Breast Reduction Surgery, Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Preparing for Surgery

During the initial consultation, the surgeon explains the surgery in detail, including risks, limitations and scarring, which is an inevitable consequence of the procedure. The surgeon also discusses where the surgery will take place, how long the woman will remain in the facility, any steps that need to be taken preoperatively, and what to expect postoperatively. Any questions a woman has are answered at this time.

In preparation for surgery, the woman has a complete physical examination. The surgeon measures the woman's breasts and usually photographs them for reference during surgery and afterwards. These photographs can also serve as documentation for insurance purposes.

Unlike a rhinoplasty (nose reduction), in which computer imaging may be used to show a prospective patient what her nose is likely to look like after surgery, the new breast size and shape, as well as positioning of the nipple and areola (the darker skin around the nipple), are usually determined during a discussion between the physician and patient.

"Preoperative imaging of any sort is of limited value for this procedure. It's a marketing tool more than anything else," says Beraka. "After assessing the size of the breasts, I ask the patient how much smaller she would like them, taking into consideration what makes sense in terms of the rest of her body. I then estimate how much tissue will need to be removed."

Most surgeons provide guidelines for eating, drinking, smoking, taking medication, and other activities before surgery. Generally, the patient should not take aspirin or similar medications for a week or two before surgery, since these medications may lead to increased bleeding. Beraka suggests women take 1,000 milligrams of vitamin C daily to promote healing, but avoid vitamin E supplements, which may also lead to increased bleeding.

If a patient smokes, she may be advised to stop. This is always a good idea, but it's especially important when general anesthesia is used, since smoking limits the amount of oxygen the body has available during surgery and recovery.

Because the size, shape, and amount of tissue in the breast will change after reduction, most women are advised to have a preoperative mammogram and a postoperative mammogram six months to a year after surgery for comparison.

The Surgery

Breast reduction is generally done on an inpatient basis. The procedure itself usually takes from two to four hours and requires an overnight stay in the hospital. In most cases, surgery is performed under general anesthesia. Generally, breast reduction involves the removal of fat, glandular tissue, and skin from the breasts; in some cases, the areola may also be reduced.

Surgical techniques vary, but according to the American Society of Plastic and Reconstructive Surgeons, "the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast." After removing excess tissue and moving the nipple and areola into their new positions, the surgeon then "brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast."

The typical procedure is:

1. The outlined areas show where skin, breast tissue, and fat are typically removed and how the areola and nipple are repositioned.

2. The arrows show how skin formerly above the nipple is brought down and sutured together to reshape the breast.

3. After surgery, scars will appear around the areola and in the crease under the breast.

Liposuction (a procedure in which excess fatty tissue is removed from a specific area of the body by means of a suction device) is sometimes used to remove excess fat from the armpit area, although some surgeons also use this procedure to remove excess fatty tissue from the breast. In some cases, if only fat needs to be removed, liposuction alone may be used to reduce breast size. The fatty tissue is also reviewed by a pathologist.

Beraka notes that newer surgical techniques, such as those popularized by Belgian surgeon Madeleine Lejour, can result in significantly less scarring around the undersurface of the breast, making the procedure "less frightening to patients contemplating reduction." However, McGuire says that while the Lejour technique can be appropriate "for specific patients," she does not believe it should be used for everyone. "The scars are shorter, but the surgeon has less control over the shape of the breast," she says. If the type of incision is important to the patient, she should discuss it with the surgeon.

Post-Op

After surgery, "they wrapped me in a bandage to hold everything in place," Richardson explains. "I was a bit uncomfortable, but I had very little pain. In fact, I never took anything stronger than extra-strength acetaminophen during recuperation."

The bandage is removed a couple of days after surgery, after which the woman wears a surgical bra 24 hours a day for about a month. "I could shower — I was up and active and doing things," says Richardson. Nevertheless, she took several weeks off from work to give her body a chance to recover before resuming a full schedule. Like most women who undergo reduction, Richardson was advised not to lift or push anything heavy for three or four weeks.

According to the American Society of Plastic and Reconstructive Surgeons, the first menstruation following surgery may cause breasts to swell and hurt, and the woman may also experience shooting pains in her breasts for several months. Patients may be advised to avoid sex for a week or so to avoid arousal that can cause the incisions to swell.

"I was relieved that my surgeon has an assistant who answered all my questions during the recovery period, like 'when will my bruises go away?' and 'when can I drive again?'" Richardson notes.

Adjusting to Change

Like most women who undergo reduction, Mary-Margaret Richardson, Kellie Feldman, and Margie were pleased with the results. "Of all the procedures I do, this one has the highest patient satisfaction, even when the results are less than perfect," Beraka says.

"I'm amazed whenever I go shopping. I can buy a dress, not separates with the top four sizes larger. My posture is so much better, and there's no rutting in my shoulders. Most of all, the pain in my neck and back is gone," Richardson says.

"I no longer have rashes under my breasts or shoulder indentations," Feldman adds. "Plus, I went on a diet and lost a total of 28 pounds, 7 of which was breast tissue. I feel much healthier."

"People ask, 'why did you wait so long?'" Richardson notes. "I tell them that when it began to be debilitating, everything sort of came together. I was scared up until the night before the surgery. But the time was right. I don't regret one minute of it."

About the Author

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