Breast Reduction

Throughout history, large breasts have generally been considered a sign of femininity highlighting a woman's ability to nurture. Yet a woman with significantly larger breasts than the aesthetic standard of her time may be seen as abnormal or deformed. In these cases there is no doubt, that large oversized breasts can be disturbing to a woman by causing a host of both physical as well as psychological symptoms. In the former these can take the form of shoulder, neck and back pain as well as cause distortion of posture and in more severe cases make breathing difficult. Large breasts can dominate a woman's appearance and make her look unbalanced and make exercise difficult or impossible to do. In psychological terms, ungainly stares and rude comments make sufferers even more self conscious which leads them to wear loose clothing to disguise their imbalance.

Although the main aim of the surgery is to reduce the volume and weight of the breast, cosmetic enhancement to fashion a normal shape remains equally important. The techniques have been modified and refined throughout the years in order to improve the safety as well as the aesthetic results.

The surgery

Before going down to theatre, the doctor uses a marking pen to draw on the breasts in order to determine the exact position and size of the newly operated breasts. He will then show you approximately where the new breast and nipple position will be. Excess breast tissue, fat and skin are then removed. During the operation, the nipples are preserved on a stalk of breast tissue and repositioned by moving them to a new higher location, all in accordance with the preoperative markings. So although a breast size reduction is performed, all patients will also benefit from a breast uplift as well. The nipple is usually positioned in a line level with approximately the middle part of your arm or your under breast crease. The suture line is situated around the nipple in its new position, and extends vertically downwards to the under-breast crease. Occasionally a small horizontal scar within the crease is also performed. Finally some tapes, and a light dressing is applied over the suture lines. All sutures used are of the dissolving kind and will not need to be removed. You will also then be asked to wear a firm sports bra for support.

Risks

As in any procedure the risk of significant infection is always possible. This is minimised by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision sites, but usually subsides over a period of about 2 weeks.

Risks such as leg and lung blood clots are rare. Early mobilisation by moving around as soon after the surgery as possible reduces this considerably.

As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very occasionally, increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin)-less than 1% incidence. If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.

As mentioned, during the operation, the nipples are preserved on a stalk of breast tissue and repositioned. In the vast majority of patients they remain natural, with normal contraction and some sensitivity. Very rarely however the stalk of the breast tissue develops inadequate blood supply to maintain nipple viability and some sloughing of part, or even more rarely, the entire nipple can occur. This complication will mean that prolonged dressing will be required over the nipple area until natural healing occurs. It is then possible to reconstruct the nipple as a secondary procedure, should this be required. Thankfully with modern techniques this complication is quite remote (less than 1%).

During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion or even chafing of the skin at any point of the incision sites. One of the most common sites is the point where the vertical scar meets the nipple and or the under-breast crease. This is a temporary complication, which will require regular dressing changes initially.

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