A breast reduction is an operation to reduce the size of your breasts by removing both skin and breast tissue .
Women have breast reductions for the following reasons:
During your initial consultation, I will explore with you in detail the outcome and look that you want to achieve as well as finding out about your general fitness for surgery.
Following this, I will examine your breasts and have a detailed discussion with you about outcomes and the scars you will have following the surgery. I will advise you as to whether a breast reduction will give you the look and size that you are after and whether it is likely to improve your symptoms or whether another breast surgery procedure would be more appropriate.
You will be given an information leaflet on breast reduction to read including a list of potential complications that can occur.
All patients wishing to proceed to surgery are offered a second free consultation in which the details of the surgery will be discussed again and where we will talk in detail about the potential complications of this operation. Any further questions that you may have will be answered at this point before consenting to surgery.
An appointment to come in for an anaesthetic assessment prior to your operation will be arranged.
You will be admitted to the ward on the day that your surgery is scheduled. The operation is carried out under General Anaesthetic, given by a Consultant Anaesthetist, and usually takes three hours to perform.
The incision (cut) on your breasts is usually made in an anchor shape and I will have marked this pattern on your breasts prior to the surgery. Excess skin and breast tissue is removed and the nipple is repositioned to suit your new breast size. The skin and breast tissue is then reshaped and closed with dissolvable stitches. Dressings will be placed over the wounds. I will occasionally place a drain into the breast at the end of the operation but don't use drains in the majority of people.
On going home, you will be advised to wear a soft supportive bra (with no underwiring) for six weeks. You will need to arrange someone to drive you home the day after the operation and may need some help at home for a few days, especially if you have young children. Your dressings will be removed at 7-10 days and you will be followed up by me in clinic 10 days after surgery, and again after 6 weeks.
You will need to take 2-3 weeks off work. The swelling in your breasts will gradually lessen over 4-6 weeks and any shooting pains that you experience should settle down in this time.
Although you can start driving a car after 48 hours, most people feel comfortable starting to drive again after two weeks.
You should not exercise (other than walking) for the first two weeks and gently re-introduce exercise after that. Full exercise can be resumed at 6 weeks assuming all your wounds have healed.
You can go back to wearing underwired bras at six weeks after your operation assuming all your wounds are healed.
You should only allow gentle contact with your breasts for the first six weeks.
The most common method of breast reduction that I use results in a scar that is shaped like an anchor (see below). Occasionally, it is more appropriate to perform the breast reduction in a way that gives only the scar around the nipple and vertically down the breast (shown below).
Anchor shaped scar
You will feel back to normal after 4 - 6 weeks. Scars will turn red after 1 - 2 months and may widen a little before fading after a year. It will take six months to one year for your breast shape to settle down.
The majority of women who have Breast Reduction Surgery are pleased with the result. Self-confidence is usually increased following the surgery and the symptoms are relieved for most women. The shape of your breasts will change with time, particularly with pregnancy, changes in body weight and ageing and the results of surgery therefore will alter as you get older.
All surgery carries some element of risk. Common side-effects can include nausea and vomiting following general anaesthesia. As mentioned earlier, the breasts will be uncomfortable, swollen and bruised following your operation.
Haematoma - This is bleeding into the tissues following surgery and can occasionally lead to women returning to theatre to stop the bleeding or remove the blood clot.
Wound infection - This can occur after any type of surgery and may need treatment with antibiotics.
Deep vein thrombosis - This can happen after any operation and general anaesthetic. It is unlikely, but the risks are increased with smoking and the use of the oral contraceptive or hormone replacement therapy. Risks are reduced by wearing preventative stockings and you may be given an anti-clotting injection to reduce this risk.
Delayed wound healing - This is most commonly at the point where the vertical scar meets the horizontal scar (the T-junction). The blood supply to this area is at its poorest. The skin may fail to heal, and separates, leaving a raw area. Occasionally, this can be extensive and will need regular dressings for several months until the wound is fully healed.
Nipple complications - The operation by its nature partially disrupts the blood supply to the nipple. There is a small but definite risk of nipple loss from this type of surgery, either total or partial loss. Your nipple sensation may be lost or altered and this may be a temporary or permanent symptom.
Asymmetry - Although every effort is made you make your breasts as symmetical as possible, there may be some lasting differences in the size and shape of your breasts following surgery.
Breastfeeding - Breastfeeding is not usually possible after breast reduction surgery although some women do successfully breastfeed following this type of operation.
Scarring - Initially, the scars will be fine, bright red lines; in most cases the scars will usually heal satisfactorily and soften, becoming much paler and less obvious after 12 months or so. Some patients have a tendency to form red and lumpy scars (hypertrophy) or keloid scars, which are broad raised scars. The scarring will be permanent.
Pregnancy - The breasts change during pregnancy so if you are planning a family it may be wiser to postpone surgery.
Fat Necrosis - This is a common complication and in this type of surgery the risk depends on the relative amount of fat and breast tissue within your breasts together with the size of the breast reduction. This usually presents with firm or hard nodular areas within your breasts which may occur several months after surgery. Occasionally these can become inflamed with reddening of the skin and a burning sensation and discomfort. This usually responds to antibiotics and anti-inflammatories but occasionally can necessitate further surgery to remove the area of concern. If you find a new lump you should consult your GP.
Having a Breast Reduction may change the appearance of your breasts on mammograms. You may have new calcium spots on your mammogram which do not need further investigation. Occasionally these may need to be biopsied. I tend to recommend a pre-operative mammogram in all women over the age of 40 undergoing a Breast Reduction.
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