A breast reduction is an operation designed to reduce the size of a breast and raise the nipples to a more normal level. Usually both breasts are reduced but sometimes a small reduction is required on one side only to make both sides more equal in size and shape.
A breast reduction can be performed for both physical and psychological symptoms associated with large breasts. The procedure takes around 2-3 hours and involves a hospital stay of around one night. Most women who undergo the procedure are delighted with their results, though there is a recovery time of a few weeks associated with the procedure.
Incisions To do a breast reduction, scars must be made around the breast. There are several techniques that can be used, but the two most popular are the anchor shape and the lollipop shape. The traditional way to perform a breast reduction leads to scars around the nipple/areolar, down from this to where the breast meets the chest wall and then across from near the armpit to near the most middle part of the breast. This is called the Wise pattern, or anchor scar technique. The lollipop scar technique is also called the vertical scar technique and the short scar technique. This involves a scar around the nipple/areolar and down from here to where the breast meets the chest wall. Both techniques have their advantages and disadvantages. The Wise pattern is often used in cases where a large amount of breast tissue is going to be removed; the vertical scar technique leads to a smaller and less noticeable scar, but the chances of revisional surgery to the scar are greater than with the Wise pattern technique and the scar takes around 6 months to smooth out. Some surgeons will use other shapes of final scar including J or L-shaped scars, or just round scars around the nipple. The best scar for your breast reduction requirement will be best determined by you and your surgeon having a full discussion about what can be done and what can't be done with the different methods available. Size Changes The amount of reduction required can be tailored for the needs of the patient and it is often possible to reduce the breast size to the size requested. The amount of tissue that needs to be removed depends on several factors, including the chest size, the current bra cup size and the size requested. After the operation, minor to moderate amounts of bruising and swelling mean that we don't see the final result for around six months. It is important to wear a supportive sports bra constantly for a couple of months after the operation, so that the breasts heal in the right position and it is important to remember that changes in breast size may still occur after weight changes, even after the operation. After your operation, there are some things that can change your breast shape and size as time goes by. These include: weight gain, weight loss, pregnancy, breast feeding and generally getting older. Risks The vast majority of women are delighted with the final results of their surgery. Sometimes the healing process can be delayed for a few weeks because of complications (the commonest of which are related to bruising, swelling and wound healing problems) but the overall satisfaction rate for breast reduction procedures remains high. The risks of breast reduction include (but are not limited to) the following: Infection The early signs of infection are redness and discharge around the wound site and feeling unwell with flu like symptoms. Often a surgeon will ask you to attend the hospital or clinic around a week after the operation, for a quick wound check to make sure that any early signs of trouble can be dealt with promptly. Blood Clots Blood clots can occur after any surgery. If a blood clot forms within the breast where the reduction has taken place this is usually spotted in the first 24 hours after the operation. If this happens, you may need to go back to the operating theatre to remove the blood clot. A different type of blood clot can form in the legs after any operation (or indeed any period of prolonged immobility, such as an aeroplane journey, or prolonged operation). These blood clots in the legs can break off and fly into the lungs causing breathing problems. Although rare, if this does happen it can happen around a week or so after the operation and you should seek emergency treatment for this. Drink plenty of fluids and keep your legs mobile after any operation to reduce the risk of blood clots in the legs (also known as DVTs, or deep venous thrombosis). Scarring Any operation or any cut in the skin leads to scarring. Most scarring after a breast reduction settles over the course of several months. Rarely, scarring can be a problem and in these cases, it will be a problem a few months after the operation. If you do have scar problems, then you might want to apply creams or ointments recommended by your surgeon, or he may want to give you injections into the scar to help reduce some of the itch and pain associated with some of the more abnormal scars. Scars may also darken if exposed to too much sun or tanning booths after an operation, so you should protect your scars from these after such an operation. Asymmetry Everyone is a little different on each side before the operation, and we can try to improve on this during the operation. For those women who have a considerable degree of asymmetry between the left and right breast before the operation, we can often make things a lot better but your left and right sides will always be a little different. Also, whenever we do an operation on two sides, the rate of healing varies, even though we do the same operation using the same techniques on both sides. As a result, sometimes the two sides can heal at different rates over the course of time. We generally will see the final result six months after the operation. Problems With Healing Sometimes, the wound may unzip, leading to infection and implant exposure. Your surgeon may choose to resuture the wound or to allow the wound to heal with dressings. This is perhaps one of the commonest problems after a breast reduction and usually this settles with a few weeks of dressings. Rarely there may be loss of tissue and this may mean you lose some of the skin around the breast, some of the fat within the breast or the nipple itself. Although these complications are rare, they can be quite devastating and may mean reconstructive surgery from your plastic surgeon. Nipple Sensitivity After a breast reduction, the nipples can change in their sensitivity. It may be uncomfortable to touch the nipples, they may become inverted, or they may become quite prominent. This usually settles over a few weeks, and during this time, nipple protection may help reduce the discomfort. Nerve Injury The nerves that supply the skin of the breast and the nipple run close to where some incisions are made and where the reshaping is performed. These nerves can often be irritated during the operation, which can sometimes lead to reduced sensation around the nipple and the skin of the breast. This is often a temporary problem, but can take up to six months to return. In rare cases, the loss of sensation around the nipple can be permanent. Size Issues Some women feel they should have been made bigger or smaller after their operation. Often this can be avoided by discussing size issues in detail with your surgeon beforehand. However, sometimes it can be difficult to know exactly what size you will be after reduction. The vast majority of women, however, are absolutely delighted with their appearance afterwards. Changes With Time Your breasts may change in size and shape with weight gain, weight loss, pregnancy, breast feeding and age. What You Need To Know About Mammograms A mammogram is an X-ray which is taken to look for breast cancer. Although having a breast reduction doesn't increase your risk of getting breast cancer it can make it harder to detect. You should know that a mammogram will be harder to interpret after a breast reduction. When a mammogram is performed, the radiologists are looking for changes inside the breast such as abnormal scarring and if you have already had a breast reduction you may show some signs of these abnormal scarring. This may make it harder to detect an early breast cancer. When you are having a mammogram you should tell your radiographer that you have had a breast reduction (if they don't already ask you). Your breast tissue that is removed may also be sent to a lab for examination to look for breast cancer. It is very rare to see any breast cancer within the removed tissue, but you should be aware of what we do. Breast Lumps During the healing period, you may develop breast lumps which may be a sign of some of the fat inside the breasts undergoing necrosis. All breast lumps should be brought to the attention of your surgeon. General Anaesthesia Since the operation is usually performed under general anaesthesia, there are also risks of a short general anaesthetic. Modern anaesthesia techniques are safer than ever before and it is very safe indeed to have a short anaesthetic, particularly when your anaesthetist is an experienced hospital consultant with an excellent safety track record. It also helps if you are as fit as possible, and you should stop smoking if you are smoker.