FEMALE BREAST REDUCTION
Introduction
Large breasts can be a source of major embarrassment. As well as the difficulty of finding clothes that fit and look elegant, they tend to interfere with active sports. Sometimes they also cause backache and their weight makes the bra straps dig in over the shoulders. There is a tendency towards skin problems in the crease below each breast. With the passage of time they will hang lower and lower and the skin can become covered in stretch marks.
Nature of the operation
Breast reduction is performed along similar lines to mastopexy (uplift) with the addition of the precise removal of breast tissue. Thus a new skin bra is created which leaves the nipple at an elevated position as well as smaller more youthful looking breasts.
Reducing the size of the breasts is a major operation. Several different techniques are used but they all cause quite significant scarring. The most usual method leaves a scar that runs around the edge of the areola and one in the crease underneath the breast with a vertical scar linking the two. These scars do not usually show outside an ordinary bra or bikini top. Although in most patients they fade with time they should be considered to be permanent.
The skin is sutured usually with absorbable sutures and a padded dressing is applied. Most patients are fit enough to go home a day or two afterwards.
Position of scarring in Breast Reduction
Postoperative events
Partial or total loss of nipple: This occurs if the blood supply to the nipple-areola complex is inadequate after the operation. If this happens further surgery will be necessary to correct this.
Swelling and bruising The breasts will be swollen and probably quite bruised and tender for a few days and need to be supported well.
Pain & discomfort is not usually severe. Standard painkillers control any discomfort or pain post operatively.
Bleeding and infection can occur post operatively as in any other surgery.
Scars may stretch and become red and raised. If the scars do not heal well they can generally be improved about a year after the original operation. Every attempt is made to make the scars as neat and inconspicuous as possible but they will always show on close examination.
Sensitivity of the nipples may well be reduced or altered.
The shape of the breasts may look quite odd initially but as time passes they will settle down to look more natural. It is unlikely that the breasts will have a perfect shape or be exactly symmetrical.
Recurrence There have been cases where further enlargement has occurred but as long as there is not excessive weight gain this is a very unlikely event.
Breast-feeding It is unlikely that a baby could be successfully breast- fed afterwards and indeed it is very important that pregnancy itself is avoided for several years because the scars will stretch badly during pregnancy unless they are completely mature.
Postoperative management
Patients are strongly advised to wear a properly fitted support bra night and day for some weeks. This supports the skin and helps the healing and gently moulds the shape of the breasts during recovery.
The dressings must be kept clean, dry and intact until they are removed. Strenuous movements should be avoided for several weeks and driving is discouraged.
After the dressings are removed the scars can be massaged with skin creams.
Result
Some surgeons have described this operation as one of the most gratifying in the whole of surgery with an extremely high success rate despite the extensive scarring. Patients say that it is like an enormous weight has been lifted. They can go on the beach without embarrassment and fit into ordinary clothes. After the operation most patients feel a tremendous sense of freedom because they can do all the things that their large breasts stopped them doing before.