Breast Reduction

Prior to breast reduction you should be healthy and in good physical shape. You should be as close to your ideal weight as possible and your weight should be stable. I do understand that having large breasts can make it difficult to loose weight but we can work together to ensure that you are in the best shape possible prior to embarking on surgery. This is important as an increased body mass index (BMI) raises your risk of complications.

Many women seeking plastic surgery feel that their breasts are too large for their frame, that their breasts are out of proportion to their body, or they are embarrassed by the size of their breasts. Women with heavy, pendulous breasts with nipples that point downward (ptosis), or women with one breast that is much larger than the other are likely to benefit from this surgery.

If you have pre-existing medical conditions it may be inappropriate to have cosmetic surgery. If you are obese you should loose weight before considering cosmetic surgery. This procedure is not appropriate for women with unrealistic expectations or those who have been encouraged by others to change their appearance.

The issues with enlarged breasts can be broken down into a few components. Firstly is an excess of breast tissue and fat which is heavy, droopy and is the cause of most symptoms. Secondly the nipple and areola are often stretched out, sit low on the breast and usually point downwards. Thirdly there is an excess of breast skin to be addressed. Finally there is often an overhang of fatty tissue in the armpit area (axilla) and around the side of the breast, extending toward the back creating a roll over the bra.

Every lady is different and you may have one, a combination of or all of the above separate but intimately related issues. A breast reduction addresses these components by reducing the overall breast volume and reshaping the breast tissue, decreasing an enlarged nipple-areola complex and repositioning it to a more youthful position on the breast, removing and re-draping excess skin and defatting the axillary and lateral breast regions to achieve a beautiful, natural contour.

Breast reductions are generally characterized by the incision placement (and therefore where the scar will sit) and by the tissue that is retained and resected. The type of reduction that is required will be individualised to your specific anatomy, the issues that need addressing and your desired outcome.

- Inverted T Scar (Wise pattern, Anchor Scar)

A breast reduction usually includes reducing the breast in both the horizontal dimension (lifting upwards) and the vertical dimension (narrowing a wide breast). Therefore the incisions are required to be vertical, horizontal and around the nipple to reposition it. The resulting scars are around the nipple, vertical from the areola to the crease under the breast and in the crease under the breast. The scar length will be kept to the minimum possible to achieve your desired outcome.

- Vertical Scar (Lollipop scar)

Some ladies only have a small amount of skin redundancy and mild ptosis (nipple droop). In these cases it is possible to minimise scarring by just having a scar around the areola and the vertical component. This technique is not appropriate for very droopy breasts or where there is significant excess skin.

- Superomedial Pedicle Technique

This is my preferred technique for reducing the breast tissue. The superomedial pedicle refers to the part of breast that is retained and through which the bold supply, nerves and milk ducts to the nipple are preserved. In this technique breast tissue, skin and fat are removed primarily from the bottom of the breasts and the residual breast tissue is shaped to create a smaller, perkier, beautiful and natural breast. I believe this technique creates the perkiest shape and has the best long-term results with the shape being maintained for many years.

- Inferior Pedicle Technique

This technique retains tissue in the lower part of the breast and may be more appropriate in some circumstances, particularly revision surgery.

- Other Pedicle Techniques

A number of other pedicles can be used for this surgery when necessary and they all retain and resect tissue in different areas. When suitable for your individual circumstances these would be discussed with you during consultation.

At your initial consultation, I spend a great deal of time getting to know you personally and taking a full medical history. The success of any cosmetic procedure relies on you being open with me at this stage. It is important for me to explore your reasons for seeking breast reduction, what you dislike and your expectations of surgery. I also need to know about your general health, lifestyle and medications, prescribed or otherwise. If you fit the age profile for the breast screening program (47 – 70 years) I will ask for an up to date result from your most recent mammogram (should be within the last 3 years).

I will examine your breasts and assess what components are problematic and what can be done to address your concerns. At the end of that consultation I will describe the surgical options to address your problems and devise your personal surgical plan. I will also explain the risks and limitations of surgery to you at this stage. I always have a second consultation to answer any questions before we book surgery.

As a female Plastic Surgeon I have an intimate understanding about how your feelings about your breasts can affect your self-image and femininity. I want to work with you to achieve your desired outcome whether that is relief of neck and back pain, being able to find clothes that fit, to improve your self-confidence or to simply have a smaller and more beautiful bust.

You should be physically fit and at or close to your ideal weight which should be stable prior to embarking on breast reduction. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop smoking at least 6 weeks ahead of surgery to reduce the risk of wound healing problems. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery.

You will need to come to hospital starved and ready for a general anaesthetic. Surgery generally takes one and a half to three hours, and an overnight stay may be required. Breast tissue that is removed is sent to the lab for routine examination. The results of these tests are available for your 6-week post-op visit and I expect the results to be normal in the vast majority of cases.

You will return to the ward around an hour after surgery and be encouraged to mobilise and eat and drink. You will feel swollen and bruised and you will be given appropriate painkillers. I rarely use drains but if I do use drains they will be removed the following day. You will need to wear a support bra immediately and day and night for six weeks.

You will go home with some light dressings and you should keep the wounds clean and dry for the first week. You will need someone to collect you support you at home for the first few days. You will be reviewed in clinic at one week post op and the dressings are changed. You can return to light exercise at two weeks provided you are wearing a supportive bra but should not do anything strenuous for 4 weeks. You should arrange to take a couple of weeks off work.

Once the scar has healed you can start to massage with a simple moisturiser. Brusing and swelling persist for a number of weeks and you may find that one side settles more quickly than the other leaving you asymmetric (lopsided) whilst the other side catches up. This is perfectly normal and we will not start to see the final results for at least six weeks, sometimes longer. The scar will be red/pink initially and slowly fade over many months or years

Early complications include swelling, bruising and altered nipple sensation. These normally settle down with time although nipple sensation may take many months to recover and in some cases the changes are permanent. Occasionally patients experience infection, haematoma (a collection of blood under the skin), delayed healing and seroma (a collection of tissue fluid). Nipple loss due to interruption of blood supply has been described but is rare. Complications of any general anaesthetic include potential cardiac or respiratory problems and blood clots in the leg (DVT or in the lung (PE).

The scars will be red / pink for a number of months however some patients developed abnormally thickened scars which may require additional treatment in the clinic. It is very unusual to have scars that require additional surgery.

As part of the procedure there should be retention of some of the structures vital for function within the tissue that is retained, leading to the nipple. Therefore there should be some intact milk ducts, nerves and blood vessels to preserve the two major functions; breast-feeding and sensation (pleasure). However as some of the breast tissue is removed, some of this function may be affected. I would encourage you to have completed your family prior to embarking on breast reduction as subsequent pregnancies may affect the cosmetic result, however this is not always possible. If you do become pregnant after surgery I advise that you should try to breast-feed if you wish however you may find it more difficult than if you had never had surgery. However some women are unable to feed even without having breast surgery. Supplementation with formula may be required if you do not produce a large volume of breast milk in any situation.

After reduction mammaplasty, sensation is normally altered (either increased or decreased) but often slowly returns to normal with time. In some cases the change is permanent. Nerve recovery can take from many months up to a year or more.

You will have been assessed during the consultation process and you will know whether or not you are likely to require liposuction as part of the procedure. Liposuction is often added to a breast reduction to improve the contour of the outer part of the breast and the arm pit area (axillary roll). Using liposuction as an adjunct to your procedure can help to minimise scar length and improve the contour of your back and any residual fat roll.

The results of a breast reduction are permanent, and your breasts should remain keep the new size and shape for many years. However, your breasts will age with you over time, you should think of this procedure as resetting the clock rather than stopping it. If you subsequently become pregnant or have large fluctuations in weight your results will be affected. In ladies with poor quality skin the results may not last as long. There is no reason to undergo any additional surgery unless you are experiencing a problem or unless you wish to do so.

You need to tell the radiographer performing the mammogram that you have had a breast reduction but it does not interfere with breast cancer detection.

Breast reduction is a common component of Mummy Makeover surgery. It all depends on how pregnancy, childbirth and breast feeding have affected your breasts. Please see my Mummy Makeover section to read more about changes that commonly occur in the breasts, the tummy and other areas of your body after pregnancy.