This procedure is designed to reduce the size and weight of the breasts by removing the lower, pendulous portion and elevating the nipple to a higher position. The result is a smaller, lifted breast with usually an improved shape.
Breast reduction is usually performed for those women who are troubled with neck/back pain and poor posture as a result of the excessive weight on the chest. Other complaints are intertrigo (rashes and infection in the skin crease under the breast) difficulty performing exercise, grooves in the shoulders from tight bra straps, difficulty finding bras and clothes that fit well and embarrassment/unwanted attention.
The operation is performed under general anaesthetic, usually takes 2-3 hours and is followed by a one night stay in hospital. In some circumstances it can be performed as a day case procedure. The excessive gland tissue, fat and skin is removed and sent for pathology testing. The nipple is kept attached to a pedicle of breast tissue that keeps it alive and nourished with a blood supply. This allows the nipple to be moved to a higher postion on the chest wall and the remaining breast closed around it. This leaves a scar around the areola and down the front of the breast (circumvertical or lollipop pattern). For larger breasts it may be necessary to also leave a scar in the crease under the breast (inverted T, anchor or Wise pattern scars). The size of the areola is usually reduced to match the new breast proportions.
All the incisions are closed with dissolving sutures which are hidden beneath the skin. The wounds are further supported with a layer of surgical glue and tape. This technique leaves the best scars without the characteristic cross-hatching or external stitches and, of course, no painful sutures/clips to remove. I do not routinely use drains for breast reduction surgery. Post-operatively the breasts should be kept supported day and night in a soft bra (surgical or sports) for 6 weeks and the scars supported with surgical tape. This tape can get wet immediately. All patients are encouraged to shower as normal the day following surgery.
Most patients are able to return to work, driving and gentle activities after 1-2 weeks. Strenuous activity should be avoided for at least 6 weeks.
Side effects
Breast reduction surgery has a high satisfaction rate. Minor complications are common and include:
1. "Suture splitting" (one of the dissolvable stitches comes to the surface of the wound in a little red pimple before it has fully dissolved).
2. Fat necrosis (lumps of scar forming inside the breast).
3. The nipples will feel numb but occasionally more sensitive.
4. There will be permanent scars on the breasts. These scars usually fade to faint lines but some people produce thickened, raised scars that may be hypertrophic or keloid.
5. There will always be some degree of asymmetry. There may be a small discrepancy in volume, shape or nipple position despite the utmost care at surgery to achieve symmetry.
Complications
Rarely there may be more serious complications that may require a return to the operating theatre:
1. Wound infection/breakdown. This usually is managed with dressings as an out-patient but occasionally will require a second operation to clean and re-suture the wound.
2. As the operation lasts for several hours, there is a small risk of blood clots forming in the legs - deep vein thrombosis (DVT). This can potentially spread to the lung as a pulmonary embolus (PE) which may be very serious. To reduce the chance of this rare complication, everyone is fitted with compression stockings (TEDS) and pneumatic calf massaging devices (SCD) during surgery and for the following evening. High risk patients are also given a blood thinning medication called Clexane.
3. It is normal to have some small bleeding from the incisions for the first few days. Occasionally there is excessive bleeding inside the breast which creates a haematoma. This is usually drained surgically meaning a return to the operating theatre.
4. If the pedicle of breast tissue that nourishes the nipple becomes compromised, the nipple may be partially or completely lost. Thankfully this is a rare complication.
5. All the excised breast tissue is tested for breast cancer. In the unlikely event that a focus of cancer is discovered it will probably be necessary to have further treatment. This may be surgical (including mastectomy), radiotherapy or chemotherapy. All patients are enouraged to have a breast ultrasound or mammogram prior to breast surgery reduction.
Further information about this procedure can be found here
http://www.plasticsurgeryfoundation.org.au/patient-information/procedures/reconstructive-surgery/breast-reconstruction/
