Breast Reduction Introduction

Also known as reduction mammaplasty, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.

Overly large breasts can cause some women to have both health and emotional problems. In addition to self image issues, you may also experience physical pain and discomfort.

The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts is as important an issue to many women as the physical discomfort and pain.

The best candidates for breast reduction

Breast reduction surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Breast reduction is a good option for you if:

  • You are physically healthy
  • You have realistic expectations
  • You don’t smoke
  • You are bothered by the feeling that your breasts are too large
  • Your breasts limit your physical activity
  • You experience back, neck and shoulder pain caused by the weight of your breasts
  • You have regular indentations from bra straps that support heavy, pendulous breasts
  • You have skin irritation beneath the breast crease
  • Your breasts hang low and have stretched skin
  • Your nipples rest below the breast crease when your breasts are unsupported
  • You have enlarged areolas caused by stretched skin

The success and safety of your breast reduction procedure highly depends on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
Be prepared to discuss:

  • Why you want the surgery, your expectations and desired outcome
  • Medical conditions, drug allergies and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries
  • Family history of breast cancer and results of any mammograms or previous biopsies

Dr. Freeman may also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine your breasts, and may take detailed measurements of their size and shape, skin quality, placement of your nipples and areolas
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes of your breast reduction procedure and any risks or potential complications
  • Discuss the use of anesthesia during your procedure for breast reduction

Breast reduction risks

The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.

Dr. Freeman will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.

The risks of breast reduction and breast reduction complications include:

  • Unfavorable scarring
  • Infection
  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Anesthesia risks
  • Bleeding (hematoma)
  • Blood clots
  • Poor wound healing
  • Breast contour and shape irregularities
  • Skin discoloration, permanent pigmentation changes, swelling and bruising
  • Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
  • Breast asymmetry
  • Fluid accumulation
  • Excessive firmness of the breast
  • Potential inability to breastfeed
  • Potential loss of skin/tissue of breast where incisions meet each other
  • Potential, partial or total loss of nipple and areola
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Pain, which may persist
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
  • Fatty tissue deep in the skin could die (fat necrosis)
  • Possibility of revisional surgery

You should know that:

  • Breast reduction surgery can interfere with certain diagnostic procedures
  • Breast and nipple piercing can cause an infection
  • Your ability to breastfeed following reduction mammaplasty may be limited; talk to your doctor if you are planning to nurse a baby
  • The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
  • Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single breast reduction procedure and another surgery may be necessary.

When you go home

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these breast reduction complications occur, you may require hospitalization and additional treatment.

Be careful

Following Dr. Freeman’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Dr. Freeman will give you specific instructions on how to care for yourself and minimize breast reduction surgery risks.

Be sure to ask questions: It’s very important to address all your questions directly with Dr. Freeman. It is natural to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with Dr. Freeman.

Planning your breast reduction surgery

After researching the basics about breast reduction, many patients want to know what to expect before breast reduction surgery.

Prior to surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
  • Stop smoking well in advance of breast reduction surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

  • What to do on the day of surgery
  • Post-operative care and follow-up

Dr. Freeman will also discuss where your procedure will be performed. Breast reduction surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center, or a hospital.

You’ll need help

If your breast reduction procedure is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery, and to stay with you the following night.

Preparing for your surgery

Dr. Freeman will give you instructions to prepare for breast reduction, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Location of your surgery

Dr. Freeman may prefer to perform the breast reduction operation in our office facility, a freestanding surgery center, or a hospital outpatient facility. Occasionally, the breast reduction may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.

Types of anesthesia

Breast reduction can be performed with a general anesthesia, so you’ll sleep through the entire operation. Dr. Freeman may use a local anesthesia, combined with a sedative to make you drowsy, so you’ll be relaxed but awake, and may feel some discomfort.

The surgery

Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.

In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.

The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and Dr. Freeman’s advice.

Step 1 – Anesthesia

Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Incision options include:

  • A circular pattern around the areola

Breast Reduction - Circular Pattern, Before Breast Reduction - Circular Pattern, After

The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.

  • A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease

Breast Reduction - Vertical Incision, Before Breast Reduction - Vertical Incision, After

  • An inverted T or anchor-shaped incision pattern

Breast Reduction - Anchor Shaped Incision, Before Breast Reduction - Anchor Shaped Incision, After

Step 3 – Removing tissue and repositioning

After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.

Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

Step 4 – Closing the incisions

The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.

Step 5 – See the results

The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.

After your surgery

Many patients have questions about recovery from breast surgery.

When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions for breast reduction recovery that may include: how to care for your breasts following breast reduction surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with Dr. Freeman. Be sure to ask Dr. Freeman specific questions about what you can expect during your individual recovery period.

  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery? When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?

Getting back to normal

You should be able to return to work within a few days, depending on the level of activity required for your job.

Follow Dr. Freeman’ advice on when to begin exercises and normal activities after breast reduction. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars from breast reduction will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast reduction for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier. ( All surgery carries some uncertainty and risk. )

Your new look

The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction.

Your better proportioned figure will likely enhance your self image and boost your self-confidence.

However, over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.

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