- Mammoplasty Reduction
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Also known as reduction mammaplasty, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.
Best Candidates for Breast Reduction
Breast reduction surgery is a highly individualized cosmetic procedure and ideal for candidates that suffer from discomfort, pain or even embarassment from overly sized breasts.
Many factors determine candidacy for breast reduction. Among other points, the best candidates for breast reduction surgery are well-adjusted women whose oversized breasts cause health and medical problems, interfere with routine activities, disrupt sleep, or suffer related self-consciousness issues. This article prepares you for your initial consultation, details how the surgery is preformed and describes what to expect after surgery.
Breast reduction is a good option for you if:
- You are physically healthy
- You have realistic expectations
- You don't smoke
- You are bothered by the feeling that your breasts are too large
- Your breasts limit your physical activity
- You experience back, neck and shoulder pain caused by the weight of your breasts
- You have regular indentations from bra straps that support heavy, pendulous breasts
- You have skin irritation beneath the breast crease
- Your breasts hang low and have stretched skin
- Your nipples rest below the breast crease when your breasts are unsupported
- You have enlarged areolas caused by stretched skin
Reasons for Breast Reduction
Breast reduction surgery is meant for women who have large breasts and want to resolve issues such as:
- Low-hanging breasts and stretched skin
- Chronic back, neck and shoulder pain
- Chronic rash under the breasts
- Deep grooves in the shoulders from bra strap pressure
- Poor posture
- Restricted activity
- Low self-esteem
- Difficulty fitting into bras and clothing
You can have breast reduction surgery at any age — even as a teenager in some cases — but most doctors recommend waiting until you're at least age 18, when your breasts are fully developed.
If you haven't started a family or your family isn't yet complete, you might postpone breast reduction surgery until pregnancy is not a factor. Changes to breast tissue during pregnancy could alter your surgical results. Also, breast-feeding may be difficult or impossible after breast reduction surgery.
What Breast Augmentation Can Do
Breast Reduction improves the shape of the breast, decreases the mass of the breast and corrects asymmetrical breasts. Removed fat is examined for signs of cancer and may serve as an early detector. You should have smaller breasts with less sagging and a decrease in conditions such as back strain, trouble breathing, sleep disruption, limited movement and skin irritation. Mammograms can be taken more easily and with higher accuracy.
There are no alternatives to surgery as a way to reduce breast tissue, although significant weight loss can decrease the size of the breast.
Preparing for Breast Reduction Surgery
Consultation between surgeon and patient is important to ensure that there is understanding and agreement with the expected final results of the procedure. Measurements and photographs may be taken. Many doctors also recommend a mammogram before the operation to ensure that there is no cancer.
Prior to breast reduction your surgeon may request:
- Get lab testing or a medical evaluation
- Take certain medications or adjust your current medications
- Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
- Stop smoking well in advance of breast reduction surgery
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Special instructions you receive will cover:
- What to do on the day of surgery
- Post-operative care and follow-up
Your plastic surgeon will also discuss where your procedure will be performed. Breast reduction surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center, or a hospital.
Breast Augmentation Surgery Overview
Breast reduction surgery is usually done under general anesthesia, either in a hospital or outpatient surgical facility.
Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.
In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.
The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon's advice.
Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome.
The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.
Incision options include:
- A circular pattern around the areola
- A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease
- An inverted T or anchor-shaped incision pattern
Incisions vary based on the patients critera, your particular anatomy, and patient-surgeon preference.
Scarless Breast Reduction
Breast reduction using liposuction alone is often referred to as "scarless" breast reduction surgery. Although some incisions are required, breast reduction through liposuction is as close as modern technology has come to allowing certain patients to improve their self-image and health without highly visible scars.
When performing breast reduction with liposuction, the surgeon makes a small incision under the armpit or in the crease beneath the breast. A surgical tube, called a cannula, is inserted into the breast through this incision and is used to break up and remove fatty tissue and reduce breast volume. Breast reduction performed through liposuction alone only affects the fatty tissue and not the connective tissue of the breast. Typically, connective tissue is affected more than fatty tissue in traditional breast reduction surgery and vertical incision breast reductions.
Removing Tissue and Repositioning
After the incision is made, the nipple-which remains tethered to its original blood and nerve supply-is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.
Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).
Closing the Incisions
The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.
Breast Reduction Results
The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.
The results of breast reduction surgery will be long-lasting. Successful breast reduction surgery can relieve pain in your upper back, neck and shoulders. It may also increase your ability to participate in physical activities and promote a more positive self-image.
Your better proportioned figure will likely enhance your self image and boost your self-confidence. Over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.
Recovery After Breast Augmentation
After breast reduction surgery, your breasts will be covered with a gauze dressing or elastic bandages. A tube may be placed under each arm to drain any excess blood or fluid. Your surgeon may prescribe medication for pain and nausea as well as antibiotics to decrease your risk of infection. During the initial recovery period, your breasts will probably feel tender and sensitive. They may also be swollen and bruised. Scarring is permanent but may fade over time.
Talk to your surgeon about when your dressings or bandages will be removed, when — or if — your stitches will be removed, and when you can return to your regular activities.
An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.
A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.
You will be given specific instructions for breast reduction recovery that may include how to care for your breasts following breast reduction surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon. Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
When You Return Home
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur after breast augmentation, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Breast Augmentation Post Operative Care
As with the recovery period following any type of surgery, breast reduction recovery will take time. To better prepare you for the recovery time, we have provided information on what to expect in the weeks and months following breast reduction.
The First Two Weeks
Some bruising and swelling are to be expected during the breast reduction recovery period, but will usually subside in a few weeks. A moisturizer may be used on the breasts to alleviate any itching and dryness, as long as it is not applied directly to the incision sites. Patients should carefully follow all post-op instructions from their doctors to minimize discomfort and speed up the healing process.
For the first two to three days after breast reduction surgery, the patient must wear an elastic bandage or a special surgical bra over gauze and dressings. Once the gauze and dressings are removed, the patient will continue to wear the surgical bra for the next several weeks of breast reduction recovery time. Stitches are typically removed one to two weeks after surgery.
Breast reduction patients are advised to avoid any heavy lifting or strenuous activity for several weeks after surgery. Most women, depending on their profession, can return to work within 10 to 14 days. Patients are instructed to abstain from sexual activity for a week or more, as sexual arousal can cause inflammation around the incisions.
The First Several Months
Any contact with the breasts should be gentle for four to six weeks following breast reduction surgery. Patients should be aware that their breasts may swell and become tender during the first menstrual period of the breast reduction recovery process. In addition, some women may experience sporadic pains for a few months, especially during menstruation. Your doctor can prescribe pain medication to alleviate these symptoms and make your recovery as comfortable as possible.
Altered sensations of the breast skin and nipple are common symptoms following surgery. Numbness of the breast and nipple may be experienced by some women for up to a year following breast reduction surgery, while others may experience hypersensitivity of the breast area. It is important to keep in mind that, in some cases, these altered sensations may be permanent.
Because breast tissue is significantly disrupted during surgery, it may take six months to a year before all swelling subsides and the final breast reduction surgery results become apparent.
Possible Breast Reduction Risks
The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.
Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
Risks and Complications of Breast Implants:
- Unfavorable scarring
- Changes in nipple or breast sensation, which may be temporary or permanent
- Anesthesia risks
- Bleeding (hematoma)
- Blood clots
- Poor wound healing
- Breast contour and shape irregularities
- Skin discoloration, permanent pigmentation changes, swelling and bruising
- Damage to deeper structures - such as nerves, blood vessels, muscles, and lungs - can occur and may be temporary or permanent
- Breast asymmetry
- Fluid accumulation
- Excessive firmness of the breast
- Potential inability to breastfeed
- Potential loss of skin/tissue of breast where incisions meet each other
- Potential partial or total loss of nipple and areola
- Deep vein thrombosis, cardiac and pulmonary complications
- Pain, which may persist
- Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents.
- Fatty tissue deep in the skin could die (fat necrosis)
- Possibility of revisional surgery
Other Important Considerations:
- Breast reduction surgery can interfere with certain diagnostic procedures
- Breast and nipple piercing can cause an infection
- Your ability to breastfeed following reduction mammaplasty may be limited; talk to your doctor if you are planning to nurse a baby
- The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
- Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations