Breast reduction
The size of the female breast depends on many factors including heredity, hormonal changes and body weight. A lot of women develop problems early on in adolescence due to heredity, while others develop problems later on, in mid age, due to hormonal changes. Regardless of the aetiology the problems caused by heavy, large breasts are the same: neck, back or shoulder pain, bra strap indentations in the shoulders, skin irritation beneath the breasts, restriction of physical activity, difficulties in fitting clothes and self-consciousness that leads to psychological problems.
Other women may find that their breasts are asymmetric, with one being much larger that the other.
Breast reduction aims at reducing the size of the breasts by removing excess fat, breast tissue and skin, making the breasts smaller and firmer. The areola (the pigmented skin surrounding the nipple) may also be reduced and repositioned.
What can I expect after the operation?
When can I resume my normal activities?
How is breast reduction performed?
Individual factor and personal preferences will determine the specific technique suited for each patient. In general, the procedure is performed under a general anaesthetic and takes approximately 3-4 hours.
In most cases an incision in placed around the areola, another one runs vertically from the bottom edge of the areola to the crease underneath the breast, and a third one runs horizontally beneath the breast following the natural curve of the breast crease (inframammary fold), forming an inverted “T”. The excess fat, breast tissue and skin are removed, the areola is shifted to a higher position, and the skin is brought together to reshape the breast.
Occasionally liposuction may be used to improve the contour under the arm. In some cases the horizontal limb of the incision may be smaller or even be done with altogether.
In some instances, with extremely large breasts, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In this case nipple sensation and the ability to breast feed may be sacrificed.
The sutures used are usually placed internally and are dissolvable. One small drain is placed on each side to prevent the collection of blood (haematoma).
What can I expect after the operation?
As already mentioned the procedure takes approximately 3 hours and the length of stay in hospital is usually 1-2 days.
Gauze dressings will be placed on your breasts and covered with an elastic bandage or a support bra. Post-operative pain is usually well tolerated and can be easily managed with regular painkillers. The day after surgery you will be encouraged to get out of bed for short periods of time. Surgical drains stay in place for 24-48 hours until drainage is minimal. The bandages are then readjusted and you are instructed to wear a wireless support bra for 3-4 weeks.
Following surgery you will experience considerable swelling and bruising of the breasts, which will gradually subside over time. Bruising usually lasts for 2-3 weeks and swelling dissipates in 2-3 months, after which time the breasts gradually assume their final shape and volume.
The scars in breast reduction may be quite lengthy and take several months to settle. Initially the scars will be red, hard and lumpy, but with time they usually fade and flatten. This process of scar maturation may be expedited by daily massage. Nipple sensation may be initially reduced but usually returns over the months to follow.
When can I resume my normal activities?
After breast reduction surgery, you can resume light activities within 2-3 days but more strenuous activities are discouraged for the first two weeks, as is sexual activity. Depending on your job you might be able to go back to work after just a couple of weeks, and full recovery to your previous activities, including exercise is expected in 4-6 weeks.
Pictures (c) ASPS, ASAPS, AAFPRS, ADAM, Allergan
