There are several different surgical techniques to reshape the breasts. All of them will involve a scar around the areola of the breast. Each method will use different scars and will have advantages and disadvantages and the surgeon may select with your approval the best technique in your particular case, in order to obtain the best possible results.
Breast Reduction Surgery
The size of women’s breasts may be determined by several factors, such as inherited genes, body weight and hormonal influences. They can, therefore, be a problem to some women early in adolescence or may not become uncomfortable until middle age following the menopause. The problem of large breasts, however, may cause similar problems at all ages and these are chiefly backache, neck pain, grooves in the shoulders from bra straps, rashes under the breasts and the feeling of self-consciousness. Moreover, because of the sexual nature of breasts the undue prominence may attract unwanted attention from the opposite sex, comments and sexual innuendoes. These can cause psychological distress to many women. Also, one of the most common complaints of women with large breasts is that it is very difficult to wear fashionable clothes and indulge in active sports, particularly in the summer months.
Reduction mammaplasty is an operation which removes the excess fat and skin from the breasts, which are reshaped and the nipples repositioned to form newer smaller breasts. This should result in more attractive breasts and reduce many of the problems outlined above.
Reduction mammaplasty may be also used to correct asymmetry of the breast, where one breast is very much larger than the other and where it is considered to be the least normal of the two.
Before the operation
It is very important that you discuss thoroughly with your surgeon beforehand the size of breasts you wish to achieve. Many women wish for a very radical reduction but in order to achieve this, the shape and aesthetic quality of the breasts may be compromised. However, in women with breasts which are only slightly larger than normal very careful thought must be given to the scarring and the potential shape and size as the outcome of the surgery may not be as aesthetically pleasing as a normal breast appearance.
Furthermore, you should be informed that (with the techniques used by other surgeons – for my revolutionary technique refer to “My Way”) very few women are able to breast feed following breast reduction surgery as the nipples are separated from the underlying milk ducts and at the time of pregnancy the milk supply will gradually dry up, sometimes with the assistance of hormone treatment. Breast reduction is no contra indication to pregnancy but young women may well wish to take the fact that they are unable to breast feed into account before embarking on this procedure.
Your surgeon is also likely to recommend that you reduce weight if you are overweight and to make alternative arrangements if you are on the contraceptive pill. Smoking does seriously affect the healing of the breast wounds and should be discouraged and attempts to give it up made.
A preoperative check-up is made according to the surgeon’s recommendations. You will meet the anesthesiologist in consultation at latest, 48 hours prior to surgery. Besides the usual preoperative examinations, you will be asked to have a mammogram and/or a breast ultra-sonography.
No medication containing aspirin will be taken for 10 days before surgery.
Hospital stay and type of anesthesia
Reduction mammaplasty is usually performed under general anesthesia. You will be asleep through the entire operation. Patients may stay in the hospital from two to four days.
After the operation
As the procedure is carried out under a general anesthetic, there may be some discomfort when you wake at the end of the operation. You will be given suitable pain killing injections or tablets. Drainage tubes are frequently used and will be removed within a short period of time. The stitches will normally be removed between ten to fourteen days. Generally, the swelling and discoloration around the incisions subside within a few days.
A well-fitting bra will need to be worn following surgery but because of the post-operative swelling the final size of your breasts may not be obvious for several weeks. There is likely to be some tenderness and lumpiness of the breasts for several weeks or even months following surgery but there is no reason why you cannot sunbathe and go swimming once the scars have fully healed.
The nipples are likely to be very much less sensitive following surgery due to the nature of the cuts and the nerve supply and it is quite possible that numbness will extend over part of the breast as well.
It is often possible to return to work within a week or so, depending on the job. You can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Any sexual activity should be avoided for a minimum of one or two weeks, and your plastic surgeon may advise you to wait longer.
It can be best appreciated one year after the procedure: the breasts are usually harmoniously shaped, symmetrical and have a natural shape. Besides the physical improvement, this operation usually has a positive effect on weight control, exercise, clothing and psychological health.
However, before this final outcome, one should be patient, wait for scars to slowly fade, and accept a regular follow-up every 3 months during one year. You should also bear in mind that scarring is a patient-related process.
Unless your operation is done at an age when your breasts are still growing, they should not re-grow afterwards. They will, however, increase in size if you either put on weight or become pregnant and decrease in size if you lose weight. Even normal breasts have a tendency to droop with time and you can expect some change in shape to occur after a reduction mammaplasty. You can delay this tendency by supporting your breasts in well-fitting bras.
The most obvious consequences are the scars. These are designed to be invisible whilst wearing normal clothing and as far as possible are designed to lie under the average bra or bikini top. Over the months following surgery the scars will fade from being red, possibly thick and uncomfortable, to becoming much more pale and less obvious. However, they will always be present and visible when clothing is not worn and the scars will vary from one woman to another. In some they may be very thin, in others they may stretch and become quite red and possibly unattractive. In the vast majority of women, however, the scars are acceptable and a small trade off for the benefit of dealing with the problems of large breasts.
It is also possible that there may be a degree of asymmetry. This is often less than existed before the surgery and can be corrected secondarily, after one or two years.
When reducing large breasts it may occasionally be necessary to adjust the folds of skin at the end of the scar, both between the breasts and at the sides. This can simply be carried out under local anesthetic several months later.
In general, in women with very large breasts the benefits of a significant reduction may outweigh the potential imperfections.
Reduction mammaplasty, even if performed for aesthetic reasons, is a genuine surgical procedure, with the consequent risks related to all medical acts. There are surgical and aesthetic complications. Concerning anesthesia, the anesthesiologist will inform you about all the anesthetic risks. You must be aware that anesthesia can sometimes cause unpredictable body reactions that can be difficult to control. The presence of an experienced anesthesiologist, in a surgical environment, means that the risks are statistically practically negligible.
As in any major operation there is a small risk of chest infection particularly among people who smoke and there is also a small risk of thrombosis in the veins of the leg, particularly for patients who are taking the contraceptive pill. Occasionally, infection from germs harboring in the ducts of the breast can be troublesome. Infection can be treated with antibiotics, but it will delay the healing process, scars are likely to be worse and there may be a need to re-stitch them at a later date. If you have a discharge from your nipple, it is most important to tell your surgeon about it before your operation.
Rarely, skin can become sloughy and form a scab which gradually separates to leave a broad scar. The nipple disc and the skin where the scar meets underneath the breast are parts most likely to be affected. People who smoke are at greater risk of this happening. Usually the scars settle well to end up as white lines but they will always be noticeable. However, some people have an inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time.
There is no evidence that reduction mammaplasty causes breast cancer. Nor does it prevent your breast from being examined for cancer in the usual way.
My Way …. “Metron Ariston”
I use the Total Posterior Pedicle technique which is an advanced and elaborate technique.
However, it delivers aesthetically superior results:
– Optimal breast shape and symmetry
– Proper nipple positioning with sparing of contractile function
– Avoiding of post-operative ptosis
– Reduced scar length
Most importantly though, it is the Functional results that make a true difference for most women:
– Lactation and Breast-Feeding ability
– Preservation of nipple sensation
This webpage aims to provide some information about the subject. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
American Society of Plastic Surgeons, British Association of Plastic, Reconstructive and Aesthetic Surgeons, French Society of Plastic, Reconstructive and Aesthetic Surgery