Breast reduction surgery: your questions answered

Dr Mark Kohout
Wednesday, November 2, 2005

What is breast reduction?
A breast reduction is an operation aimed at removing excessive breast tissue and fatty tissue in order to leave the breast smaller, better-shaped and in proportion with the rest of the body. The nipple is elevated to a more youthful position and the shape of the breast is improved.

Women with large, heavy breasts may experience several health concerns related to their breasts such as back pain, neck pain, grooves in the shoulders from bra straps, pain in the breasts and rashes under the breasts. Women with arthritis of the spine and shoulders may have more symptoms than usual because of the added weight of heavy breasts. Some women are bothered by the psychological embarrassment of large breasts. In other situations, athletic, active women and women who are trying to lose weight are inhibited by the size of their breasts. Often, it is difficult and expensive to find clothes that fit. Breast reduction can minimise or eliminate these problems.

Is breast reduction for me?
Any of the following conditions may make you a candidate for breast reduction surgery:

  • Breasts that are too large in proportion to your body frame
  • Heavy, pendulous breasts with nipples and areolas that point downward
  • One breast that is much larger than the other
  • Back, neck or shoulder pain caused by the weight of your breasts
  • Skin irritation or infections beneath your breasts
  • Indentations in your shoulders from tight bra straps
  • Restriction of physical activity due to the size and weight of your breasts
  • Dissatisfaction or self-consciousness about the largeness of your breasts

Initial consultation
During the initial consultation, you may be asked to point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can be realistically achieved.

You will be asked about your medical history including previous operations, past and present medical conditions and current medications. Your plastic surgeon will examine you and take measurements. Your surgeon will discuss with you the details of the operation and the possible risks and complications associated with the procedure.

Breast reduction can be performed at any age after breast development has stopped. Childbirth and breast feeding may have significant and unpredictable effects on the size and shape of your breasts. If you plan to breast feed in the future, you should discuss this with your plastic surgeon as breast reduction surgery has a significant effect on your subsequent ability to breast feed. You should tell your plastic surgeon if you plan to lose a significant amount of weight as this may also affect the size and shape of your breasts.

Preparation for surgery
It is a good idea to lose weight prior to surgery to a level you would like to keep long-term, since weight loss after the operation will affect the shape and size of your breasts. Smokers will be asked to stop smoking three weeks before surgery as nicotine in cigarette smoke interferes with blood circulation. Aspirin and some anti-inflammatory drugs used for the treatment of arthritis can cause increased bleeding, so you should avoid taking these medications for two weeks before surgery.

Your operation
Breast reduction surgery is usually performed on an inpatient basis and you should expect to stay in hospital for three to five days. The operation takes about two and a half to three and a half hours, depending on the amount of tissue to be removed and on the method used.

There are a number of different techniques in breast reduction surgery. Some operations are more suited to a particular breast size or shape. Some will produce well-shaped breast but create long scars. Others can be performed with relatively minor scarring but may not be suitable for very large breasts. Personal preferences will also determine the specific technique selected. Your plastic surgeon will help you decide on the surgical technique that will result in the best outcome for you.

After surgery
It is important to realise that the amount of time it takes for recovery varies greatly among individuals. The day after surgery, you will be encouraged to get out of bed for short periods of time and your mobilisation will be rapidly increased. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts.

Any surgical drains will be removed a day or two after surgery, at which time your dressings may also be changed. You will be instructed to wear a support bra for a few weeks, until the swelling and discolouration of your breasts diminishes. Generally, stitches will be removed within one week after surgery.

You may notice that you feel less sensation in the nipple and areola areas. This usually is temporary. However, it may take months or even more than a year before sensation returns to normal. Your breasts will take some time to assume a more natural shape: you will notice the breasts changing slightly for up to 12 months. Incisions will initially be red or pink in colour and they will remain this way for many months following surgery. Eventually, the scars will become lighter and they will assume the colour of your surrounding skin until they become barely visible.

When can I start my normal activities?
It is often possible to return to work within two weeks, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. It is important not to do any strenuous exercise of the upper body and chest for two weeks as this increases the chances of bleeding. After that, care must be taken to be extremely gentle with your breasts for at least the next six weeks. Contact sports should be avoided for at least eight weeks.

Surgery results
Breast reduction surgery will make your breasts smaller and firmer. Without the excessive weight of large breasts, you may find greater enjoyment in playing sports and engaging in other physical activity.

Breast reduction often makes a dramatic change in your appearance. It may take some time to adjust to your new body image. Most women, however, eventually become comfortable with their smaller breasts and are very happy with the results of surgery. In fact, the level of patient satisfaction resulting after breast reduction is among the highest of any plastic surgery procedure.

The reduction of breast volume is permanent. However it is important to realise that if you gain or lose a significant amount of weight or become pregnant, your breast size and shape may change.

Is breast reduction surgery covered by Medicare?
If your breasts cause problems such as neck pain or skin irritation, then Medicare will cover part of the cost of your surgery and anaesthetic. Private health funds will generally cover the private hospital costs.

Dr Mark Kohout FRACS
Plastic Surgeon
Ph: 1300 551 151
Leichhardt — Bondi Junction — Orange NSW

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