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Breast reduction – the pros and cons
For breast reduction surgery, there are many techniques with the choice depending on the amount of reduction required, the position of the nipples and concerns regarding scarring.
Fatty tissue, glandular tissue and skin are excised. The resultant breasts are smaller, better shaped and have lifted nipples. The final size is an important consideration and should be in proportion with your body. However, it should be noted that your cup size cannot be guaranteed, and that your chest size will not change, only your cup size.
At consultation, a medical and breast history (both personal and family) and examination are completed and underarm glands are assessed. The pre-operative workup, the surgical techniques and likely post-operative course is outlined. Before and after photographs are used to ensure your expectations are realistic and scar patterns are explained. Measurements are needed to plan the surgery. At the hospital it is necessary to draw and measure the breast reduction pattern, either in a sitting or standing position.
Surgery is performed in hospital, usually with a general anaesthetic. The surgical time depends on the amount of reduction and is usually between two and three hours. Drainage tubes are not routinely used.
Post-operative care
The breasts are carefully dressed and bandaged which may feel tight in the immediate post-operative period. Early walking and mobilization are encouraged. Post-operative pain is usually well controlled. Sedentary work and activities can be resumed in 1-2 weeks. At post-operative visits this will carefully be monitored. Advice will be given on the wearing of bras and on wound care. In general sport-type bras without underwires are preferred and it may be necessary to use a hospital supplied binder until swelling has settled to allow accurate fitting of new bras. You will need to be seen on a regular basis until the swelling has settled.
A mammogram is suggested at six months after surgery to establish a base line to compare your scar pattern should subsequent mammograms be required.
A loss of weight or gain of weight or subsequent pregnancy can affect the final outcomes.
Risks of surgery
All surgery has some risks and these include bleeding, bruising, infection, scarring and problems associated with wound healing. Excessive pain on one side may indicate a problem on that side. Discomfort should be about equal on both sides.
There are some risks specific to breast surgery. Theses usually increase with larger volume of reduction.
Numbness of the nipples is common and usually resolves or improves. It may, however, take up to 18 months before it settles and in some cases numbness may be permanent. A few people get an increase in nipple sensitivity. At times nipples may not survive and may need to be reconstructed. A degree of asymmetry is fairly common and there may be small differences in breast size, shape, lift, height, nipple position and areola size.
Breast feeding may still be possible after breast reduction surgery. A rough guide is that one third of women can breast feed, one third can breastfeed with supplementation and one third cannot breastfeed. Again, this is proportional to the amount of breast tissue that needs to be removed. The larger the reduction, the less likely breast feeding will be possible.
Wound healing problems may occur with breast reduction surgery. Two sites below the nipple, the T-junctions, are the most common associated with problems which may vary from a small blister to partial opening of the wounds. These usually settle with dressings.
There is a rare incidence of finding breast cancer in association with breast reduction surgery. This can either be at the time of initial examination or during the surgery, or from the breast tissue that is sent away for analysis. Should this occur it will be treated on its merits depending on the site, size and type of cancer discovered.
Overall, there may be an improvement in breast pain, breast heaviness, posture, back pain, neck pain and bra-strap grooving. In general, breast reduction is extremely well tolerated , with very good outcomes.