Breast reduction is an operation that is planned to reduce too big breasts and adjust them respectively to the rest of the body. The surgery may be also performed with considerable breast asymmetry, when one side is much larger than the other one. Women who have too big breasts may suffer from pain ailments within the neck and back, painful grooves where bra straps left marks on shoulders, skin irritation and rash in skin folds below breasts.
What is the breast reduction surgery about?
There are many techniques, which may be used in order to reduce breasts. The selection partially depends on the amount of breast tissue that is to be removed and on skin quality.
Incisions are made in order to shape the breast in smaller form. Incisions may cover one or more of the following areas:
around the areola of nipple (round skin around the nipple) – vertically down from the areola to the fold under the breast
horizontally within the fold under breast
Excessive amount of breast tissue and skin is removed and the whole breast is reshaped and lifted up, together with the nipple and areola, to obtain a more youthful look. Incisions are sutured in a manner reducing scars to minimum. You can have two small tubes introduced (drainage) into each breast in order to evacuate blood or fluid excess. These tubes shall be removed before the patient goes home. The procedure lasts about 3-4 hours and is conducted under general anaesthesia (you will sleep during the surgery). Operated area may be swollen, cyanosed and oversensitive, and therefore you may experience pain during the following several days. Simple analgesics shall reduce discomfort to minimum, although it is recommended to avoid Aspirin during the first several weeks after the surgery.
If there are no complications, the patient can go home 3 days after the procedure.
What is the risk and side effects related with the surgery?
When plastic surgery is taken into consideration, it may be an extremely pleasant experience. Complications are extremely rare and they are usually quite small. Nevertheless, this certainly is not an operation deprived of any risk and it is important to be aware of all possible complications.
Haematoma (accumulation of blood within the wound) is a rare phenomenon, which usually occurs within first 24 hours after the procedure. Large haematomas need to be absolutely evacuated in an operating room, under general anaesthesia. Postoperative infection may occur, yet again this is also a very rare phenomenon. Infections can be effectively treated with antibiotics.
Every surgeon prefers different manner of treatment, hence results cannot always be anticipated. Weak or delayed healing is quite sporadic. Therapeutic difficulties may range from small issues, such as small areas of wound disruption, to severe problems such as lost part of skin or nipple. Although such situations are extremely rare, yet they may require skin grafting or wound suturing, and this means subsequent surgeries. Elderly people, patients suffering from diabetes or obese people are more prone to the risk of delayed healing.
There is always a risk that permanent scars will remain in places where incisions are made. Breast reduction surgery stands as a compromise between large and uncomfortable breasts and smaller ones, characterised by better shape and greater symmetry, yet with scars that are almost invisible. Although scars usually vanish and become soft even up to one year after the procedure, they may become condensed and expanded. It is far more probable that thick scars (overgrown scars, keloid scars) shall be created in case of people with pale and dark skin. However, scars are planned in such a manner that they remain hidden under regular bra or bikini top.
The feeling of numbness in the area around the nipple changes constantly, but this is noting unusual after this particular surgery. What may also change is the ability of the nipple to react to external stimuli.
Breastfeeding in the future may also prove impossible, since the operation includes removal of certain lactiferous ducts guided to the area of the nipple. It is worth remembering that many women, who did not undergo any operation, are also incapable of breastfeeding.
Asymmetry or other breast shape irregularities may also be enumerated among consequences of the surgery. In rare cases subsequent operation is required in order to improve that condition.
There is also the general risk related with all surgeries. In extremely rare situations the patient may suffer from thromboses in lower limbs (f. ex. deep vein thrombosis – DVT), which need to treated. Some clots may be ruptured and move to lungs, causing acute dyspnoea and chest pain. This is known as pulmonary embolism, and the probability of its occurrence is higher in people smoking cigarettes.
All risk factors shall be discussed in detail during your consultation in the clinic. If you have any questions or doubts, do not hesitate to discuss them with plastic surgeon.
How to prepare for the surgery?
Surgeon will then show you possible dates of operation, and then he will ask you to choose the most suitable one. When planning the surgery, the date should be schedules within two weeks after the lat menstruation, which will limit the risk of post-operative complications. Depending on your age and general condition, you may be asked to perform routine blood tests and heart examination (morphology, ionogram, APTT), chest X-ray, ECG and breast ultrasound examination before admittance. What is quite significant is the fact that throughout the whole time you have the chance to ask all questions that came to your mind during the process or that caused your concern.
On the day of the surgery you will be admitted to the hospital. In case of general anaesthesia you will be asked not to eat and not to drink six hours before the operation, and this also concerns chewing a gum.
If you smoke, it is worth considering giving up smoking six weeks before the surgery. The following rule is true: the longer you smoke and the sooner you give up, the better, since smoking decreases the amount of oxygen in your blood and may considerably increase the risk of post-operative complications.
It is extremely important to inform the surgeon, anaesthesiologist or nurse on the day of the operation about all prescription medications and over the counter drugs you are taking, including all information concerning recreational drug administration.
Avoid taking medications containing acetylsalicylic acid 2 weeks prior to operation, as these drugs increase the risk of bleeding during the surgery. You may also be asked to discontinue using hormone replacement therapy or oral contraception 30 days before the scheduled procedure. Your physician will advise you on this matter.
Make sure you will be transported home after the operation. Someone needs to take you home, because even after several days spent in the clinic it is required to have someone to help you with transport.
What happens during the post-operative period?
After regaining consciousness and when the anaesthetic agent will no longer be active, we will encourage you to sit in the bed.
Small tubes (the so-called drainage) may be placed in each breast, to evacuate blood and fluids. Drains will be removed before you go home.
Dressing is usually removed after one or two weeks. You will be informed to wear a sports bra during the day and during the night for three to six weeks, to support forming the breast tissue to obtain its new shape. After this time wear this bra during the day. Avoid wearing underwire bras at least during the first four weeks after the surgery.
Before leaving the clinic, you will once again be examined by a surgeon and/or a nurse. All permanent sutures should be removed 7 to 10 days after the surgery.
We would like to once again remind you that you will not be able to drive a car in this condition, hence it will be best to have someone at your side, who will stay with you at home during the next few days. In case you have any doubts during this period, do not hesitate to contact the clinic and ask for advice.
What is the anticipated period of convalescence, absence at work and when can the patient return to normal activity?
Period of convalescence and full recovery may differ, depending on individual features of each patient, hence the recommendations below should be only perceived as a form of advice. In case you have any doubts during this period, do not hesitate to contact the clinic and ask for advice.
During the first few days you may feel uncomfortable when trying to stand straight, however, it is important to try and walk, every two hours during the day and early in the evening. Lying in bed for too long increases the risk of blood clots in lower limbs. Hence, it is important that you gradually increase your physical activity during the next few days.
Avoid sunbathing topless within 6 months following the surgery, and certainly avoid such activity during the first few months. Scars are much more sensitive to sunlight at that time, as it may cause discolorations.
Breast reduction after surgery – step by step
Day 1 to 3
You stay in the clinic under the care of physicians and nurses and you simply follow their recommendations.
5-14 days
Remove sutures on 7 and 9 day after the surgery. You can experience pulling and slight pain when you move. You gradually begin to increase your activity. Depending on the type of your work, you should be able to return to work after about 2 weeks, but only if you feel safe.
3 to 6 weeks
Avoid lifting or pushing heavy objects for at least four weeks. It is not essential to wear bra at night, but it is recommended to wear it during the day. You slowly regain sensation in breast and around the nipple. This will continue to improve.
6 to 9 months
Scars begin to become softer and begin vanishing. This is the time when you can start evaluating the results.
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