisfaction with your breast size.

Breast reduction surgery is typically recommended for women who have completed their breast development. However, breast reduction can be performed at a younger age in teenagers who experience unusual growth of their breasts, termed juvenile breast hypertrophy.

Breast reduction surgery can be performed with various techniques, but the procedure is almost always performed using general anesthesia. Usually, your plastic surgeon makes an incision similar in shape to an anchor or an inverted keyhole from the top of the nipple to the natural fold under the breast called the inframammary crease. Then, excess fat, skin, and tissue are removed, and the remaining skin and areola are repositioned. During surgery, the nipple and areola are connected to their sensory nerves and nutrient vessels and are moved up on the breast mound to correct nipple areola sagging. Although various techniques have been described and are performed routinely, all techniques result in a significant reduction of breast size and improved breast contour shape and nipple areola projection. Excess skin is trimmed around the nipple-areola complex, and the remaining breast tissue is tucked around the nipple-areola complex. The remaining skin on each side of the breast is moved around the nipple-areola complex to support their lifted position.

On your initial visit, your surgeon will evaluate your health status by obtaining blood work. If you are 40 years or older or if you have had a personal or family history of breast symptoms (tenderness, lumps, nipple discharge) you will have to obtain a mammogram. If you are a smoker, you should quit for 1 month prior to your breast reduction surgery to minimize the risks of implant infection. In addition, it is prudent to quit smoking for 6 weeks following surgery to ensure a well-healed surgical incision line. Finally, you will need to arrange for a friend or a spouse to care for any small children who may need to be lifted since you will be sore for the first couple days following surgery.

Since your surgery will require general anesthesia, you must take several precautions before surgery. First, you must avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated into your lungs during induction of anesthesia. Since you will have anesthetic medications administered throughout the case, you will remain groggy for several hours and require a ride to and from the surgery center. It would be best if you chose a conscientious caretaker who can spend the first night with you.

Breast reduction surgery can alleviate the symptoms associated with large breasts, such as back and neck pain, shoulder strain, skin irritation, poor posture, difficulty participating in strenuous sports activities, difficulty fitting in clothes, and self-consciousness created by dissatisfaction with your breast size. This procedure not only eliminates physical discomfort and limitations, but it can also improve the appearance of your breasts. As long as patients do not have significant weight gain or loss and do not become pregnant, they can enjoy a lifetime of comfortable and aesthetically pleasing breasts.

Since breast reduction surgery will require general anesthesia, it must be performed in an operating room that is part of a hospital institution or outpatient surgery center. Less frequently, patients may be operated on in an in-house office based operating room, but it is of utmost importance for patients to make sure that the office facility is accredited by a surgical accreditation body such as AAAASF.

Routine breast reduction surgery requires administering a general anesthetic to keep you asleep throughout the procedure.

After surgery, you will be taken into a recovery area, where you will be closely monitored. Awaking from surgery, you may find small drainage tubes placed in your breasts to avoid the accumulation of fluids. Gauze dressings will be placed on your breasts and covered with an elastic bandage or surgical bra that must be worn for about one week after surgery. You may also experience a loss of sensation in your breast and nipple area, which is usually temporary. The incisions and tissue movement involved in the surgery may cause your breasts to become sore, swollen, and bruised. Pain will be treated with medication prescribed by your plastic surgeon. Strenuous activity such as straining, bending, and heavy lifting is off-limits for 3 to 4 weeks. Your stitches will be placed internally, and externally you will find your incisions sealed with a sealant. Your incisions will remain red or pink for a few months after surgery. Your breasts will also require some time to assume a more natural shape.

Patients will have a full recovery within 4 to 6 weeks of surgery. Patients can return to work if it is not strenuous within two weeks of surgery. Patients will be allowed to wear a sports bra as early as two weeks following surgery and all routine undergarments following four weeks.

a) Numbness: Swelling after surgery usually results in loss of feeling in the breast and nipple area during the first several weeks. This impairment should be temporary and last no longer than a few months. In some cases, the loss of feeling can last longer or become permanent due to nerve damage, as some sensory nerves are too small to be detected by the naked eye during surgery.

b) Scarring: Incisions may be lumpy and red for a few months, but they become less apparent over time and usually fade to thin white lines. Healing scars can usually be covered completely by a bra or swimsuit top. Please note that smoking impedes healing and typically results in more prominent and prolonged surgical scars.

c) Breast/Nipple asymmetry: Breasts may not be the same size and shape, and nipples could be positioned unevenly depending on preoperative asymmetry. In general, symmetry is dramatically improved following breast reduction surgery.

d) Nursing problems: Women may not be able to breastfeed since the surgery removes a portion of the breast glands and milk ducts, leading to the nipples.

a) Hematoma: Hematoma refers to the accumulation of blood in the early postoperative period, which pools into a pocket. Hematomas provide a perfect medium for harboring the growth of bacteria. So if you have an infection anywhere in your body, the bacteria will travel through the bloodstream and grow in the hematoma; this can lead to an infection and an open wound. Drains can be placed in surgery to avoid a hematoma so any fluid accumulation can be drained. Drains are usually kept in place for 4 to 5 days. In addition, patients are checked preoperatively to ensure they do not have a blood clotting deficiency. If blood clotting deficiencies are detected, then these can be corrected.

b) Seroma: Seroma formation refers to the accumulation of plasma fluid in pockets created by surgical soft tissue elevation and disruption of lymphatic vessels. This fluid accumulates due to a low blood count and protein deficiency, which may be present in breast reduction patients. This fluid can be a nuisance to patients requiring several aspirations in the office before their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. Drains that can be placed in surgery effectively prevent seroma formation.

c) Infection: An infection rarely occurs after breast reduction surgery. An infection may result in disruption of surgical incision lines. It may leave the patient with an open breast wound, especially at the middle and inferior aspect of the breast mound over the inframammary crease line. Prolonged antibiotics and possible removal of antibiotics may be required to fight infection and prevent further extension of the infection. The risk of infections is avoided by using a sterile technique, intra-operative antibiotics, and sealing all incision sites so that bacteria can't get in through external contact. In addition, infections are less likely in patients who don't smoke cigarettes or in smokers who quit smoking for at least one month before surgery.

d) Pulmonary embolism: Blood clots may form in leg veins during surgery when the patient is under general anesthesia. Patients with a leg vein clot will complain postoperatively of pain in their calves. Patient's with this complaint should be taken seriously and treated if a vein clot is diagnosed. Early treatment of patients with a deep leg vein will avoid migrating leg vein clots to the heart and lungs, causing pulmonary embolism. Even though pulmonary emboli are rare, pulmonary emboli are the leading cause of death after surgery. Pulmonary emboli must be detected early by performing a CT Scan and should be treated urgently.