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Breast Reduction

Large breasts can be a major cause of embarrassment and discomfort for some women and may interfere with their ability to wear well-fitting clothing and to exercise normally.

Breast reduction surgery is designed to reduce the size of a woman's breasts and to lift them and provide a good aesthetic shape too. In my own practice, I routinely use a technique which leaves a so-called lollipop scar i.e one which passes around the edge of the areola and then vertically passes from the areola to the inframammary crease. The surgery typically leaves the breasts slightly over-lifted in the beginning but gravity and time settle things down very well.

Surgery is performed under general anaesthesia and usually involves 1-2 nights in hospital. At the end of the procedure, the wounds are supported by external dressings and a surgical corset or binder, which is replaced early in the post-operative period by a sports bra. I personally recommend that patients wear their sports bras for 6 weeks, night and day, except when bathing. After discharge from hospital we expect patients to be involved in light normal daily activities and to gradually return to normal activities over a period of weeks, once the wounds are healing satisfactorily. It is usually unsafe to drive for 2-3 weeks after the procedure and most patients will take a fortnight off work although those involved in manual activities, such as nurses, may need to take much longer.

For most women, the surgery involves reducing the size of the breasts but leaving them in proportion with the rest of the figure.

Complications

Bleeding occurs in approximately 1 in 20 patients and is typically an early event, occurring within hours of surgery. Treatment usually involves a return to the operating theatre where, under general anaesthetic once more, the wounds are opened and any blood that may have collected is removed before closing the wounds again. This complication occasionally occurs following discharge from hospital and is clinically very obvious because of the swelling and discomfort that it causes in the breast that is affected.

Infection

Infection occurs in approximately 3% of patients and usually evolves between the time of discharge from hospital and the date to return for the first outpatient visit. Symptoms and signs include swelling, redness, pain, fever, feeling unwell and ultimately a discharge of pus from the wound. Superficial infections can be managed by antibiotics alone but more severe infections, perhaps even the development of an abscess, may require re-hospitalisation and even additional surgery.

Removal of breast tissue has an impact on the blood and nerve supply to the nipple. Reducing the blood supply carries with it a very small risk that the nipple may perish (necrosis). In non-smoking women who are otherwise fit and well, undergoing an average breast reduction, this risk is extremely low. Loss of nerve supply to the nipple may lead to a loss of skin sensation. Numbness can in some cases, effect both breasts and may be permanent (approximately a third of patients).

Some areas of the wound may be slow to heal after breast reduction - the typical is continued dressings.

For women who have not yet completed their families and are contemplating breast reduction surgery, it is important to note that breastfeeding will almost certainly be impossible after breast reduction has been performed. This may be a reason to defer surgery until the family is complete.

Final size and perfect symmetry cannot be guaranteed, indeed, most women's breasts are not identical, either in shape or size. If at the end of surgery minor differences persist, which are acceptable to the patient and myself then I do not recommend further treatment. Secondary surgery may be helpful, though, for some patients who have issues with their size or shape following surgery. The most common reason to re-operate is minor scar revision, often performed under local anaesthetic on an outpatient basis.

General complications can occur including deep vein thrombosis and pulmonary embolism.

Key Points - Breast Reduction

• Surgery leaves the breasts smaller and uplifted
• Surgery typically leaves a lollypop scar around the nipple and vertically down to the breast crease.
• Surgery is performed under a general anaesthetic with 1-2 nights in hospital post-operatively
• I recommend patients wear a sports bra for 4-6 weeks post-operatively
• Appearances tend to settle and improve over the first 2-3 months
• Driving will not be possible for 2-4 weeks after surgery
• Office workers should be fit to return to work after a fortnight