Breast Reduction

The operation is performed under an anaesthetic. The procedure takes 3-4 hours to perform depending on the size of the breasts to be reduced. Dissolvable sutures are used saving the patients the inconvenience of stitch removal. Small drains are inserted at the time of the operation and are removed the following day. Patients can shower the following day after their operation. Patients usually stay in hospital for between two and three nights. An elastic sports bra is worn continuously, apart from showering, for the first two weeks post-operatively. Patients can return to work between two and three weeks post-operatively. Light exercise and walking can commence two works post-operatively. Swimming may be recommenced three weeks post-operatively. Heavy upper body gym work can be recommenced six weeks post-operatively.

The scars will be significant and obvious in the early months after surgery. They usually improve with time. There is usually a scar around each nipple, a vertical scar (the “seam” of the “skin brassiere”) below the nipple for about 5cm down to meet a curved horizontal scar which may be long, passing from near the midline in front to outside the breast near the armpit. This horizontal scar is long following large reductions and with the patient standing would be visible at each end but usually only to close inspection – while the vertical scar usually fades to be slightly stretched. At times the scars, moreso the horizontal one, can be more obvious than desired. They may even show keloid change, in patients with this tendency, becoming red, thick and itchy. These scars can usually be improved by a second operation if necessary.

Post-operatively there may be a breakdown of the wound edges near the “T” junction of the skin bra. This is usually a temporary nuisance requiring dressings and rarely makes any difference to the final result. Post-operative haematoma and infection may occur.

To reduce the risk of healing problems and infection, all patients are placed on perioperative antibiotics. Patients are instructed to cease smoking four weeks pre-operatively and six weeks post-operatively. The scar line takes approximately four to six weeks to heal. The scars are obvious in the first three months post-operatively. Patients are instructed to wear a special tape during this time which aids with scar maturation and helps the scars to fade. Like all scars on the body, final scar maturation takes approximately twelve months. Scar problems include keloid formation (itchiness, tenderness and persistent redness) or minor scar issues such as puckering. Revision under local anaesthetic to remove minor puckering at the end of the scar lines is a straight forward procedure performed under local anaesthetic.

Keloid scars respond to small doses of steroid injected into the scar to hasten the scar maturation process. Dr Flood has found in his practice, with his special scar care programme post-operatively, that he has not had to perform any steroid injections to correct keloid scarring post breast reduction surgery.

Sensation of the nipple may be affected. It can be altered, being “lost”, “made different”, “sore” or it may even be “improved”.

The operation is planned in such a way to ensure that an adequate blood supply is maintained to the various remaining anatomical parts of the breast, such as skin, fat, breast tissue and nipple. At times, if the circulation is inadequate, tissue may die. This is not common, but is more likely in very large breasts or in patients with poor circulation. At times surgeons may have to compromise the desired size and shape to help maintain an adequate circulation.

As a general rule, reduction mammaplasty patients are advised not to breastfeed. Parts of the breast tissue are separated from the ducts in the nipple and problems may arise, or the milk output be too limited. However, as a note of interest, women with large breasts tend to have a low milk output so might have problems breastfeeding anyway.

There is no documented risk of producing breast cancer. However, there is evidence that the risk of breast cancer is reduced because breast glandular tissue is removed which has the potential to become cancerous. All patients have a preoperative mammography. Twelve months following their operation a further mammogram is performed to be used as a base line for future mammograms.

Generally there is no great discomfort. There may be some tender spots but these are usually temporary.

Should there still be any questions regarding this surgery, be sure to get them answered in advance by the plastic surgeon. Well-meaning friends are not a good source of information! Find out everything before the operation – a well informed patient is a happy one!

Finally, obviously there can be no guarantee with any surgery. Remember, improvement not perfection is the realistic aim. A further operation may be required to improve the result.