Breast Reduction

The size of women’s breasts may be determined by several factors, such as inherited genes, body weight and hormonal influences. They can, therefore, be a problem to some women early in adolescence or may not become uncomfortable until middle age following the menopause or the use of HRT.

The problem of large breasts, however, may cause similar problems at all ages and these are mainly backache, neck pain, grooves in the shoulders from bra straps, rashes under the breasts and the feeling of self consciousness. Because of the sexual nature of breasts, the undue prominence may attract unwanted attention from the opposite sex, comments and sexual innuendos. These can cause psychological distress to many women. One of the commonest complaints of women with large breasts is that it is very difficult to wear fashionable clothes and indulge in active sports, particularly in the summer months.

What can be done?

Breast Reduction is an operation which removes the excess fat and skin from the breasts, which are then reshaped and the nipples repositioned to form smaller breasts. This should result in more attractive breasts and reduce many of the problems outlined above.The breasts can be reshaped into several surgical designs and all of these will involve an incision around the areola of the breasts.  Each design will have different scars, and will have advantages and disadvantages, however the design which is best for you will be decided in your consultation with your surgeon, and approved by you.  All of them will involve a scar around the areola of the breast. Each method will use different scars and will have advantages and disadvantages and your surgeon may select, with your approval, the best technique in your particular case.

 Will the improvement last?

Unless your operation is done at an age when your breasts are still growing they should not regrow afterwards. They will, however, increase in size if you either put on weight or become pregnant and decrease in size if you lose weight . Even normal breasts have a tendency to droop with time and you can expect some change in shape to occur after a Breast Reduction. You can delay this tendency by supporting your breasts in well fitting bras.

What you should do before the operation?

Your surgeon is likely to recommend that you reduce weight if you are overweight and to make alternative arrangements if you are on the contraceptive pill. Smoking can seriously affect the healing process and the outcome of the scarring, and we strongly advise that you stop smoking for the best results.

What can you expect at the time of the operation?

The procedure is carried out under general anaesthetic and when you wake from the operation, you may feel some discomfort.  This can last for one to two weeks.  You will be discharged with antibiotics and pain relief.  Drainage tubes may also be used and are generally removed within 24-48 hours.  You are usually in hospital for one night and discharged the following day, although on occasions you may be in for two nights if the surgeon thinks this is required.  Sutures will be removed at approximately 7-10 days after your operation and this will be carried out in your outpatients appointment at the hospital.  You will require help at home once you are discharged, for approximately two to six weeks, depending on your age and your fitness level.  You will require a SUPPORT BRA for at least six weeks after your operation.  You will have post-operative swelling so your surgeon will advise the approximate size needed.  Your breasts may feel tender and lumpy for several weeks or even months following your operation and this is perfectly normal.

What Are The Consequences?

Apart from the change of shape and reduction in size, the most obvious consequences are the scars.Scars are permanent and will remain a permanent feature of your appearance, however they should become less obvious over the following months and should fade from being red, and should become paler and less obvious, with good scar management from you.  The scars will always be visible when clothing is not worn.  Some scars may be quite thin, but others may stretch and become quite red, thick and unsightly.  In the vast majority of women, the scars are acceptable and are a small trade-off for the benefits of dealing with the problems of large breasts.  Very few women are able to breast feed after breast reduction surgery, as the nipples are separated from the underlying milk ducts, and at the time of pregnancy  the milk supply will gradually dry up, sometimes with the assistance of hormone treatment.  Breast reduction is no contraindication to pregnancy but young women may well wish to take into account the fact that they may be unable to breast feed, before embarking on this procedure.  The nipples are likely to be much less sensitive following this surgery, due to the nature of the incisions and the nerve supply, and it is quite possible that this numbness could extend over the breast area as well

What Are The Limitations?

It is very important that you discuss thoroughly with your surgeon beforehand the size of breasts you wish to achieve. Many women wish for a very radical reduction but in order to achieve this the shape and aesthetic quality of the breasts may be compromised. It is also possible that there may be a degree of asymmetry, but this is often less than existed before surgery. In women with very large breasts the benefits of a significant reduction may outweigh the potential imperfections of poor shape and loss of nipple function and sensitivity. However, in women with breasts which are only slightly larger than normal very careful thought must be given to the scarring and the potential shape and size as the outcome of the surgery may not be as aesthetically pleasing as a normal breast appearance.

What Are The Risks?

Any major operation with a general anaesthetic carries a small risk of chest infection, particularly among people who smoke and there is also a risk of thrombosis in the veins of the leg, particularly for patients who are taking the contraceptive pill.

Occasionally, heavy bleeding can occur after the operation is finished, which may need a further operation and a blood transfusion. Occasionally, infection from germs harbouring in the ducts of the breast can be troublesome. Infection can be treated with antibiotics but it will delay the healing process.  Scars are likely to be worse to start with and there may be a need to re-stitch them at a later date. If you have a discharge from your nipple it is most important to tell your surgeon about it before your operation.

Occasionally, skin can become sloughy and form a scab, which gradually separates and leaves a broad scar. The nipple disc and the skin where the scar meets underneath the breast, are the parts most likely to be affected. People who smoke are at greater risk of this happening. Usually the scars settle well and can be seen as pale pink or white line, but they will always be present and always be noticeable when you are unclothed. However, some people have an inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time.

When reducing large breasts it may occasionally be necessary to adjust the folds of skin at the end of the scar, both between the breasts and at the sides. This can simply be carried out under local anaesthetic several months later.

There is no evidence to suggest that Breast Reduction causes breast cancer, nor does it prevent your breast from being examined for cancer in the usual way.

ARNICA tablets will reduce swelling. They may be bought from a CHEMIST. These should be started a few days before surgery and continued for several days afterwards.

The sutures you have are dissolving and do not need removing. Occasionally a small piece of suture may remain and need removing.

You must keep your dressing as dry as possible until your follow up appointment.

Swelling and bruising may be severe.

You should have been measured for bra size preoperatively. Although it is difficult to be precise about your size after surgery, you should have an indication of the size of the SPORTS BRA you will need. As a general rule expect to keep your chest measurement (36, 38 etc) but you should reduce your cup size. Immediately after surgery there will be occasionally dramatic swelling, which means you may be alarmed that your breasts still appear large. Swelling will decrease over the next 6 – 12 months.

Please bear in mind that we will endeavor to give you the breast reduction you desire, but it may be that to obtain the desired reduction in size, this may compromise wound healing as well as shape of the breast. This will have been discussed with you at your initial consultation and in your pre operative discussion on the day of surgery. The operation we have performed is to ensure a SAFE and NATURAL result.

Scarring is always an issue and hopefully your scarring will be reasonable. If scarring is an issue we will endeavor to correct this. There is usually no charge for this, however, a facility fee may be charged. Any corrective surgery will only be undertaken when post operative swelling settles which may be after 9 – 12 months.

At your follow up appointment you will be given further advice regarding scar massage.

Do You Have Any Questions?

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