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
 |
| Heavy
breasts can lead to physical discomfort, a variety of
medical problems, shoulder indentations due to tight
bra straps, and extreme self-consciousness. |
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 is generally done in
a hospital, as an inpatient procedure. The surgery itself
usually takes two to four hours, but may take longer in some
cases. You can expect to remain in the hospital two to three
days.
Type of Anesthesia
Breast reduction is nearly always
performed under general anesthesia. You'll be asleep through
the entire operation.
The Surgery
 |
| Incisions
outline the area of skin, breast tissue, and fat to be
removed and the new position for the nipple. |
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.)
 |
| Skin
formerly located above the nipple is brought down and
together to reshape the breast. Sutures close the
incisions, giving the breast it's new contour. |
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.
 |
| Scars
around the areola, below it, and in the crease under
the breast are permanent, but can be easily concealed
by clothing. |
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.
 |
| With
smaller, better proportioned breasts, you'll feel more
comfortable and your clothes will fit better. |
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.
