Introduction to Breast Reduction
Breast reduction, also known as reduction mammoplasty, is a procedure used to reduce the weight and volume of the breasts, and also to alter to shape. Genes, hormones and weight are the determinants of breast size. Breast reduction surgery can help women who are dissatisfied with their breast shape, weight or droop.
What is a Breast Reduction?
Breast reduction, also known as reduction mammoplasty, is normally requested when a woman is unhappy with the size or weight of her breasts. When breast size is not the concern then a breast lift on its own may be a more suitable option, although the results of a breast lift will last longer when combined with a breast reduction.
Large breasts can be restrictive and cause back, shoulder and neck pain. A breast reduction can make it possible to do sports such as running, that were too uncomfortable with large breasts. Most importantly, breast reduction and, or a breast lift may help increase your confidence and improve your self-esteem.
Your plastic surgeon will advise if a breast reduction needs to be combined with a breast lift, to achieve your goals.
What happens during breast reduction surgery?
The majority of plastic surgeons will perform breast reduction surgery under a general anesthetic and on average the procedure takes between two to four hours. Dependent on your existing breast shape, skin and the degree you want your breasts reduced will determine the incisions needed. Your scars and final breast shape will depend on what degree of skin and tissue needs to be removed to produce, a pleasing breast shape and positive outcome.
What happens during a breast lift procedure?
Various incisions can be used for a breast lift or a breast lift combined with a reduction. Your plastic surgeon will discuss your options and advise which method is most likely to give you the breast shape you desire.
What are different types of breast lifts?
1. Crescent lift
This method is only suitable when no reduction and only a small degree of lift is required. Your surgeon will cut around the lower part of your areola leaving your nipple attached and remove a segment of excess skin before suturing the skin back around the bottom edge of the areola. Nipples will appear higher and more central and breast shape is improved.
Your scars once healed will be barely noticeable as long as there are no complications.
2. Peri-Areolar or “Donut” Lift
This procedure involves making a circular incision around the edge of the areola and removing the nipples. Excess skin is removed and then the nipples are reattached higher up. The skin is sutured back around the edge of the areola which leaves a fine scar that is barely visible as long as it heals well. This may occasionally be combined with breast reduction surgery and is most effective for lifting breasts that need to be only a moderate degree higher.
3. Vertical or “Lollipop” Lift
This method is normally combined with breast reduction surgery. Your surgeon will make two incisions, one around the edge of the areola, and one running vertically from the bottom of the areola to the inframammary fold, creating a “lollipop” shape. The resulting scars will fade however they will always be noticeable.
4. Inverted T or Anchor lift
When the nipples sit very low down and there is a deep mammary fold and excessive sagging an anchor lift will be recommended. This method is the most likely to be combined with breast reduction surgery. Three incisions are made, one around the edge of the areola, one vertically from the bottom of the areola to the breast crease, and one along the inframammary fold. The scar looks like an anchor and will be noticeable, hence the name of the procedure.
How will I feel when I come round after the general anesthetic?
- Immediately after your operation, you may have nausea and, or vomiting, this may continue for up to a day.
- Some people will feel cold and shivery, this will normally pass within a few hours.
- When there are existing memory problems; or in older individuals, there may be temporary memory loss after surgery, although rare, some individuals may experience confusion and memory loss that can last for years.
- It may be painful or difficult to pass urine immediately after surgery this will normally pass and if necessary a catheter will be fitted for between a few hours and a couple of days, although occasionally it may be required for up to a week.
- Feeling dizzy is normal after a general anesthetic and you will be monitored and given fluids if necessary.
- The area where you had your canula for your general anesthetic or where a drip has been inserted may feel sore and bruised for a few days, this will normally dissipate within a week.
- During your operation a tube is inserted down your throat to help you breathe; this can make your throat sore and occasionally cause small cuts on your lips and, or tongue; rarely there may also be damage to your teeth and you must make your anesthetist aware of any dental work that has been done before surgery.
Possible serious complications and risks with all surgical procedures
- It is possible to wake up during an operation performed with a general anesthetic, this is extremely rare as you are monitored at all times by your anesthetist who will top up your general anesthetic when required, to prevent this from happening
- General anesthetic can cause a serious allergic reaction (anaphylaxis)
- Thrombosis (blood clots) can occur following surgery which may be fatal if left untreated
One person in every 100,000 cases, will die under a general anesthetic
How long does it take to recover after a breast reduction?
Dependent on how much skin and breast tissue has been removed you may need to stay in the hospital for a few nights and drains will normally be used to allow for the removal of excess fluid or blood and prevent future complications occurring. You will have pain and some bruising, for between two to four weeks. The swelling will significantly reduce within 6 months, although it can take up to a year for all residual swelling to disappear.
When you return home, you should allow yourself a minimum of one week to rest, before returning to work. Strenuous activities and driving should be avoided for between four and six weeks.
When can I wear a bra after a breast reduction?
You will need to constantly wear and sleep in a soft, non-underwired bra, for six weeks. It is advisable to continue wearing a bra as much as possible after six weeks, however, you don’t need to sleep in it. You should not wear an underwired bra for a minimum of three months.
The most common risks of breast reduction and breast lift surgery
A collection of fluid (seromas) or blood (hematomas) forming which may cause swelling, pain and bruising, the body may absorb smaller hematomas and seromas; bigger ones will normally require a surgical drain to help the body expel the excess fluid and, or blood more effectively.
There is a higher risk of nerve damage and a reduction in sensitivity or numbness of nipples or areas of the breast occurring with breast reduction surgery, especially when combined with a breast lift. The risks are slightly lower if you are only opting for a breast lift.
With any incision there is a risk of keloid scars developing, this can occur anytime even years later after surgery and your scar will become thicker and more raised. Always advise your surgeon if you have ever had a keloid scar, this will allow them to put in some additional measures that may help to prevent future keloids developing.
Due to the invasive nature of breast reduction surgery infection is a common risk, this will be minimised with antibiotics When an infection is not controlled, it may lead to necrosis, this causes the skin cells to die causing open wounds.
Signs of infection after a breast reduction
A high fever, shivering or feeling disorientated and, or dizzy are signs of an infection that require immediate medical attention.
It is also very important to seek medical attention if you notice an increase in swelling and, or discharge, an unpleasant smell or a sudden increase in the level of pain you have been experiencing
Infections are normally treated with intravenous antibiotics and drains may be used to remove any fluid that could harbor bacteria.
You may go home with your drains still in place. You will have been shown how to empty them and monitor the fluid being expelled prior to leaving the hospital. To prevent the drains pulling on the incision site it is advisable to wear a drain management garment. This will make it easy to access your drains and keep the drain bulbs secure in the pockets or pouches inside the garment. Your drains will rarely remain in place for any longer than 21 days, due to the increased risk of infection after this time.
Signs of drain-related infection
- A temperature of 101 degrees F (38.3 C) or higher
- The skin surrounding the drain becoming redder
- An increase in discharge or unpleasant smell from the drain site
- A thicker liquid or a sudden change in the colour of the liquid in the drain bulbs
- An increase in pain or discomfort
- The skin feeling firmer or tighter around the drain site
When to call your surgeon
- If you notice bright red liquid in your drain bulbs for more than two days
- Any signs or symptoms of an infection
- When there is a sudden reduction or lack of liquid in the drain bulbs
- When a drain falls out
Removing your drains after breast reduction
Drains will be removed by your surgeon or under his supervision. The sutures are cut and the tubing is gently pulled out by hand, this will only take a few minutes. This will likely cause some discomfort and some women do find it painful. The excision sites will leave small scars.
When your drains have been removed it will be easier to get an idea of how your breasts will look. You should not expect to see the real result of a breast reduction for around three to six months due to swelling. The result of a breast lift will normally be apparent after three months.
You are now free to wear underwired bras or no bra if you prefer, although it is strongly advised to not spend long periods without a bra, if you want to maintain your results for as long as possible.
Breast feeding after breast reduction and uplift procedures
During a breast reduction it is likely your milk ducts will be severed making it impossible to breast feed. With a breast lift it may be possible to avoid cutting through your milk ducts, therefore giving you the ability to still breast feed after the procedure. Your plastic surgeon will advise you if they think they will have to severe your milk ducts, during your chosen procedure.
What questions should you ask your plastic surgeon before breast reduction with uplift or breast uplift surgery?
- How many breast reduction and uplift procedures, have you performed in the last 12 months?
- What method do you use most often and why?
- Have any of your patients been admitted into intensive care after the procedure?
- What would happen if I need intensive care after the procedure?
- How many of your patients had any complications after surgery?
- What did you do to rectify them and was there any charge?
- How long do you provide after and revision surgery for complications?
How to prepare for a breast reduction?
You will need to take some general health tests before your surgery to check if you are fit to have the operation. Medications like contraceptive pills or anti-inflammatory drugs should also be avoided before the operation. You will be encouraged to stop smoking and lose weight as they slow the healing process. Your surgeon will talk you through the risks and benefits before the operation and ask you to sign a consent form.
You will be asked not to eat or drink for six hours prior to the surgery.
What happens after a breast reduction?
After the surgery, you are required to stay in the hospital for a few nights to allow you to rest and heal. You will also be closely monitored to check the potential development of haematoma (bleeding inside the breast tissue) within the first 24 hours after the operation, in which you will be prompted to have another operation to drain and stop the blood. You will be allowed to go home if there are no noticeable issues after one to two days. At home, you should rest more and avoid strenuous activities or driving for a for weeks. Expect up to few months, although it may vary depending on your age and fitness level, for full recovery. While recovering, look out for signs and symptoms such as swelling and discharge around your breasts or high fever, in which you need to contact your GP immediately.
You should also be aware that all breast reduction surgeries will leave scars at a few places. You may also note asymmetry in the size and shape of your breasts. Other possible problems include wound healing where infections may take place. Some women experience loss of nipple sensation and failure for the nipples to become erect. Loss of the ability to breastfeed is also common side effects of the surgery.