Breast Reduction

|


Breast reduction surgery is effective in eliminating many of the common problems that result from having overly large breasts.  This includes symptoms such as back pain, shoulder grooving from bra straps, skin irritation under the breasts, as well as generalized discomfort associated with large breast size.  Clothing becomes more manageable and a better physical appearance results not only because the breasts are smaller but also because the accompanying lift lengthens the distance between the bottom of the breasts and the waist.  This gives a slimmer and less matronly appearance.  Swimwear becomes an option for many who previously would not consider it.  Psychological benefits such as improved self confidence and emergence of a more extroverted personality commonly occur following breast reduction surgery.

Breast reduction can be performed at any age although there are two main age groups.  Young women from ages 17 to 30 who have not had children represent the largest group.  Older women who have developed large breasts as a result of weight gain or postmenopausal changes also commonly seek breast reduction surgery.  Both groups are effectively treated by this surgery.

Women often ask if the results of breast reduction surgery are permanent.  While it is extremely rare for the breasts to grow new tissue after surgery, significant weight gain, multiple pregnancies, and postmenopausal changes can cause the breasts to enlarge.  In general however, the results of breast reduction surgery remain stable over time.

It will still be necessary to wear a bra after breast reduction surgery.  However, the bra does not have to work hard to keep the breasts lifted because a surgical lift of the breasts is an integral part of breast reduction surgery.  The bra functions instead to merely hold the breasts in place and therefore is more comfortable to wear.

Breast reduction surgery removes both glandular tissue as well as stretched skin.  At the same time the nipple is raised and the diameter of the areola is reduced.  Contrary to a common misconception the nipple and areola is not completely disconnected from the breast. These structures are left attached to the underlying glandular tissue during surgery in order to preserve their blood supply and sensation.  However, in cases of extreme breast enlargement with very low nipple position complete removal and replacement of the nipple and areola as a graft may be the best option.  The nipple and areola has a near normal appearance after surgery in these cases but sensation is absent.  This procedure is called free nipple graft transplantation.  It applies only to a small minority of breast reduction candidates.

There are two methods of performing breast reduction.  In both types the excess breast tissue and skin is removed.  The skin is removed only from the lower part of the breast in order to avoid scars above the level of the nipple.  The older method of breast reduction leaves an extensive “anchor” scar pattern that includes a scar around the areola, one extending vertically down to the crease under the breast, and a long scar in the crease itself.  Today, surgeons are using this method less and less and opting instead for the Lejour or “lollipop” scar method.  This technique was developed in Europe by two surgeons (LeJour and Lassus) many years ago and has been more recently introduced here in the United States.  It has fewer scars: only around the edge of the areola and vertically down to the crease under the breast.  There is no scar in the crease itself.  This method also has the advantage over the anchor technique of being able to make a wide breast significantly narrower.  It also results in a more pleasing conical shape compared to the flat shape that the anchor method typically produces.

It is not possible to guarantee a particular cup size as a result of surgery.  It is more important to create the best aesthetic shape taking into consideration chest dimensions as well as overall height and weight.  Very flat, pancake-like breasts can result if an excessive amount of breast tissue is removed.  Most women decrease their breast size by at least one cup size and those who are DD or larger often decrease by two.  In all cases enough tissue is removed to relieve symptoms while at the same time create the best possible shape. 

Any form of surgery, including plastic surgery, will leave scars. The scars can spread in some cases no matter how meticulous the skin closure is performed during surgery.  The scars usually fade with time and patients seeking breast reduction are rarely troubled by their appearance.  However, it is important to realize that all scars are permanent and their width, texture, and color are not predictable in advance. 

A breast reduction by nature disturbs the glandular architecture and this may affect the ability to breast-feed.  Generally, the larger the reduction the more lactation is likely to be disturbed.  It is impossible to predict beforehand what breast function will be like after surgery.  However those having more of a lift (with only a slight reduction) can probably expect near normal lactation ability.

Removal of breast tissue may result in diminished nipple sensation.  This condition may be temporary but can take over a year to improve.  Recovery may not be complete.  As in the case of breast-feeding ability, larger reductions tend to disturb function more.  Those who need very large reductions may have a permanent loss of nipple sensation on one or both sides.  Nipples sometimes can become unpleasantly hypersensitive after surgery.  This condition is more benign and eventually resolves.

Women over thirty-five should have a mammogram prior to surgery if they have not had one within the past year.  Mammograms are not permitted again until six months after surgery.

Breast reduction is always performed under general anesthesia but patients are able to go home the same day. The operation usually takes at least 3.5 hours but can easily take one more hour in the case of very large breast size.  The surgery is performed entirely by Dr. Hidalgo.  Blood transfusion is not necessary for breast reduction and therefore preoperative blood donation is not required.  Breast tissue removed at surgery is always submitted to the pathologist for routine examination.The pathology department of Lenox Hill Hospital reviews the tissue and charges separately for their services.
  
Breast reduction surgery is conceptually a more superficial type of surgery because the breasts lie outside of the main body cavities and structures.   There is usually less pain as a result.  Most women describe a burning feeling in the areas of the skin incisions after surgery but very few report more significant discomfort.  Nevertheless, pain medication is available and can be taken as needed.

It is not necessary to purchase any special bras prior to surgery.  A simple surgical bra that opens in the front will be placed at the end of the procedure and will be worn for the first week after surgery.   Regular bras with underwires can be worn after one week.

Plastic drains placed under the skin are removed at one week at the first postoperative visit.  This usually takes fifteen minutes and is generally not a painful process.  Most of the stitches dissolve and do not require removal.  Most activities except lifting and carrying heavy items can be resumed after one week.  It is usually possible to return to work after one week.  Activities that require heavy lifting should be avoided for at least six weeks.  Tennis, jogging, and most other sports may be resumed six weeks following surgery.  Aerobic exercise that does not involve the upper body such as an exercise bike or fast walking can be resumed much sooner.

The most common complication following breast reduction surgery is hematoma, a collection of blood under the skin.  This occurs in a very small percentage of patients and may require return to the operating room to remove it. Other unusual complications include infection, delayed healing of incisions, excessive scarring, and partial or complete loss of the nipple (very rare).

Copyright © 2007 David A Hidalgo, M.D.


| back to top |