What is Breast Reduction Surgery?
A breast reduction is an operation designed to make large breasts smaller, perter and more in proportion with the rest of your body. The operation can also be performed to make each breast a similar size if one side is much larger than the other.
Women with excessively large breasts may complain of having constant neck and back pain, painful grooves where bra straps have cut into the shoulders and skin irritation or rashes in the crease beneath the breast. People say that they cannot find clothes that fit, have poor posture and find many activities difficult due to the size of their breasts. In addition, unusually large breasts can make a person feel extremely self conscious and embarrassed.
What does the surgery involve?
There are a number of techniques that can be used for breast reduction. The one selected depends in part upon the amount of breast tissue that has to be removed and the quality of the skin.
Incisions are made in order to sculpt the breasts into a smaller shape. The incisions may include one or more of the following;-
- Around the areola (the dark skin surrounding the nipple)
- Vertically down from the areola to the breast crease
- Horizontally in the breast crease
Excess breast tissue and skin is removed and the entire breast is reshaped with the nipples moved to a higher and more youthful position. The incisions are stitched up in a way that reduces scarring to a minimum. You may have a tube (drain) placed in each breast to drain off any blood or excess fluid. The drains will be removed before you go home.
The surgery takes between two to four hours to complete.
A breast reduction is usually performed under a general anaesthetic (you will be asleep during the procedure).
The operated area may be swollen for a few days and you will experience some pain. Simple painkillers are all that is normally required although aspirin should be avoided for the first few weeks following your operation.
Providing all is well, you can expect to go home the day after surgery.
What are the risks and side effects of surgery?
Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of possible complications.
Rarely a haematoma (collection of blood in the wound) can occur. This is most likely to occur within 24 hours of surgery. Large haematomas may need to be drained in the operating theatre, under a general anaesthetic.
Infection may occur but again this is rare. Infections can usually be treated successfully with antibiotics.
Everybody heals differently, and this is not always predictable. Poor or delayed healing occasionally occur. These healing difficulties can range from minor problems, such as small areas of wound separation, to major issues, such as skin or nipple loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery. People who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.
There is always permanent scarring where the incisions are made. Breast reduction surgery is a trade off between large, uncomfortable breasts and smaller ones with scars. Although these usually fade and soften up to a year after surgery, scars can occasionally thicken and stretch. Darker skinned people have more of a chance of forming thick scars (hypertrophic or keloid scars). The scars are designed so they lie under the average bra or bikini top.
Permanently reduced nipple sensation is not uncommon after this procedure. The ability of the nipple to go erect may also be affected.
Future breast feeding may not be possible as the surgery does involve removing some of the milk ducts that lead to the nipple area.
Breast asymmetry/shape irregularities can occur following this operation. In rare cases, further surgery is needed to correct this.
Fat necrosis. Sometimes, areas of fat and breast tissue within the breast form hard lumps. Usually, no specific treatment is required and the problem settles down over about 12 months.
There are general risks associated with all operations. Very occasionally a blood clot can form in the leg (deep vein thrombosis or DVT) which would require medical treatment. Part of these clots can also break off and move up to the lungs, causing acute shortness of breath and pain in the chest. This is known as a pulmonary embolus (P.E). Developing a chest infection is uncommon but more likely to happen to people who smoke.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with your surgeon. Decisions about cosmetic surgery should never be rushed.
How do I prepare for surgery?
Having had your initial consultation, if you decide to proceed, a mutually convenient date for your operation will be made. Prior to your admission, you may be invited to attend the hospital for a pre-operative assessment with a nurse. Depending on your age and general health, routine blood tests, a heart tracing (ECG) or mammogram may be taken. You will be given the opportunity to ask any questions you may have or raise any concerns.
You will be admitted to the hospital on the day of your operation. If you are having a general anaesthetic, you will be asked not to eat anything six hours before surgery. Black tea/coffee or non-fizzy drinks (nothing containing milk) can be taken up to two hours before surgery. Chewing gum should also be avoided six hours before your operation.
It is important to inform your surgeon, anaesthetist and nurse of any medicines (self or GP prescribed) or recreational drugs you take. Medicines containing aspirin should be avoided for two weeks before the operation since they increase the risk of bleeding during surgery. If there are any other medications that may affect surgery then this will be discussed with you at your first appointment.
You will not be able to drive yourself home from hospital and ideally, you should have someone to stay with you for a few days to lend a hand.
What happens after the operation?
Once you have recovered from your anaesthetic, you will be encouraged to sit up in bed.
A small tube (called a drain) may be placed in each breast to drain off blood and fluid. These tubes would be removed the next day before you go home.
The dressings are usually removed after one to two weeks. You will be advised to wear a sports bra day and night for the next three to six weeks to give support and help to mould the breast tissue to its new shape. After this time, a bra should always be worn during the day. Avoid wearing an underwired bra for at least the first four weeks.
Before you leave the hospital, you will be given a follow up appointment to see either the surgeon and/or nurse. This is to check on your progress and also the wounds. If non dissolvable stitches have been used, these will be removed about 10 days after surgery.
What is the estimated time for recovery, absence from work and return to usual activities?
Recovery times vary from one person to another so use the times given below as a guide only. If you have any concerns during this period, do contact the hospital team for advice.
In the first two days after your operation, it is important for you to be out of bed and walking every two hours during the day and early evening. Staying in bed too long increases your chances of developing clots in the legs. Gradually increase your activity over the next few days.
Avoid sunbathing topless for up to a year after the operation and certainly for the first few months. The scars are more sensitive to sunlight and burn more easily.
Breast reduction post surgery timeline
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Day 1 to 7
You may have some discomfort for a week. Mild painkillers will help with this but avoid taking aspirin.
Keep walking around to avoid post operative complications.
Sports bra worn day and night for about 3 weeks.
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Week 2
Might pull and hurt a little when you move around.
Any non dissolvable stitches would be removed.
Gradually begin to increase your activity.
Depending on your job, should be able to return to work from 2 weeks.
Drive only when you feel safe.
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4 to 6 weeks
Avoid lifting or pushing anything heavy for at least four weeks.
No need to wear a bra during the night but keep one on during the day.
Loss of sensation to breast and nipple area continues to improve.
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6 to 9 months
Scars will begin to soften and fade.
Can start to judge the result.