If you're considering breast reduction...
Women with very large, pendulous breasts may experience a variety of
medical problems caused by the excessive weight-from back and neck
pain and skin irritation to skeletal deformities and breathing
problems. Bra straps may leave indentations in their shoulders. And
unusually large breasts can make a woman-or a teenage girl-feel
Breast reduction, technically known as reduction mammaplasty, is
designed for such women. The 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.
If you're considering breast reduction, this will give you a basic
understanding of the procedure- when it can help, how it's
performed, and what results you can expect. It can't answer all of
your questions, since a lot depends on your individual
circumstances. Please be sure to ask your doctor if there is
anything about the procedure you don't understand.
Heavy breasts can lead to physical discomfort, a variety of medical
problems, shoulder indentations due to tight bra straps, and extreme
THE BEST CANDIDATES FOR BREAST REDUCTION
Breast reduction is usually performed for physical relief rather
than simply cosmetic improvement. Most women who have the surgery
are troubled by very large, sagging breasts that restrict their
activities and cause them physical discomfort.
In most cases, breast reduction isn't performed until a woman's
breasts are fully developed; however, it can be done earlier if
large breasts are causing serious physical discomfort. The best
candidates are those who are mature enough to fully understand the
procedure and have realistic expectations about the results. Breast
reduction is not recommended for women who intend to breast-feed.
ALL SURGERY CARRIES SOME UNCERTAINTY AND
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 after surgery;
these can be treated with antibiotic creams. You can reduce your
risks by closely following your physician's advice both before and
The 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 die. (The nipple and areola can
usually be rebuilt, however, using skin grafts from elsewhere on the
PLANNING YOUR SURGERY
In your initial consultation, it's important to discuss your
expectations frankly with your surgeon, and to listen to his or her
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 your insurance
coverage.) He or she 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 surgeon should describe the procedure in detail, explaining its
risks and limitations and making sure you understand the scarring
that will result. The surgeon should also explain the anesthesia he
or she will use, the facility where the surgery will be performed,
and the costs. (Some insurance companies will pay for breast
reduction if it's medically necessary; however, they may require
that a certain amount of breast tissue be removed. Check your
policy, and have your surgeon write a "predetermination letter" if
Incisions outline the area of skin, breast tissue, and fat to be
removed and the new position for the nipple.
PREPARING FOR YOUR SURGERY
Your surgeon may require you to have 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.
Some surgeons suggest that their patients diet before the operation.
Breast reduction doesn't usually require a blood transfusion.
However, if a large amount of breast tissue will be removed, your
physician may advise you to have a unit of blood drawn ahead of
time. That way, if a transfusion should be needed, your own blood
can be used.
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
WHERE YOUR SURGERY WILL BE PERFORMED
Breast reduction surgery may be performed in a hospital, an
outpatient surgery center or an office-based surgical suite. If you
are admitted to the hospital, your stay will be a short one. The
surgery itself usually takes two to four hours, but may take longer
in some cases.
TYPE OF ANESTHESIA
Breast reduction is nearly always performed under general
anesthesia. You'll be asleep through the entire operation.
Techniques for breast reduction vary, but the most common procedure
involves an anchor-shaped incision that circles the areola, extends
downward, and follows the natural curve of the crease beneath the
breast. The surgeon removes excess glandular tissue, fat, and skin,
and moves the nipple and areola into their new position. He or she
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 be used that eliminate the vertical part
of the scar. And occasionally, when only fat needs to be removed,
liposuction alone can be used to reduce breast size, leaving minimal
Skin formerly located above the nipple is brought down and together
to reshape the breast. Sutures close the incisions, giving the
breast it's new contour.
AFTER YOUR SURGERY
After surgery, you'll be wrapped in an elastic bandage or a surgical
bra over gauze dressings. A small tube may be placed in each breast
to drain off blood and fluids for the first day or two.
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.
Your surgeon will prescribe medication to lessen the pain.
The bandages will be removed a day or two after surgery, though
you'll continue wearing the surgical bra around the clock for
several weeks, until the swelling and bruising subside. Your
stitches will be removed in one to three weeks.
If your breast skin is very dry following surgery, you can apply a
moisturizer several times a day, but be sure to keep the suture area
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.
Scars around the areola, below it, and in the crease under the
breast are permanent, but can be easily concealed by clothing.
GETTING BACK TO NORMAL
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.
Your surgeon will give you detailed instructions for resuming your
normal activities. Most women can return to work (if it's not too
strenuous) and social activities in about two 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 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.
A small amount of fluid draining from your surgical wound, or some
crusting, is normal. If you have any unusual symptoms, such as
bleeding or severe pain, don't hesitate to call your doctor.
YOUR NEW LOOK
Although much of the swelling and bruising will disappear in the
first few weeks, it may be six months to a year before your breasts
settle into their new shape. Even then, their shape may fluctuate in
response to your hormonal shifts, weight changes, and pregnancy.
Your surgeon will make every effort to make your scars as
inconspicuous as possible. Still, it's important to remember that
breast reduction scars are extensive and permanent. They often
remain lumpy and red for months, then gradually become less obvious,
sometimes eventually fading to thin white lines. Fortunately, the
scars can usually be placed so that you can wear even low-cut tops.
Of all plastic surgery procedures, breast reduction results in the
quickest body-image changes. You'll be rid of the physical
discomfort of large breasts, your body will look better
proportioned, and clothes will fit you better.
However, as much as you may have desired these changes, you'll need
time to adjust to your new image-as will your family and friends. Be
patient with yourself, and with them. Keep in mind why you had this
surgery, and chances are that, like most women, you'll be pleased
with the results.
With smaller, better proportioned breasts, you'll feel more
comfortable and your clothes will fit better.
Carton J. Perry, M.D. Houston, TX
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