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Reduction mammoplasty – Women who have larger breasts experience a lot more than just dissatisfaction with their image. They also experience physical pain as well as discomfort. Excessively large breasts and the excess weight of breast tissue can result in pain as well as physical conditions which weaken the ability of a woman to live an active life. Besides the physical pain and discomfort, the self-consciousness and emotional discomfort often associated with having larger breasts is as important an issue to a lot of women.
Breast reduction can be described as a surgical procedure to help reduce the size of large breasts that cause physical pain and are disproportionate to the body. Technically referred to as reduction mammoplasty, a breast reduction procedure enhances breast shape and size and eases the conditions associated with large breasts. These include:
- Saggy, stretched skin and a low breast profile in which, when unsupported, the nipples rest below the breast crease.
- Neck, back, and shoulder pain caused due to the weight of excess breast tissue.
- Restricted physical activity and associated discomfort caused due to breast size.
- Skin irritation under the breast crease.
- An enlarged areola (dark skin surrounding the nipples) caused due to stretched skin.
- Shoulder discomfort and indentation caused due to bra straps that support heavy and pendulous breasts.
A breast reduction procedure can be performed bilaterally (on both breasts) or unilaterally (on one breast). It is usually considered as a reconstructive procedure and can be covered by health insurance when performed to relieve medical symptoms. A lot of insurers define breast reduction as a reconstructive procedure based upon the amount of tissue which will be removed. However, pre-certification is often needed for coverage or reimbursement.
Breast reduction treatment can be performed at any age. However, it is best performed after the breasts are fully developed. Since a significant amount of breast tissue is removed, a breast reduction procedure may affect the ability to breast feed. Any changes in breasts caused due to pregnancy can alter the results of previous breast reduction surgery, as can significant fluctuations in weight.
In general, good candidates for breast reduction surgery are women of relatively stable and normal weight, whose breast development is complete. The procedure is best performed on:
- Healthy individuals who don’t have any life-threatening disease or medical condition that can impair healing.
- People with positive outlooks and specific goals to improve the shape and size of their breasts.
How do I Begin?
Consulting a plastic surgeon is the first step to learning how breast reduction can help improve the appearance of your breasts and relieve the pain, discomfort and associated symptoms you have been experiencing due to large, pendulous breasts.
The doctor will discuss what proportions would be pleasing. He will also discuss the size as well as position of the nipple and areola that will be lifted during the procedure.
Be honest about your expectations from the procedure. The surgeon’s goal is to provide you with aesthetically pleasing results that you are happy with.
The consultation appointment is specifically designed to fully educate you about the breast reduction procedure in a non-pressured environment. The consultation will include the following:
- A discussion about your goals, and an evaluation of your individual case.
- The different options available in breast reduction surgery.
- The prescribed course of treatment suggested by the plastic surgeon.
- The likely outcome of the breast reduction procedure including any risks or possible complications.
- Answers to all your queries.
The patient’s personal outlook and overall health can greatly impact the results of the breast reduction procedure. This will be carefully evaluated during consultation with the plastic surgeon. The success of the procedure, safety and your overall satisfaction demand that you:
- Disclose your health history, present use of medications, vitamins, herbal supplements, tobacco, alcohol and drugs.
- Honestly share your expectations.
- Be truthful about your personal breast health or any history of breast cancer in your family.
- Commit to precisely following all the instructions given by the plastic surgeon.
By consulting your plastic surgeon and following all the instructions given by him/her, you are taking a crucial step in assuring your own safety. The surgeons performing breast reduction surgery are certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. This certification designates surgeons who are exclusively trained in plastic surgery of the face as well as body.
HOW IT WORKS
A breast reduction procedure is mostly performed through incisions, with surgical removal of excess fat, skin and glandular tissue that contribute towards large, pendulous breasts. The keyhole incision pattern is the most common approach to this procedure.
The nipples (areola), which remain tethered to their original blood and nerve supply, are then repositioned. If required, the nipple is reduced by excising the skin at the perimeter. The vertical incisions are then brought together in order to reshape the now smaller breasts. Non-removable sutures are layered deep inside the breast tissue to support the newly shaped breasts. Following this, sutures, skin adhesives and surgical tape close the skin.
Depending upon the amount of skin and tissue which needs to be removed and the quality of skin elasticity, there are alternative incision patterns that could be recommended. One such pattern is a circular pattern around the nipple. Another pattern is a racquet-shaped pattern with an incision around the nipple and vertically down to the breast crease. Sometimes, for very large and pendulous breasts, the areola might need to be removed and then transplanted at a higher position on the breasts. However, the incision lines which remain are visible and leave permanent scars, even though they are usually well concealed under a bra or swimsuit.
In certain cases, the excess fat may be removed using liposuction in combination with excision techniques. In case the breast size is large due to fatty tissue and excessive skin is not a factor, then liposuction alone can be used for breast reduction. In all cases, the technique that is used to reduce breast size would be determined by your breast composition, individual condition, amount of reduction wanted, and surgeon and patient preferences.
Preparing for the Procedure
The surgeon will carefully explain the breast reduction procedure to you.
Before any surgery, you will be given specific instructions which include:
Pre-surgical considerations, medications and diagnostic testing
- Specific information related to the use of anesthetics.
- Day of surgery instructions as well as medications.
- Postoperative care and follow-ups
In addition to this, you will be asked to sign consent forms which indicate that you completely understand the procedure that you will be undergoing, including the possible risks and complications.
The risks associated with breast reduction include blood pooling under the skin (hematoma), infection, blood clots, and poor healing on the site of incision. Changes in breast or nipple sensation are generally temporary. People who smoke are at increased risk of poor wound healing, especially at the areola and nipple. For this reason, smokers are advised to stop smoking for many weeks before and after the surgery. All surgeries carry risks that are associated with anesthesia. These as well as additional risks would be discussed prior to your consent.
It is very important to address all your questions directly with the plastic surgeon. It is quite natural to feel some level of nervousness and anxiety, whether it is excitement about the anticipated results or preoperative stress. It is best to discuss any such feelings with the surgeon.
What to Expect
Breast reduction can be performed in the plastic surgeon’s accredited office-based surgical facility, a hospital or an ambulatory surgical facility. The type of anesthesia used will be based upon the requirements of your specific procedure as well as considerations of surgeon and patient preference. The surgeon and assisting staff will fully attend to your safety and comfort.
Once the procedure has been completed, dressings or bandages will be applied to the incisions. A support bra or elastic bandage should be worn in order to reduce the swelling and support the breasts while they heal. A small, thin tube can be temporarily placed underneath the skin to drain any excess blood that might collect. Before being discharged, you and an accompanying friend, family member or caregiver will be given specific instructions which may include:
- How you should care for the surgical site.
- Oral or topical medications to heal the surgical site and reduce the risk of infections.
- Specific concerns to look out for at the surgical site and related to overall health
- Instructions related to when you should schedule a follow-up with the surgeon.
Progress and Healing
The initial healing process will include some swelling and discomfort on the incision site. Discomfort is common, but can be easily controlled with the help of medication. For the initial few weeks, the surgeon may recommend around the clock use of a support bra. It is very important to keep the incision site clean. You will be instructed to engage in light walking as soon as possible in order to minimize the possibility of blood clots and other associated complications.
Carefully follow all the instructions given by the surgeon as it is essential for the success of the outcome. Returning to light activities is possible whenever you feel ready, generally within a couple of days after surgery.
The sutures will be removed within ten days after the surgery. You can return to work and resume routine activities at this time, as long as you don’t engage in any vigorous exercise or heavy lifting.
The healing will continue for many weeks as the swelling subsides and the shape and position of the breasts settle. Continue to follow the surgeon’s instructions and go for your follow-up visits as scheduled.
Results and Outlook
Results from the breast reduction procedure will become noticeable over the next couple of months as the breast shape and position continue to settle. The incision lines are permanent scars; however, they will fade over a period of time and can be easily hidden under most swimsuits.
The new breast size will free you from the pain and physical limitations that you experienced prior to the breast reduction procedure. Your new and proportioned figure will improve your self-image and also boost your self-confidence. Breast reduction surgery is considered permanent. However, over a period of time, your breasts could continue to change as a result of aging, gravity and weight fluctuations.
Some of the criteria are as follows:
- 18 years of age and older
- Women whose activities are limited as a result of large breasts
- Mature enough to fully understand the procedure
- Experiencing physical discomfort caused due to large breasts
- Not presently pregnant or breastfeeding
- Not intending to breastfeed in the future
- Wishing to improve the appearance of the breasts
- In good physical as well as psychological health
- Having realistic expectations from the procedure
The above mentioned criteria is only a partial list that the surgeon will consider while deciding whether or not the procedure is appropriate for you. Make sure to ask the surgeon whether he/she considers you a good candidate for the breast reduction procedure.
What are the most common benefits of breast reduction?
Breast reduction has proven very successful in reducing the weight of heavy breasts, thereby making it a lot easier to enjoy an active lifestyle. A lot of women have found this surgery effective in relieving chronic neck, back and shoulder pain. The main benefit of this surgery is functional, but you also get a breast lift, which can improve your body image and enhance your overall appearance.
Do I require any special tests or X-rays?
FIn case you are in good health and only want a local anesthetic, you might not need any special X-rays or tests. However, if you are suffering from any serious disease, such as diabetes, the surgeon may order certain tests. In case you are going to need a general anesthetic, the anesthesiologist might order special tests in order to prepare for the anesthetic. Most surgeons take photographs both before and after the surgery. If you are over 35 years of age, you must have a mammogram.
Does the procedure cause any pain?
The surgical incision made for the breast reduction is quite large. However, it is placed in areas of the breast which are not too sensitive. Also, since the nerves to the breast skin are stretched out due to the weight of the breasts over time, the skin becomes less sensitive. Hence, the pain after surgery is easily managed with the help of oral pain medications. At first, there is some discomfort while walking, getting out of bed, or performing any activity which causes the breasts to move. The breasts may continue to be sore for the first few days after the surgery.
When will I get back to normal?
You may be up and about the next day, but your breasts might still ache occasionally for a few weeks. You must avoid pushing or lifting or anything that is over 15 pounds for at least 3 to 4 weeks. Most women are able to return to work (if it is not too strenuous) and routine activities in around 2 weeks. Since sexual arousal could cause your incisions to swell, it is important to avoid sex for at least a week or more. Avoid anything but gentle contact with the breasts for around 6 weeks.
Is there any risk involved?
Breast reduction surgery is not a simple procedure, but it is generally safe when performed by a qualified and experienced plastic surgeon. As in the case of any surgery, there is always a possibility of certain complications, including infection, bleeding, or a reaction to anesthesia. After surgery, some patients may develop small sores around their nipples, but this can be treated with the help of antibiotic creams. You can reduce the risks by following the instructions provided before and after surgery.
The treatment leaves behind noticeable and permanent scars, but these can be easily covered with your bra or swimsuit. Poor healing and wider scars are a lot more common in smokers. Sometimes, the surgery can cause unevenly positioned nipples or slightly mismatched breasts. Also, future breast-feeding might not be possible, as the surgery removes most of the milk ducts that lead to the nipples. Some patients might experience permanent loss of sensation in their breasts or nipples. Although rarely, the areola and nipples might lose their blood supply and the tissues will die. Usually, the areola and nipples can be rebuilt by using skin grafts from other parts of the body.
What are the long-term effects for most people?
Breast reduction has among the most instant and dramatic results of all plastic surgery procedures. The chronic physical pain and discomfort disappear, the body is better proportioned, and clothes fit a lot better. However, some women find that as much as they wished for these changes, they need some time to adjust to the new body image. After the initial adjustment period, most women are extremely pleased with the results.
The surgeon will ensure that the incisions as inconspicuous as possible. However, the scarring caused due to the surgery is quite extensive and permanent. The scars are long and remain brown or pink for many years. For some women these scars become wider, but for others, they gradually fade and become less noticeable. Wider scars and poor healing are more common in individuals who smoke. Thankfully, the scars are situated in areas that are not visible. Future breast-feeding might not be possible because the surgery removes many of the milk ducts that lead to the nipples.
Can breast reduction be combined with other procedures?
In the past few years, a major trend is for patients to have more than one procedure at the same time. This lowers cost and means that you only have to go through one period of pain and recovery. Except in rare cases, this doesn’t significantly increase the risk of surgery.
How do I prepare for the sugery?
We routinely need you to have a mammogram (x-ray of the breast) prior to surgery. You will be given specific instructions on how to prepare for the procedure, including guidelines on eating, drinking, and avoiding certain medicines that affect blood clotting, such as aspirin and anti-inflammatory drugs.
What happens after the procedure?
Following surgery, you will be wrapped with a surgical bra over a gauze dressing. You might feel some discomfort on the first day, particularly when you cough or move around. However, there is nothing to worry about as the surgeon will prescribe medication to reduce the pain.
After the procedure, your breasts will be examined and measured. The doctor may also photograph your breasts for reference both before and after the surgery.