Breast Reduction

Introduction

I will discuss your general medical history, together with details of any previous breast surgery. I need to know if you take any current medication, including: anticoagulants, diabetic treatments, any allergies including to antibiotics, cardiac drugs or for blood pressure, thyroxine etc.

After an examination, I will have shown you what may be expected post-operatively by defining the area of breast tissue to be removed and the new position of the nipple. It is normal for breasts to have a degree of asymmetry, and although I will strive to make the breasts as symmetrical as possible, often it is not possible to achieve perfect symmetry. Further, it is not possible to guarantee a particular cup size of the breasts post-operatively. You need to bear this in mind, if it will influence your decision whether to go ahead with surgery.

You always have the option of not having the surgery, if you feel your expectations cannot be met to your satisfaction. After breast reduction surgery, breast-feeding is unpredictable. If this is of concern to you, perhaps it may be wise to delay the operation until a more appropriate time.

Procedure Details

Breast reduction is carried out under general anaesthesia and requires one or two nights’ stay in hospital. The procedure takes approximately two hours. I will take exact measurements of the breasts at the pre-operative marking up session, on the morning of your surgery.

Having marked out the incision sites pre-operatively, I will remove the excess skin from the breasts having left the nipple on a stalk. The nipple is then repositioned in a lifted position. The suture line will be anchor shaped extending around the nipple in its’ new position, then vertically downwards to the under-breast crease and extending in that crease from a point near the mid-line around towards the underarms. Dissolvable sutures will be used which will not require removal. Dressings will be applied. Drainage tubes are inserted at the end of the operation to remove any ooze of fluid or blood post-operatively. These will be removed once the fluid has stopped, usually on the first post-operative day.

New dressings may then be applied and the patient will then be allowed to go home. As blood clotting is sometimes a problem with this procedure, you may be asked to wear anti-embolism stockings (TEDs) on your legs as a precautionary measure. These should not be removed until advised. You will also get out of bed and move around as soon as possible after surgery.

Summary

Scarring is a consideration with breast reduction. As explained, scars will usually, eventually return to normal skin colour, but you should not assume that they can ever be described as hairline. Bearing this in mind, the results following breast reduction are usually excellent. It is probably one of the most successful and immediately satisfying of aesthetic plastic surgery procedures, allowing the patient to enjoy a more active life with increased self-esteem and confidence.

Aftercare

Following surgery your breasts may be uncomfortable, this is easily relieved, initially by an injection and thereafter by taking two mild pain-killing tablets (such as Paracetamol) as required. Aspirin must be avoided. You should be aware that bruising of the skin of your new breasts may occur and swelling of the breast tissue may cause them to appear larger than anticipated in the first few months. However, this will probably improve markedly in two to three months.

Meticulous care is taken at the operation to stop any bleeding points. Occasionally, a blood vessel leaks after the operation is over and if a significant collection (haematoma) occurs, it may necessitate a return to theatre. If a haematoma is minor, then natural re-absorption will occur. As in any surgery, there is a possibility of infection but this is readily treated with antibiotics and/or dressings as required.

In some patients there is some minor loss of wound adhesion, but this is a temporary complication resulting in a small scab, which separates after a few weeks. Delayed wound healing is more likely if you smoke tobacco or drink excess alcohol after surgery. Immediately after surgery your new breast size will be apparent, but, the final shape may take around six months to emerge. The dressings should be kept clean and dry for one to two weeks following surgery in order to allow sound healing to occur. A comfortably fitting bra is also necessary for the first six weeks.

Numbness of the nipples and the surrounding skin is common after breast reduction although many patients experience the return of sensation immediately, albeit not completely normal at first. The nipples are preserved on a stalk of breast tissue and in the vast majority of patients they remain natural with normal contraction and some sensitivity. Exceptionally, the stalk of the breast tissue has inadequate blood vessels to maintain nipple viability and part or even the entire nipple may die. This complication means that prolonged dressings may be required over the nipple area until natural healing occurs. It is then possible to reconstruct the nipple as a secondary procedure should this be required. There may well be some asymmetry of the breasts post-operatively, but I take great lengths during the surgery to minimise this, as far as is possible.

The scars can initially be red and raised, and can take up to eighteen months to become pale and flat depending on the healing qualities of the individual. Firm pressure on these scars with a well fitting bra will help if this is a problem. Expect to feel tired for up to two weeks following surgery. You may drive after the first week but do not return to vigorous exercise for at least six weeks and, as dressings may have to be prolonged if healing is delayed, it is advisable not to make any travel plans for a month or so.

General advice

You should arrange for someone to drive you home from hospital. You will experience mild discomfort after your surgery and it is recommended that you take one or two pain relieving tablets (such as Paracetamol) on a regular basis for the first week or so. DO NOT TAKE ASPIRIN OR ANY PRODUCTS CONTAINING ASPIRIN as this may prolong or cause bleeding in the early postoperative period. Your breasts will be swollen and tender and there may be some bruising initially, though this should settle by two weeks. Though most of the bruising does settle by the first 14 days you will have a smaller degree of residual swelling which can take up to three months before this settles and you achieve your final cup size It is important to rest as much as possible for the first week after surgery and limit your arm movement for the first week. I would have advised you to purchase a sports bra beforehand and it is wise to wear your bra day and night for the first two weeks to support the scar lines and provide maximal comfort. After two weeks you can wear the bra in the daytime only and by six weeks you can commence wearing underwired bras.

Bathing

Buried, dissolvable stitches are most commonly used, but occasionally the dermis layer of thye skin can be thin and in this instance, a removable stitch will be used. You should avoid getting the wounds or dressings wet for the first week.

Post surgery operation

At one week post operatively you will be seen by the nurse in the Dressing Clinic who will remove the dressing and inspect your breasts. If the wound is healing nicely at this stage you may recommence showering your breasts then. If the wounds are still a little moist after one week they will be redressed by the nurse and an appointment given to revisit the nurse in weeks time. Once the wounds are clean and dry you will be advised when you can recommence bathing.

Exercise

It is very important in the early period after your operation that you move around your home as much as possible, setting yourself a daily walking programme and not lying in bed for protracted periods. After a good week of rest you may commence gentle arm movements and arm exercises and by one week post operatively you should be ready to recommence light duties and after two weeks can commence light household duties, but should avoid heavy lifting for a month. By four to six weeks post operatively you may recommence light gym work, and should be able to return to full normal activities by six weeks.

Driving

Following breast reduction people feel confident to return to driving at various time periods, but you should refrain from driving for the first two weeks. After this you may recommence driving once you feel confident to undertake an emergency stop, until you feel confident to do this you should refrain from driving.

Smoking

I would have advised that it is important to stop smoking prior to your operation in order to reduce the risks of complications.

Returning to work

Following the breast reduction, the type of job that you do determines when you can return to work.

Skin care

The scar will take time to mature. Over the first six weeks your scar will become stronger and stronger. During those first six weeks the scar will pretty much look after itself. By weeks 3-4 you should commence moisturising and massaging this scar and rubbing quite vigorously, the aim being to soften the scar and speed up final scar maturation. The delicate scar tissue is at greater risk of sunburn if exposed to the sun, therefore, you are advised to avoid sun exposure to any scar tissue for the first six weeks of healing, after this if the area is to be exposed to sunlight you should apply sun protection factor 50 sun block to exposed scar tissue.

Complications

Though most people experience uneventful post operative recovery, if you develop any of the following you should contact the ward:

  • Temperature greater than 38.5°
  • Severe pain not alleviated by simple painkillers
  • Fresh bleeding from the wound, other than a minor ooze
  • Sudden rapid enlargement of one or other breast
Helpful Statistics

General Anaesthetic

Limited mobility: 1 day

Surgical Bra: 4-6 Weeks

Hospital stay: 1 night

Washing: 48 hours

Full recovery: 4-6 weeks

Surgery time: 1-1.5 hours

Driving: 1-2 weeks

No smoking 2 weeks before and after any surgery

Off work: 1-2 weeks

Exercise: 4-6 weeks

Patient Journeys

  • I feel completely refreshed and although some people did not see why I wanted to have it done I did and it has made me feel renewed. Well done to Anthony and his team for their support and care. So recommended.

  • I feel so appreciative of my surgery and I would like to highly recommend the expertise of Mr. Armstrong and his professional and caring team.