What is it?

Breast reduction is the removal of excess skin and breast tissue with re-positioning of the nipple to a higher situation.  It is most frequently performed for heavy breasts that results in physical problems, rather than for cosmetic appearance.

The Operation

The surgery is performed under general anaesthesia.  There are different techniques depending on how big the breasts are and how much tissue needs to be removed.  The surgery is performed with pre-operative marks as guidelines.  In moderate size breasts the nipple is left attached to underlying breast tissue, excess skin and breast tissue is removed and then the nipple is placed in a new higher position.  The remaining skin and breast tissue is sutured together.  The types of scars that commonly arise are, a scar that goes around the nipple at its new position and a scar that extends from the new nipple position downward underneath the breast.  In bigger breasts, there is often a scar that goes underneath the breast from the midline to the side.  Drains are usually required and a supportive dressing is placed after surgery.

Any Alternatives

Weight loss can occasionally make breasts smaller but this does not usually lead to re-positioning of the nipple in a higher more youthful appearance.  Weight loss can also cause empty sagging breasts.

Before the Operation

Breast reduction surgery takes between two and three hours to do and therefore is a major operative procedure.  It is important that the patient’s general health has been assessed and it is advisable to stop smoking.  The surgeon will visit pre-operatively and discuss the size the patient wishes.  Marks will then be placed on the patient’s chest according to the type of operative procedure to be performed.  Blood tests may also be taken prior to surgery, as very occasionally a blood transfusion is required.  It may also be necessary to take a course of iron tablets following the surgery.  As the operation takes some time to do, measures to prevent clots in the legs are undertaken usually along the lines of special stockings, improvement of the blood flow in legs during surgery, or the addition of blood thinning agents prior to surgery.

After – In Hospital

You may notice a firm bandage around your chest when you wake up.  This may also make your breathing slightly restricted.  It is there to provide comfort and also to decrease swelling around the breasts after surgery.   It is likely that you will be in a semi-upright position following surgery. Again this helps to decrease swelling and pain.  Pain and discomfort following surgery is common and can be treated with pain-killing injections or tablets.  Regular painkillers will be needed on return home along the lines of Paracetamol.  There will be a drain in each breast to remove excess fluid that can accumulate following surgery.  It is also likely that there will be an intravenous drip, which is usually removed when you are able to tolerate diet and fluids comfortably.  The nurse will check your blood pressure, temperature and pulse rate following the surgery and in some operations it will be necessary to check the blood supply to the nipple on a regular basis. After the surgery you will be encouraged to gradually increase your mobility and independence.  Assistance will be given with shallow bathing and general hygiene until you are able to manage this independently.  The dressings usually remain intact for twenty-four to forty-eight hours following surgery at which time the drains are usually removed.  The stitch line will then be cleaned as necessary and a new dressing applied.  It is often useful at this time to have soft support type bra that can accommodate a small dressing.  This gives support to the breast and decreases pain.  Your stay in hospital will be variable and will depend on the type of surgery that has been performed and the amount of drainage from the breasts.  You may expect to go home within two to three days following surgery.

After – At Home

You may experience pain and discomfort in your breasts, which is usually adequately treated with simple painkillers.  Should you find increased unexpected pain it will be most important to let the hospital know of your pain and discomfort.  As with any major surgical procedure, you may feel tired following the surgery and may need assistance in doing ordinary daily tasks.  It is important to avoid getting the suture line wet.  It is likely that you will be asked to attend the outpatients if only to review the dressings.  It is probably best to also avoid driving at this time as pain and discomfort may prevent adequate control of the steering wheel.
On most occasions, the sutures that are used to close the breast reduction surgery are of a dissolvable type but occasionally some sutures may need to be removed.  This usually takes place some two weeks following surgery.

Possible Complications

Breast reduction surgery takes some time to perform and may be considered a major operative procedure.  As with any major surgery you may bleed during the surgery and very occasionally a blood transfusion may be required.  The drains are placed in the breasts after surgery as there is often some bleeding that can occur.  Very rarely bleeding can continue to such an extent that a return to theatre is required.  This is why it is important to have regular post-operative checks on the ward by the nurses.

Infection can occur in the post-operative phase and this is minimised by good surgical technique. Antibiotics are sometimes given around the time of surgery.  Regular reviews after surgery indicates if there is evidence of infection and occasionally it is necessary to have a course of antibiotics.  Often, due to the extent of the surgery, the skin of the breasts appears red. This is more commonly related to inflammation rather than infection.

There is often some irregularities around the scars immediately following surgery but these tend to settle down and get better as the swelling disperses and the skin tightens.  Occasionally there are some areas underneath the breast where the skin does not heal immediately and dressings may be required for up to six to eight weeks afterwards.  This is related to the tension that is needed to reshape the new breast, which the skin does not tolerate.  Very very occasionally, skin grafting may be required if significant skin breakdown occurs.  Personal care and hygiene can be maintained once the wounds have become sealed.  This varies from one to two weeks.  If dressings are required because of minor wound problems, your doctor may still be happy for you to shower, dab the area dry and have it redressed.  Supportive bras, which are not under wired, can keep the breasts comfortable following surgery.  It is sometimes necessary to wear them at nighttime as well for comfort.

Return to work can take place from two to three weeks after surgery depending on the physical requirements.

When driving it would important to make sure that there is no interference with turning the wheel or areas of pain which may cause some difficulty with the need to perform an emergency stop.

Direct trauma onto the breast can cause the wounds to split open.  However, one should wear a safety belt when driving or a passenger in a car.

It may take some time for the redness of the skin underneath the breast to settle down.  If the breasts are very big prior to surgery, the ends of the scars may remain prominent.  Should this be the case they may need to be ‘tidied up’.  This is a procedure that can usually be performed under local anaesthesia.

General Advice

The majority of people who have breast reductions are happy with the size and shape of the breasts following surgery.  It can take six to nine months for the swelling to subside entirely.  The outcome of the surgery that some people are not so happy with is the scarring.  The scars, although they look neat initially, can become red itchy and raised above the level of the surrounding skin.  As well as becoming somewhat unsightly they can also give rise to concern.  Some techniques are available to try and make the scars more comfortable including local silicone sheet dressings, local massage or the occasional use of laser treatment.  The scars may become particularly troublesome close to the midline and most surgeons try and avoid placing scars too close to the midline.  This helps with the problems with the scar formation but also avoids putting scars where the patient may want to show their cleavage.  The breasts tend to remain in a satisfactory position but as time goes by, droopiness of the breasts can occur again.  Excess weight gain or pregnancy can precipitate increased size and therefore droopiness to occur more rapidly.

It is not always possible to match the breast sizes following surgery and this may become more apparent when the swelling has decreased.  Depending on the type of breast surgery that has been performed it may be possible to breast-feed if one becomes pregnant.