Breast Reduction
Breast reduction (or reduction mammoplasty) is an operation where excess tissue and skin are removed from the breasts. The breasts are then reshaped to form smaller breasts, and the nipples are repositioned.
The operation can be used to even up the size of the breasts where one is much larger than the other.
Breast reduction surgery can relieve the discomfort caused by large breasts, such as:
- back, neck and shoulder pain and grooves in the shoulders from bra straps
- excessive sweating, rashes and skin infections under the breasts
After having breast reduction, many women find it easier to participate in sports, and feel happier and less self-conscious about the way they look.
Getting advice
It’s important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a reputable surgeon or give advice about how to choose which hospital to be treated in.
Before opting for breast reduction, you should consider the result you hope to achieve. Some women initially want a radical reduction in size, but this can affect the final shape and appearance of the breasts, so a more moderate reduction may be a better option.
Because breast size alters with body weight, you will be more suitable for surgery if your weight is stable. Your breasts may increase in size again if you put on weight or become pregnant.
Preparing for your operation
Your surgeon will discuss how to prepare for your operation. For example, if you smoke you may be asked to quit, as smoking will increase your risk of getting a chest or wound infection and slow your recovery.
Breast reductions are usually done under a general anaesthetic. This means you will be asleep during the procedure. You will be asked not to eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
You will usually need to stay in hospital for one to two days.
Bring in a soft, supportive bra without underwiring to wear after surgery. Your surgeon will advise you about the most suitable type of bra beforehand.
At the hospital, your nurse will explain how you will be cared for during your stay, and may do some tests such as checking your heart rate and blood pressure, and testing your urine.
Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
Your surgeon may draw on your breasts to show the planned size and shape. Photographs may be taken, so that the results of surgery can be compared with your original appearance.
Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
About the operation
The operation usually takes two to four hours.
Typically, the excess breast tissue is removed through cuts on the lower part of the breasts and the nipples are moved to suit the new shape.
The skin is reshaped and the cuts are closed with stitches (which may be dissolvable) and your breasts are wrapped in a special supportive dressing or support bra.
Fine plastic tubes may be left in each breast for up to 48 hours afterwards. These allow blood and fluids to drain into a bag.
What to expect afterwards
You will be given painkillers to help relieve any discomfort as the general anaesthetic wears off. Your anaesthetist may also prescribe painkillers and antibiotics for the first few days after the operation.
Your nurse will give you advice about getting out of bed, bathing, diet and gentle exercises.
Before you go home, you will be given advice about caring for the healing wounds and a date for a follow-up appointment. You may have several follow-ups to check on your progress.
If your surgeon has fitted you with a special supportive dressing, this will be removed about a week after surgery. Otherwise you will go home, wearing your support bra.
Dissolvable stitches will disappear on their own in seven to 10 days. Non-dissolvable stitches are removed a week after surgery.
Recovering from breast surgery
At home, if you need them you can usually take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.
General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.
Follow your surgeon’s advice about driving. You shouldn’t drive until you are confident that you could perform an emergency stop without discomfort.
You will need to wear the support bra for four to six weeks after the operation. This helps to stop the weight of the breasts pulling on the healing wounds.
Scars will continue to fade for several months. Occasionally you will be left with small folds of skin at the end of the scar, both between and at the sides of the breasts. You may need to have a second operation to remove these.
If you have any concerns or get pain that can’t be controlled with painkillers, a high temperature or your breasts feel unusually hot to touch, contact your GP or the hospital as you may have developed an infection.
At your follow-up appointment, your surgeon will give advice about when you can resume your usual activities and return to work.
It may take several months before your breasts settle into their new shape.
What are the risks?
Breast reduction surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
Side-effects
ins>These are the unwanted, but mostly temporary effects of a successful treatment, for example, feeling sick as a result of the general anaesthetic.
After surgery, you will have pain, swelling, tenderness and bruising for at least a few days. Using extra pillows when sleeping can help reduce the swelling around your breasts.
You will have scars, they will be pink and noticeable at first, but they should fade gradually.
Changes in sensation are quite common. Different parts of the breast, including the nipple, can become more or less sensitive. This is more likely if the position of the nipples has been moved during surgery. Numbness can be permanent.
Depending on the type of breast reduction surgery you have, you may be unable to breastfeed after the operation.
Complications
This is when problems occur during or after the operation. Most women are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Specific complications of breast reduction are rare, but can include:
- infection – this may need antibiotic treatment and sometimes further surgery
- bleeding inside the breast (haematoma) – may require further surgery
- unusual red or raised scars (keloids) – can take years to improve
- alterations in the blood supply may result in the loss of part, or even all, of the nipple
- breasts may be uneven in size and shape
- nipples may not be level with each other
It’s possible that you still won’t be satisfied with your appearance after the operation.
The exact risks are specific to you and will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
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