Breast Reduction Surgery

Breast Reduction Surgery

Macromastia is the medical term used to describe large to extremely large breasts.

While it is a benign condition, women living with macromastia suffer from associated symptoms that cause significant reduction in their quality of life.

Table of Contents – Breast Reduction

Benefits of Breast Reduction Surgery

Studies have shown that as well as reduction of back pain, breast reduction surgery results in significantly improved quality of life, physical health, body image and sexual function.

A study, published in the Plastic and Reconstructive Surgery Journal in Nov 2019*, looked at 132 women undergoing breast reduction surgery and their responses to a quality-of-life questionnaire. The questionnaire was carried out before and 12 months after surgery.  Women in this study reported an average improvement of 30 – 50 points (on 100-point scales) in Satisfaction with Breasts, Psychosocial, Sexual and Physical well-being.

*DOI: 10.1097/PRS.0000000000006114

Am I eligible for breast reduction surgery?

For most women, breast reduction surgery is more about relieving chronic physical problems than getting more beautiful looking breasts.

If you suffer from the symptoms listed above, and they impact your quality of life, then you will likely benefit from reduction surgery.

Breast reduction is sometimes performed when removing a breast cancer. This it is called a therapeutic mammaplasty. Breast reduction is also done if previous cancer surgery on one breast has resulted in a marked difference in size (asymmetry) causing symptoms.

When is breast reduction not recommended?

If you suffer from substantial or significant medical comorbidities such as heart disease, lung disease, morbid obesity, poorly controlled diabetes, or other medical conditions that could pose a significant risk if you were to have a general anaesthetic, or impaired wound healing, then you will not be offered breast reduction surgery, even if you suffer from the symptoms listed above.

You will not be offered surgery if you are an active smoker.  Smokers have and increased risk of wound healing complications and post-operative infection 5 times greater than non-smokers.

When should I do it?

It is best to have breast reduction surgery is when your breasts or body are less likely to undergo radical changes such as developmental growth (e.g., puberty or pregnancy), major weight gain, or weight loss.  

The size of breasts can change with significant fluctuations in weight. If your body weight is not stable prior to a breast reduction, the end result is not completely predictable if your weight changes after surgery. 

Breast size and appearance will also change after pregnancy. As such for a more predictable result, breast reduction surgery is best done after you have completed your family.

Macromastia in adolescent girls can pose significant physical and psychological problems.  Breast reduction can be beneficial however, ongoing breast development after surgery may cause regrowth of breast tissue in these young patients. In general, breast growth is completed at the time of skeletal maturity (usually by age 18).

Preparing for surgery

Whenever possible, it is ideal that you have reached a stable body weight. You must stop smoking before surgery as this increases your risk of complications.

Any medications or dietary supplements that impair blood clotting must be stopped prior to surgery. You must discuss the timing of when to stop each specific medications or supplement with your surgeon.

All patients must have breast cancer screening prior to reduction surgery. This will involve ultrasounds and/or mammograms. However, despite adequate preoperative checks, breast cancer is found incidentally in up to 2.4 % of patients having reduction surgery.

If breast cancer is found, the case should be looked at by an oncologic breast surgeon – like Dr Fuentes – with a multidisciplinary breast cancer team to determine what other treatments are required.

Patients who undergo breast reduction surgery can and should resume breast cancer screening. You can re-start screening 12 months after surgery. However, if you feel a breast lump any time after the operation you must not hesitate to get it checked out.

Risks – Breast Reduction Surgery

Before having any surgery, it is extremely important that you are informed and understand the potential risks, complications and side effects the specific operation may carry.

 While all care and measures are taken to minimise or totally avoid these complications or side effects, complications may and do occur despite the best medical care.

General Risks:

• Deep venous thrombosis (DVT),
• Pulmonary embolism (PE)
• Anaphylaxis/ allergic reactions
• General anaesthetic risk
• Postoperative bleeding needing return to surgery.

Wound or scar related risks

• Unsatisfactory scarring e.g.  widened scars, sub-optimally placed scars, hypertrophic scars, keloid
• Scar or wound breakdown
• Change in pigmentation of nipple and areola
• Dog-ear scar-deformity

Appearance related risks

• Subtle or significant breast asymmetry
• Nipple areola position asymmetry
• Dissatisfaction with shape or size of breasts
• Dissatisfaction with appearance of nipple and areola

Specific complications of breast reduction

• Skin necrosis, this is loss of skin over a portion of the breast. Typically, at edges of scars
• Fat necrosis, this causes loss of breast volume and altered shape of the breast
• Necrosis of the nipple/areola, this can cause a partial or total loss of the nipple or areola

What to expect from surgery

 The operation is done under general anaesthetic and usually takes 3 to 4 hours. Most patients stay in hospital overnight and a drain is inserted during surgery in each breast to drain blood and fluid. This drain is usually removed the next day. The wounds are all covered in waterproof dressings. They remain in place for 10 to 14 days. You will be able to shower over them.

Most patients are discharged the day after surgery.

You may experience mild to moderate pain after surgery. This is generally managed with simple oral pain killers.  Most women find their breasts feel firm, sore and lumpy after surgery. Most find it difficult to sleep on their side for 4 to 8 weeks after the operation as the post-operative swelling subsides. There will be various amount of bruising and swelling that settles in due time.

What am I allowed to do and what should I avoid after surgery?

On Discharge

• Have someone drive you home after surgery and help you at home for 1-2 days.
• Get plenty of rest.
• Follow balanced diet.
• Take pain medication as prescribed.
• Do not drink alcohol when taking pain medications.
• Do not smoke, as smoking delays healing and increases the risk of complications.

Activities

• Start walking as soon as possible, this helps to reduce swelling and lowers the chance of blood clots.
• Do not drive until you are no longer taking any heavy pain medications (opiates).
• Do not drive until you have full range of motion with your arms.
• Refrain from vigorous activity with your arms for 4-6 weeks. Increase activity gradually as tolerated. You can do gentle exercise like stretching and Thai Chi.
• Avoid lifting anything over 5 Kg for 2 weeks.
• Resume social and employment activities in about 2 weeks (if not too strenuous).
• Wear surgical bra for 6 weeks – only remove to shower

 Can I breast feed after surgery?

Women who undergo breast reduction before or during their childbearing years are at potential risk of the inability to breastfeed or having future difficulties with breast feeding.

Nevertheless, some women find that they are still able to breast feed despite the operation.

Will surgery change nipple sensation?

Change in sensation of the nipple may occur after breast reduction surgery. This can range from transient altered sensation, to partial, or complete loss of sensation. Some women report overall improved sensation to the nipple and areola after breast reduction and some experience temporary hypersensitivity.

Before Breast Reduction Surgery

After Breast Reduction Surgery