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Breast Reduction

Procedures  | Breast Reduction

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Some women develop breasts that are larger than they would like. The consequences may be aesthetic-a matronly look with a disproportion between the chest and the rest of the figure. There are also commonly functional problems-back and neck pain, bra strap grooves on the top of the shoulders, a stooped posture, skin changes from chronic moisture under the breasts, and occasionally breast pain resulting from the weight of the breasts pulling away from the chest wall. To address this problem, reduction of the weight of the breast is a welcome relief.

Breast reduction, however, must address more than just excess weight. Almost always, the nipple and areola are sitting lower on the chest wall than is proper. The breast shape may be flattened, and there is a surplus of skin, especially when the volume of breast tissue is reduced. This excess skin makes the breast look droopy-called "ptosis." Reduction of the breasts is one of the most appreciated operations performed by plastic surgeons.

 

General questions...

    • What is accomplished by a breast reduction?

    Breast reduction is an operation designed to address the constellation of problems listed above. The breast is reduced in weight. The breast mound is reshaped to a more youthful appearance. The nipple and areola are resized and repositioned higher on the chest wall. The excess skin is pruned. Not only must the surgeon accomplish these goals for each breast but in the end, the breasts should be symmetrical.
    • How is the final breast size determined?

    Breast size is determined by the patient. Most women wish to be in the vicinity of a "C" cup when the operation is complete. A few may want to be a bit smaller, a few larger. Most patients who are asked a year or so after the operation about their results wish the surgeon had reduced them a little more.

    Sculpting the skin envelope is, in my hands, a "free-hand" technique. That is, there is no set of predefined incisions that are used. The advantage for the patient is that the incisions are only as long as they absolutely have to be to remove the excess skin.
    • Will there be scars resulting from breast reduction surgery?

    Most women who choose to have their breasts reduced are more concerned about the way they feel as a consequence of their generous size rather than the way they look. Nevertheless, aesthetic satisfaction is a priority for the plastic surgeon. Unfortunately, to accomplish all of the objectives of a reduction, relatively long incisions are necessary. Patients need to understand exactly where these incisions will be. Due to basic biologic "geometry," breast reduction, the more excess skin there is and the longer the consequent incisions need to be. But even in a modest reduction, are an important consideration.

    Almost all patients who have reductions acknowledge that their breasts, in addition to being smaller, look more youthful and better positioned. In the end, the final aesthetic product depends almost exclusively on how the scars remodel and fade. During the operation, the techniques employed for skin closure are proven the best for a favorable scar. Post-operatively, patients are given special instructions and occasionally tools (such as silicone patches) that can favor the healing process. Nevertheless, Mother Nature is a partner in the whole healing affair, and "she" may not allow the ideal scar. In any event, it takes many months for the incisions to fade until they are nearly invisible. Revisions may be necessary if Mother Nature doesn't cooperate. Fortunately, most scars end up very satisfactoy.
    • Will a bra be necessary after breast reduction surgery?

    Women must support their breasts after reduction (particularly during exercise) with a good support bra. Gravity continues to effect the breast mound, and some droopiness will reemerge if the breasts are not properly supported.
    • Will I lose sensation in my nipple after breast reduction surgery?

    Most patients will gain back most or all of their sensitivity in the nipple and areola. The occasional patient may not. Those at greatest risk are women with extremely large breasts, diabetics, smokers, post-menopausal, and previous breast surgery. Breast feeding is usually possible in those women who become pregnant after a reduction. The process of breast feeding may, however, result in some sagging of the breast as it can in the unoperated breast.
    • Will I be able to breast feed after breast reduction?

    Breast feeding is usually possible in those women who become pregnant after a reduction. It is not known precisely how it effects the ability to breast feed (not all women are capable of breast feeding). It certainly would not increase the ability to breast feed.

    The process of breast feeding may, however, result in some sagging of the breast as it can in the unoperated breast.
    • Are patients pleased with the results?

    Most patients with breast reductions are delighted with the result. As stated above, the final aesthetic product is determined primarily by the appearance of the scar. Most patients end up with very acceptable scars but may take many months to arrive there. Nevertheless, even with the slow evolution of an acceptable scar breast reduction patients are very happy.

    In a review of my own breast reduction patients, symptoms of back pain, shoulder pain, bra strap grooves, skin problems under the breasts, and chest wall pain were nearly totally eliminated in the study group. This was true even in women who had relatively small reductions-less than 1000 grams total. Every woman in the study stated that they would have the operation again if they had to do it all over.

    We also found, not altogether surprisingly, that after the patients had recovered from their reductions, they went on to lose an additional 13 to 14 pounds. When we investigated the reason for this by way of telephone interview, it became clear that the burden of heavy breasts had kept them from exercising the way they would have liked. After the reduction, a more vigorous lifestyle became possible, and weight loss followed.

Important information to know...

    • What is the effect of breast reduction on breast cancer and mammography?

    Women are able to have satisfactory mammograms after reduction and should schedule them as per their physician's recommended routine. Breast reduction does reduce the risk of breast cancer. It does not change the need for mammograms and other cancer screening tests.
    • What are the post-operative instructions?

    1. The dressings are supported by a bra that is provided to you in the operating room. Leave it in place until the second day after the operation (about 48 hours). Take off the bra and remove the pads that are not adherent to your breasts. Any dressings that stick should be teased off or taken into the shower for removal aided by water. Wash the breasts thoroughly but gently in the shower and blot dry.

    Apply a small amount of antibiotic ointment to the incisions. Replace the dressings (a clean wash cloth will do) and support them with the surgical bra. Repeat this routine daily. Wear the bra night and day until you are rechecked in the office and given new directions. Generally patients switch to an absorbant exercise bra when the sutures are removed (about 10 days) and the draining is minimal. No underwires until given clearance by Dr. Zubowicz.

    2. Light activity only the first two days after surgery, then gradually begin to increase from day to day. By the third or fourth day post-op you should be able to go about your basic daily activities. Soreness will persist for at least several more days. Most patients can return to desk-type work when they feel comfortable (about one week). Remember, absolutely no heavy lifting, pushing or pulling until released by Dr. Zubowicz.

    3. Have your prescriptions filled prior to surgery, and take all medications as prescribed by Dr. Zubowicz. If you do not use the Phenergan suppositories, you may store them in the refrigerator where they will keep for up to a year.

    4. Schedule a follow-up appointment with Dr. Zubowicz for one week after surgery. Your stitches will probably be ready to come out the following week (10 to 14 days). The sutures securing the areola are buried and dissolvable.

    5. Do not be alarmed if your breasts are not completely round or symmetrical immediately after removing the dressings. Swelling will create temporary distortion and this will correct itself in several weeks. Any large differences in size should be reported to Dr. Zubowicz. In rare cases a hematoma (collection of blood under the skin) may cause one breast to be much larger and/or more painful than the other.

    6.Report to Dr. Zubowicz any fever, large amount of drainage, significant asymmetry of the breasts, or inordinate pain. Feel free to ask any questions by calling 404 814-1100.