Breast reduction is indicated when the size of the breasts cause symptoms such as back pain, neck pain, grooves on the shoulders and recurrent skin infections (intertrigo) on the underside of the breast. A woman may also seek breast reduction so that the breasts match her frame.
Breast reduction involves removal of the excess breast tissue, reshaping the breast, elevating the nipple and redraping the breast with the reduced skin envelope. This may be achieved through a T-shaped scar, short vertical scar (‘lollipop scar’) or a scar going round the nipple/areola. The choice largely depends on the size and shape of the breast and the area of the breast that needs to be reduced. The surgery takes 3 hours or more under a general anaesthetic. It will involve at least an overnight stay in hospital. Drains will be used to allow any blood or fluid that collects in the breast to drain out into a bottle. The drains are generally removed the following day although occasionally they may have to stay in longer. The stitches are dissolvable and do not need to be removed.
- Normal activity can be resumed in 2 weeks
- Avoid exercising for 6 weeks
- Avoid lifting heavy weights for 6 weeks
- Do not go on long haul flights for 6 weeks to avoid the risk of deep vein thrombosis
- Wear a sports bra day and night for at least 4 weeks
- Shower normally after week 2
- Avoid baths for three weeks
- Infection- may require antibiotics and frequent dressing changes. This occurs most commonly along the incisions due to the deeper stitches
- Bleeding-significant bleeding requiring a return to the operating room is rare (l %)
- Bruising- common to a greater or lesser extent but rarely causes harm
- Swelling- some degree of swelling is common after any operation. Sometimes fluid may collect in the deeper parts of the breast and cause one breast to look larger than the other. This fluid tends to disperse but may need draining.
- Wound breakdown – may happen if the wound gets infected and will heal in a few weeks. Most commonly this happens at the T junction.
- Skin necrosis- skin going black and breaking down is rare but more common in women who smoke or have health problems such as diabetes.
- Fat necrosis – is inevitable. Some of the fat within the breast dies and forms a hard lump. This does not cause any harm but may cause alarm because a scan is often necessary to confirm the diagnosis
- Calcifications – will occur in some cases but these merely indicate the area of surgery. Calcifications in the breast are merely indicators that something has changed in the breast and they tell us which part of the breast that change has occurred.
- Nipple necrosis- the nipple may partially or completely die if the blood supply to it is compromised. This will be replaced by scar tissue resulting in the loss of the nipple mound. The incidence is less than 5% and tends to occur in very large droopy breasts where the nipple is very low.
- Altered sensation of the skin/nipple- this tends to improve within a few months.
- Asymmetry- there may be mild differences between the two breasts. It is not always possible to get perfect symmetry.
- Scars- the scar tends to heal to leave a faint thin line. The use of silicone tapes, sheeting or gel has proven benefits in making the scar flatter, thinner and paler
- Breast reduction disturbs the tissues and may cause breast cancer- untrue
- Breast reduction usually goes wrong – untrue. Almost always patients are happy with the outcome
- Mammograms may be difficult to interpret following breast reduction- there is some truth in this and hence women over 40 are advised to have a mammogram before their surgery. This serves as a template for future mammograms and helps discover hidden changes (cancerous or non-cancerous) which may need surgery
- Breast reduction cannot be repeated- this is untrue but it is helpful to have the details of the previous operation
- Breast reduction can prevent breast feeding- untrue but supplemental feeding may be required.