Very large pendulous breasts may cause substantial discomfort. Common complaints include back and neck ache, deep strap marks and skin irritation below the breasts from the constant moisture there. Self-consciousness, restriction of physical activity and difficulty with finding clothing and swim wear may also be a problem. The breast reduction procedure is designed to alleviate these symptoms. The breasts are reduced by removal of fat, breast tissue and skin and usually the nipple is relocated to a higher position as large breasts have commonly sagged.
The pigmented skin around the nipple (areola) is also usually reduced during this procedure. Ideally, the breasts are reduced to a size that is in proportion to the rest of your body. Breast reduction results in substantial scars. There are techniques to minimise scars which are appropriate for some patients, particularly those who are young and not too large and close to their ideal body weight. However, most patients gladly accept the scars for the improvement in comfort that they receive, as the symptoms from large breasts are often quite severe.
Dr Scamp will show you photographs of the scars at your consultation.
Do I need breast reduction?
If you are having severe symptoms from your back or neck or skin rashes below the breast or are self-conscious about the size of your breasts and impeded in your physical activity by their size, then you may well benefit from breast reduction. Remember substantial scars result from breast reduction. Dr Scamp will do everything he can to make these scars as fine as possible, but they are visible and they are permanent. The operation is more suited to easing someone’s physical symptoms than it is for cosmetic improvement.
When can I have breast reduction?
In general breast reduction is not performed until the breasts are fully developed. Occasionally young girls get quite severe excessive breast growth and require surgery before their growth has been completed. There is a risk however with this that regrowth of the breast tissue can occur after surgery and a repeat surgery may be required. Breast reduction reduces your chances of being able to breast feed quite substantially so ideally it is not performed until after childbearing has been completed. However, this may not be possible if the symptoms of excess breast size are severe.
What are the risks of breast reduction?
All surgery carries with it some risk. Bleeding and infection are common risks in all surgery. Avoid medications that are prone to make you bleed prior to surgery. These include aspirin, high dose vitamin E and arthritis pills. Red wine and smoking also increase your risk of bleeding.
You will be given antibiotics from the time of the surgery to reduce your risk of infection. almost all patients lose sensation to their nipples after breast reduction. Ninety percent of people get return of sensation by approximately three months. Some people even say their sensation is better than it was prior to surgery. There is a risk however that you may permanently lose sensation to both nipples. This is particularly true when breasts are extremely large.
It is common to have a difference in the shape and the size of your two breasts. At surgery every attempt will be made to closely match the size and position of your breasts. However, there is commonly some residual difference. Rarely, especially when the reduction is particularly large or the patient is diabetic or smokes circulation to the nipple may be lost and the nipple may die and leave a scar. It is possible to reconstruct the nipple using grafts from elsewhere in the body. By avoiding smoking for six weeks prior to surgery and getting yourself close to your ideal weight prior to surgery, you can substantially reduce the risk of this rare event occurring.
Occasionally the scars of breast reduction require revision 12 or more months after surgery. It is important to be as close as possible to your ideal weight prior to surgery. Weight loss after a breast reduction may result in the breast looking wide, flat and empty and it may sag. The surgery is also much safer if weight is reduced prior to surgery. The risk of complication is reduced as the tissues are less tense when manipulated at surgery.
It is also much easier to judge the ideal size for your build when your weight is close to the ideal range. If your surgery is done when you are overweight and you subsequently lose weight when you are less encumbered by large breasts, you will find that you may need further surgery to reshape the breasts. Strangely enough, occasionally women even request breast augmentation (enlargement) when they have undergone breast reduction followed by substantial weight loss.
Getting yourself in the best possible shape prior to surgery will reduce the risk of this occurring and make the procedure safer for you.
How do I plan my surgery?
If you contact Dr Scamp’s office (ph: 07 5539 1000) his staff will be able to give you an idea of costs of the surgery including hospital or day theatre costs and anaesthesia costs. They will also be able to advise you how much you are likely to get back from your health fund and from Medicare. You will be sent information to read on the surgery and it is wise to make a list of questions to ask Dr Scamp at consultation.
If you are traveling from a distance it may be possible to arrange an initial telephone consultation with Dr Scamp prior to seeing him to minimise the amount of time that you need to spend away from home. Many questions can be answered by his staff and practice nurse.
Preparation for surgery
Cease smoking at least six weeks prior to surgery and optimise your weight as this makes for a better cosmetic result and makes the surgery much safer. Avoid medications that make you bleed including aspirin, vitamin E, etc. Make sure you will have some help at home especially if you are undergoing day surgery.
Where will I have my surgery?
Breast reduction can either be performed in a day theatre or with a one or two night hospital stay. If you are going to have the surgery performed as a day patient make sure you have someone to take care of you for the first few days and also to relieve you from housework until you feel up to doing it again. This is usually for about a week.
Types of anaesthesia
Breast reduction is performed under general anaesthesia. Once you are asleep, injections will be placed into the breast to make you numb for 12 hours after surgery. This reduces the discomfort of the procedure substantially.
What is done at surgery?
Breast reduction can be performed though a number of different scars. For most people the scar is in the shape of an anchor with a circular scar around the areola and then extending vertically down to the fold below the breast and across that fold. If the reduction is small and the patient is young and close to their ideal weight, it may be possible to perform the surgery via a scar that is smaller than this.
These operations are known as the Lejour or Benelli techniques. Doctor Scamp will discuss the technique that is the most suitable for you at the time of surgery. Excess breast gland, fat and skin is removed from the breast and the nipple relocated to the appropriate higher position.
Sometimes liposuction is used to reduce the lateral bulging of the breast and maintain a shorter scar. Occasionally where there is minimal sag and modest excess of breast size, liposuction can be used to reduce the breast down with a very small scar. The nipples are not usually detached, but simply left attached to the breast gland and rotated to a higher position. Only if the breasts are exceptionally large are the nipples removed and replaced back as grafts. This technique is avoided as sensory recovery is likely to be poorer and often the shape is less life-like. The sutures used for this surgery are internal and absorbable. Only if one protrudes will it need to be removed.
What do I expect after surgery?
At the end of the operation an adhesive dressing may be applied. A surgical bra may be recommended. There may be a drain from each breast removing any excess blood. The drains are usually removed after one day and the dressing comes off a few days later. Thereafter you will be encouraged to wear tape on your scars for up to three months to try and get the best possible scar.
You will be given antibiotics into the vein during the surgery and pills to take after surgery to reduce the pain. Most patients are usually surprised with how comfortable they are after breast reduction. Expect the nipples and much of the breast to feel numb after surgery. Over three months you will find a large amount of these sensations return. Further sensory recovery may take up to two years.
How long will I take to recover?
Most people can return to work a week after surgery. Two weeks break should certainly see you fit. Physical activity is discouraged until two weeks after surgery. Gentle return to exercise at that stage is advised. The breasts are likely to remain tender to touch for several weeks thereafter.
When will I be completely recovered?
It is probably not advisable to buy a new bra until at least six weeks after surgery. Your shape and size will settle as the swelling disappears. The scars themselves take about a year to get to their best but are usually quite presentable after three months. Remember however that the scars are permanent and in some people they can be raised or red (keloid).
The scars are designed and placed to be inconspicuous even in low cut clothing. By using sutures that absorb slowly and tapes to support your scar, Doctor Scamp aims to provide you with the best possible scars from your surgery. Despite the fact that it takes some time for the breasts themselves to settle in, people who undergo breast reduction notice an immediate improvement in their comfort when they have lost the encumbrance of heavy breasts.
While it will take you time to get used to your new shape, and it will take time for the breasts themselves to get to look their best, you will probably find that the improved comfort is there immediately. Please write down any further questions you have and ask Dr Scamp when you see him at consultation.