Breast Reduction (Mammoplasty)

A breast reduction is a procedure to make your breasts smaller. It can sometimes help to improve their shape too.

You may benefit from a breast reduction procedure if one or more of the following applies to you:

• You are self-conscious about the size of your breasts either in the workplace or during exercising
• You suffer from rashes, sweating and blistering under your breasts
• You suffer from grooves in your shoulders from your bra straps
• You struggle to find comfortable “off the shelf” bras and dresses and often have to order special bespoke clothes
• You suffer from back and neck ache or poor posture because of the weight of your breasts

Depending on the original size, it is difficult to reduce a breast smaller than a C/D cup size as any smaller and there is a risk of less well shaped breasts and complications to the nipple.

Successful breast reduction patients tend to be very happy after this surgery as they are more comfortable with their appearance and are able to wear better fitting clothes.

• The operation is performed under general anaesthetic (unconscious) and takes on average 3 hrs and an overnight stay in hospital
• Incisions are made around the areolar/nipple and down the breast to enable the excess skin of the breast to be removed (anchor-shaped/inverted T scar)
• The excess skin and fat of the breast are removed
• The breast is reshaped and the nipple is lifted
• If your breasts are very large it may be necessary to completely detach the nipple and areola and reattach them to a higher position. This is more indicated in larger reductions.
• Drain tubes may be inserted and these are usually removed the day after surgery
• Dressings are placed for two weeks usually
• Support bra is recommended for 6 weeks - 8 weeks

• If you are overweight, losing weight can reduce the size of your breasts
• Custom fitted clothes may make it easier to cope with large breasts but these are usually more expensive than off the shelf ones
• Liposuction may be appropriate for some women to reduce breast volume – this can sometimes be beneficial in addition to breast reduction surgery

• Smoking increases the risks of complications of surgery
• Cessation of smoking and nicotine products prior to surgery can therefore help reduce your risk of developing complications associated with smoking – Mr Sharma recommends stopping smoking for at least 6 weeks before and after surgery
• Maintain a healthy weight – there are higher risks of developing complications if you are overweight
• Regular exercise can help you prepare for an operation and improve your long term health. In the immediate post-operative period this should be avoided for a period of time depending on your individual circumstances. Mr Sharma will discuss this with you prior to your surgery
• Some herbal supplements can lead to thinning of the blood and potentially increase your risk of developing complications. You are advised to stop these 6-8 weeks prior to having your surgery

Mr Sharma and his excellent team will ensure all appropriate tests are performed prior to surgery, and that measures are taken during surgery to minimise your risk of developing any complications.

In the majority of cases this operation is carried out very successfully with good cosmetic results, however as with any surgical procedure there is a small chance of side effects or complications. This is a list of potential complications that you need to be aware of:

• Bleeding You may have excessive bleeding from within the breast envelope, which may result in a collection of blood (haematoma) beneath the wound site.  If this occurs you could experience excessive pain and swelling in the breast tissue. The collected blood may need to be removed in the operating theatre; this may necessitate another operation. 
• Wound infection There is a risk of wound infection, which can occur at any time following surgery. Symptoms of infection may include increased swelling, redness, fluid leakage, which may smell offensive, and increased pain at the site of the operation.  If your wound becomes infected you may need treatment with antibiotics, occasionally this may mean admission to hospital for antibiotics to be given through a drip.  After a wound infection, healing may be delayed and you may need dressings for a longer period than normal.
• Wound breakdown Wound breakdown may occasionally occur following surgery.  It may happen if the stitch line does not heal properly and the wound may breakdown or gape.  If this happens you will require dressings for a longer period of time; rarely, a further operation may be needed. After wound breakdown your scar may not have as good a cosmetic result than if your wound had healed without problems. This is fairly common at the T-junction site of the scar.
• Scarring You will have permanent, visible scars on your skin. Scars tend to improve over a period of 18 months following surgery.  In some people, for unknown reasons, scars can become raised, red and lumpy; unfortunately this is largely beyond surgical control.  The risk of this occurring on the breast is greater if you have already developed thickened scars following accidents or operations elsewhere.  The way a scar develops depends as much on how your body heals as it does on your surgeon’s skills. Mr Sharma has been trained in a technique of minimal scar suturing to help achieve the best scars for his patients. He also has a regimen of scar management that he advises all his patients to follow to achieve the best results.
• Difference in size or shape of one breast compared to the other (asymmetry) After breast reduction surgery, some degree of asymmetry of shape and size of the breast and of the scarring may be evident.  It is not always possible to produce a natural cleavage or look and it is difficult to predict exactly how your breasts will look after the operation. Most women’s breasts are a different shape and size prior to surgery. It is often possible to correct small asymmetries or scarring with a small local anaesthetic operation.
• Nipple and skin sensation You may have reduced or permanent loss of sensation to your nipple or breast skin after this operation. Hypersensitivity may occur to the nipple areola, which maybe self-limiting. If free nipple grafts are used, in large reductions, the nipples will have no sensation as they are detached and grafted.
• Loss of skin including the nipple This is a rare complication. However, even in the best surgeon’s hands this can happen as the operation involves repositioning of the nipple and breast tissues and sometimes the blood supply to these structures can be compromised. The risk is higher if you smoke, are overweight, have very large or droopy breasts or have other medical conditions such as diabetes. In large reductions where the nipple has to be repositioned by a large height sometimes the nipple and areolar are detached as a graft and secured in the new position (Free nipple graft)
• Reduced ability to breast feed In a breast reduction the repositioning of the nipple and reshaping of the breast tissue can result in the milk ducts being damaged or removed. This may reduce your ability to breast feed in the future
• Developing a lump or Fat Necrosis It is common to get lumps in your breast caused by minor damage to areas of fat during the operation. These can become firm and swollen. Usually they tend to shrink over months but sometimes scar tissue forms around them and a hard lump is felt. This can be alarming but is usually reassuringly clear on an ultrasound scan differentiating it from breast cancer. You will then need to learn to recognise what this lump feels like so you do not confuse it with breast cancer.

The following possible complications are associated with your general anaesthetic and surgery:

• Deep vein thrombosis (DVT) This is a blood clot that arises in the deep veins of the leg or pelvis.  A deep vein thrombosis can happen if your mobility is restricted or you are inactive for a time following your operation.  You may be given injections that help to prevent this from happening.  You can reduce the risk of deep vein thrombosis by wearing the elastic stockings supplied, during and after your operation and moving your legs about whilst you are in bed.  Getting up and walking as soon as you are well enough may also reduce the risk of a DVT.
• Chest infection A chest infection can occur following any general anaesthetic. You can reduce the risk of this happening by taking regular deep breaths following surgery and getting up and sitting out of bed as soon as you are well enough.  If you smoke you can reduce the risk of a chest infection by stopping smoking for at least 6 weeks prior to your operation.

Mammography

• A breast reduction operation should not interfere with a mammogram (a breast scan used to detect breast cancer)
• Any women over the age of 40 Mr Sharma advises has a recent mammogram prior to cosmetic breast surgery

Histology

• The incidence of breast cancer currently in the United Kingdom is roughly 1/8 women. Therefore, the tissue removed in breast reduction surgery is always sent off to the histopathology laboratory to exclude any evidence of breast cancer.

Longevity of Results

• The results of breast reduction surgery improve gradually over the first 3-6 months
• Your breasts should become softer and more natural and the scars should fade
• Your breasts are dynamic and they change through different parts of your life in terms of their shape and consistency. A Breast Reduction  procedure does not stop this normal physiological process it just resets the clock at the time of surgery
• If you become pregnant or put on weight and then lose weight your breasts may start sagging again.

Please purchase the sports bra and breast band, combined or separate garments and bring to the hospital on the day of surgery.  The bra and band can be applied in theatre or when you return to the ward. The bra will be the same measurement around your body, the cup size will generally go down. If possible purchase a few bra sizes and seek advice from the company if bras not worn can be returned.

2 web sites to browse will give an idea of what is recommended and bras and bands can be purchased from these companies;

www.eurosurgical.co.uk
Design Veronique – breast wear brochure

www.macom-medical.com
post-surgical-compression-garments/womens/post-surgical-compression-bras

Download a BAAPS patient information leaflet for breast reduction by clicking here