ARE YOU CONSIDERING BREAST REDUCTION?…
Women with very large, pendulous breasts may experience a variety of medical problems, from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations or scalloping of their shoulders. Unusually large breasts during breast-feeding can make a woman feel extremely self-conscious.
Breast reduction, technically known as reduction mammoplasty, is designed for such women. The surgical 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.
THE BEST CANDIDATES FOR BREAST REDUCTION:
Over time, a woman’s breasts begin to sag and the areolas become larger.
Breast reduction is usually performed for medical indications rather than simply cosmetic improvement. Women who have the surgery complain of the following:
Very large, sagging breasts that restrict their activities
The breasts cause them physical discomfort, posture trouble and back pain.
In spite of well-fitting bras they experience neck spasm and shoulder scalloping.
In the folds beneath the breast, irritation and eventually infection repeatedly occurs and requires treatment that is often ineffective.
Being unable to find properly fitting affordable bras.
In most cases, breast reduction isn’t performed until a woman’s breasts are fully developed, so reoperation can be avoided. In certain cases it can be done earlier if large breasts are causing serious physical discomfort. Younger women should ideally have stopped growing before undergoing breast reduction surgery, usually at age 24 or greater, to reduce hypertrophic scars as well.
The best candidates are those who are mature enough to fully understand the surgical procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed. Morbid obesity can cause breast enlargement, which will improve with weight loss.
ALL SURGERY COMES WITH 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 and incisions after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following our advice both before and after surgery.
The surgical 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 be lost (The nipple and areola can usually be rebuilt, however, using a skin graft from elsewhere on the body).
PLANNING YOUR SURGERY
In your initial consultation, it’s important to discuss your expectations frankly with Dr. Dolynchuk, and to listen to his 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 Medicare coverage.) He 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.
The surgeon will describe the surgical procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He should also explain the anesthesia he will use, the facility where the surgery will be performed, and the costs. Medicare will pay for breast reduction if it’s medically necessary; however, they may require that a certain amount of breast tissue be removed and that symptoms are present due to breast size. You may require 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. We may suggest that our patients try to be around an ideal weight before the operation. Breast reduction doesn’t usually require a blood transfusion. However, if a large amount of breast tissue will be removed, we may advise you to take an iron supplement ahead of time. 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.
Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast its new contour. Techniques for breast reduction vary, but the most common procedure involves an inverted “T” or anchor shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast.
The doctor removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He 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 he used that eliminate the horizontal 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.
Breast reduction is generally done in a hospital, as an inpatient procedure. The surgery itself usually takes two to three hours, but may take longer in some cases. You can expect to remain in the hospital overnight. Drains are placed at surgery and are removed the following morning before discharge. You remain in the initial dressing until seen back at one week.
TYPES OF ANAESTHESIA:
Breast reduction is nearly always performed under general anesthesia. You’ll be asleep through the entire operation. Local anaesthetic is infiltrated along the wounds during surgery to help with post-op discomfort as well.
After surgery, you’ll be wrapped in elastic net or a surgical tape over gauze dressings. A small tube will be placed in each breast to drain off blood and fluids for the first day. 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. The doctor will prescribe medication to lessen the pain.
The bandages will he removed a week after surgery, and the support bra is used. You will continue wearing the bra around the clock for several weeks (2 weeks), until the swelling and bruising subside. Your stitches will dissolve in three to six weeks. The Micropore® paper tape or Mepitac® silicone tape should be used for the six week period post surgery. Sometimes a stitch will spit and may need trimming. Do not panic. Sometimes the area may open, for which applying Polysporin® ointment to the area will help things to heal. In some cases there is a leakage of fluid which you can dress with a Band-Aid® to absorb the leakage. This is normal. Use of silicone ointment can be used after the skin has healed initially around the nipple and at 6 weeks to the rest of the scars nightly to reduce redness.
If you have a high fever and pain and the area of the incision line is red, we suggest seeking medical attention. There may be an infection. If your breast skin is very dry or itchy following surgery, you can apply a moisturizer several times a day, but he 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.
If your expectations are realistic, chances are you’ll be satisfied with your breast reduction. Remember the surgery was done to reduce your back pain.
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.
Most women can return to work (if it’s not too strenuous) and social activities in about two to three 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 and paper tape called Micropore® 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.
Remember that with the surgery there are scars. Initially they may be red but will gradually fade over time.
In some cases patients can form other types of scars that are raised and red. These are hypertrophic or keloid scars. Unfortunately, there is no way of knowing whether you will form these types of scars accurately. However, if you have a strong previous tendency for such scars a preventative course may be offered, involving steroid or chemotherapy.
In some cases patients can have dog-ears (little amounts of skin at the sides of breasts). Sometimes they are revised after a year post op. However, Medicare does not cover the cost of revision surgery.