Plastic Surgery

Breast reduction (Reduction mammoplasty)

What is the Breast reduction (Reduction mammoplasty)?

Female breast reduction, also known as reduction mammoplasty, is an operation to reduce the weight and volume of the breasts.

During the procedure, fat, glandular tissue and skin are removed from the breasts, which are then reshaped and the nipples repositioned.

Breast size is determined by genes, hormones, body frame and weight. For most women, breast size is proportionate to the body, but for some, the breasts are particularly large.

Breasts are sensitive to the hormone estrogen. They can grow during adolescence or later in life following the menopause or because of the use of hormone replacement therapy. Some women also develop a noticeable asymmetry (difference in size or shape) between their breasts.

Breast reduction surgery can help women who are unhappy with the shape, weight or droop of their breasts by making them smaller and more lifted. However, breast size alters with body weight, so even after surgery, your breasts may increase in size if you put on weight or become pregnant.

You may consider a breast reduction surgery if you have physical discomfort due to having large breasts. Physical problems may include:

- backache

- neck pain

- skin irritation

- poor posture

- excessive sweating, rashes and skin

- infections under the breasts

- weals or grooves on the shoulders from bra straps

- an inability to exercise or take part in sports

What is the procedure?

Depending on your personal situation, the procedure can be performed in an outpatient facility or you may have to stay at least one night in the hospital. The surgery itself takes about three to five hours and is performed under general anesthesia. Your surgeon will make an incision around your nipple, then downward on the breast, in a keyhole form. The excess skin, tissue and fat are removed and your nipple is relocated for cosmetic purposes. Your surgeon may use drainage tubes and the incision site is then sutured. Your breasts will be wrapped in special gauze. If required, you may also wear a surgical bra.

What kind of result can you expect?

Patients who undergo breast reduction surgery are usually seeking relief from physical symptoms caused by the excessive weight of large breasts. Breast reduction surgery can solve many of these problems as well as make your breasts smaller and firmer. After the surgery, your breasts will be more proportional to the rest of your body.

Successful breast reduction surgery can relieve pain in your upper back, neck and shoulders. It might also increase your ability to participate in physical activities and promote a more positive self-image.

Although you'll see results immediately, remember that it can take months for the swelling to completely subside and the surgical scars to fade. The final result is generally permanent - although breast shape and size can change due to factors such as aging and weight gain or loss.

Recovery period and recommendations

It is likely that your breasts will be swollen and feel tender and lumpy after surgery. The final appearance of your breasts may not be obvious for several weeks.

Full recovery from breast reduction varies between individuals, so it's important to follow your surgeon's advice, but usually you will be back to normal within six weeks.

The length of time you need to keep the dressings on will depend on how quickly your wounds heal. After one to two weeks, your stitches will either dissolve or be removed at an outpatient clinic.

Avoid stretching, strenuous exercise and heavy lifting for up to six weeks after your operation. You also need to keep your breasts supported by wearing a well-fitting, wireless sports bra.

Scars are usually quite red for the first six weeks after surgery. They then change to a purple color over the next three months before fading to white. Most scars heal well but occasionally patients are left with red and lumpy scars that do not improve in appearance.

Possible side effects and complications

Although any surgery carries risks, the potential complications specific to breast surgery include:

• Scarring. The main disadvantage of having breast reduction surgery is that you will be left with permanent scarring. The operation, when done using the anchor technique, leaves three scars: one around the nipple (areola), one from the nipple to the crease below the breast (this is the worst scar as it takes the most tension) and one from the breast bone to the armpit along the crease below the breast. The severity of scarring largely depends on the individual. Some women are left with red and raised scars but most scars fade over time and should be invisible under normal clothing and most bras or bikini tops.

• Uneven shape. Your breasts will change shape after reduction surgery. There is a chance that they may end up slightly lopsided, lumpy or with uneven nipples.

• Wound healing problems. Wound healing problems after breast reduction surgery are common, particularly after the anchor scar procedure where the vertical and horizontal scars meet. Most wound problems are minor and can be simply managed and treated. More severe wound complications, such as infection, skin loss and wound separation may take longer to heal. Occasionally, some fat in the breasts dies off, leaving them red and lumpy. This is called fat necrosis and can take some time to settle. There can also be some excess skin left around the scars and, if this does not settle after a few months, it may need to be surgically removed. If you smoke or have diabetes, you may have poor circulation which will affect how quickly your wounds heal.

• Loss of nipple sensation. Some women lose sensation in their nipples after a breast reduction, including their ability to become erect. This is because the nerve supply to the nipple can be damaged during surgery. Very rarely, a disrupted blood supply may cause your nipple to die and fall off. This is more likely if you are a heavy smoker or you have poor circulation. Depending on the type of breast reduction you have, if your nipples have been separated from the milk ducts during the operation, you may be unable to breastfeed after the operation.

• Infection. Any kind of surgical procedure carries a potential risk of infection. This can be treated with antibiotics and sometimes further surgery. If you do get an infection after your surgery, this will delay the healing process.

• Hematoma. Occasionally bleeding occurs inside the breast tissue making it swollen and painful. This is called a hematoma and generally occurs within the first 24 hours after the operation. If this happens, you may need to have another operation to drain the blood and stop the bleeding.

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