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Breast Reduction

Breast Reduction surgery, also known as Reduction Mammoplasty, is a procedure used to remove excess fat, tissue and skin from the breasts.

The size of women’s breasts may be determined by several factors, such as inherited genes, body weight and hormonal influences. They can, therefore, be a problem to some women early in adolescence or may not become uncomfortable until middle age following the menopause or the use of HRT. The problem of large breasts, however, may cause similar problems at all ages and these are chiefly backache, neck pain, grooves in the shoulders from bra straps, rashes under the breasts and the feeling of self-consciousness. Because of the sexual nature of breasts the undue prominence may attract unwanted attention from the opposite sex, comments and sexual innuendoes. These can cause psychological distress to many women. One of the commonest complaints of women with large breasts is that it is very difficult to wear fashionable clothes and indulge in active sports, particularly in the summer months.

The goal of Breast Reduction surgery is to reduce the size of your breasts and reshape them so that they are proportionate to the rest of your body and are no longer a source of physical discomfort. This commonly requested, predictable procedure has the dual benefits of improving your appearance while relieving the physical and emotional burden of overly large breasts.

Hospital Stay: Hospital Stay: 1 day
Duration: Duration: 2-5 hrs
Cost Estimate: Cost Estimate: 2475 USD - 6000 USD These are indicative prices in Indian Hospitals

Breast Reduction surgery is meant for women who have large breasts and want to resolve issues such as:

  • Chronic back, neck and shoulder pain
  • Chronic rash or skin irritation under the breasts
  • Deep grooves in the shoulders from bra strap pressure
  • Restricted activity
  • Poor self-image related to large breasts
  • Difficulty fitting into bras and clothing
  • Difficulty sleeping

You can have Breast Reduction surgery at any age – even as a teenager in some cases. However, it’s usually best to wait until your breasts are fully developed. If you haven’t started a family or your family isn’t yet complete, you might postpone Breast Reduction surgery until pregnancy isn’t an issue. Changes to breast tissue during pregnancy could affect your surgical results. Also, breast-feeding might be challenging after Breast Reduction surgery

Breast Reduction surgery, which usually takes from three to five hours, is performed in a hospital or surgical center. An overnight stay is not usually required. The surgery commonly involves three incisions. After the surgeon removes excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areolas may be reduced in size. Skin that was located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.

  • Your surgeon will use a surgical marker on your skin to indicate where the incisions will be. These markings are especially important, because your breasts change shape once you are lying on your back on the operating table.
  • Most surgeons prefer general anesthesia for this procedure. A few may perform Breast Reduction with intravenous sedation, also known as “twilight sedation.”
  • Your incision pattern will depend on the size of your breasts, how much your breasts sag and where your nipple-areola complex is positioned. With each technique the areolas can be made smaller if they’re too large. An areolatome, more commonly known as a “cookie cutter,” is used as a circular template to make the new areola size. The cookie cutter diameter ranges from thirty-eight to forty-five millimeters. Here are some commonly used incision patterns:
    • Microincisions are used for breasts that are fatty (not fibrous) and not sagging. Liposuction is used to decrease breast size. Small incisions allow the liposuction cannula (tube) to enter the breast.
    • A donut incision, or periareolar incision, is made solely around the border of the areolas.
    • A keyhole incision, also known as a lollipop incision, is made around the border of the areolas and vertically down from the areolas to the breast crease.
    • An anchor incision, the most common technique used by plastic surgeons, involves three distinct cuts. One incision is made around the border of the areolas; the second extends down vertically from the areolas to the breast crease and merges with a third incision along the breast crease.
  • Your surgeon will remove excess breast skin and fat with a scalpel and/or cautery instrument based on the size breast you desire. If your breasts are asymmetrical (or uneven), the surgeon may remove more tissue from one breast than the other. He or she will then reshape the remaining skin and fat to create a more youthful breast shape and move the nipple-areola complex to a higher position.
  • In most cases, drains will be placed in the breasts to collect excess fluid.
  • Breast incisions are then closed with sutures that go from the deep tissue layers to the more superficial layers (the skin).

The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.

After the procedure

Your breasts will be covered with a gauze dressing or bandages. A tube might be placed under each arm to drain any excess blood or fluid. Your surgeon will likely prescribe medication for pain as well as antibiotics to decrease your risk of infection.

For the first days or week, your breasts will probably feel tender and sensitive. They might also be swollen and bruised. Your surgeon might recommend an elastic compression bra initially to protect the breasts.

You’ll need to limit physical activity for two to four weeks while the breasts heal. Your surgeon also may recommend avoiding underwire bras for a month after surgery.

Scarring usually fades over time. You will need a follow-up visit with your surgeon to remove stitches and check your recovery.

Aftercare & recovery:

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:

  • Drains, if they have been placed
  • Normal symptoms you will experience
  • Potential signs of complication

Risks:

Breast Reduction surgery has the same risks as any other type of major surgery – bleeding, infection and an adverse reaction to the anesthesia.

The risk of poor wound healing seems to increase with the amount of breast tissue removed. However, it isn’t clear that women with a higher body mass index are at greater risk of complications from Breast Reduction surgery.

Recovery time frame after Breast Reduction

It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

Results:

Successful Breast Reduction surgery can relieve pain in your upper back, neck and shoulders. It might also increase your ability to participate in physical activities and promote a more positive self-image.

Although you’ll see results immediately, remember that it can take months for the swelling to completely go down and the surgical scars to fade. The final result is generally permanent — although breast shape and size can change due to factors such as aging and weight gain or loss.

Also known as Reduction Mammaplasty, Breast Reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.

Reduction mammaplasty is an operation which removes the excess fat and skin from the breasts, which are reshaped and the nipples repositioned to form newer smaller breasts. This should result in more attractive breasts and reduce many of the problems outlined above. There are several different surgical designs to reshape the breasts and are illustrated opposite. All of them will involve a scar around the areola of the breast. Each method will use different scars and will have advantages and disadvantages and your surgeon may select with your approval the best technique in your particular case. Reduction Mammaplasty may be used to correct asymmetry of the breast, where one breast is very much larger than the other and where it is considered to be the least normal of the two.

Apart from the change of shape and reduction in size the most obvious consequences are the scars. These are designed to be invisible whilst wearing normal clothing and as far as possible are designed to lie under the average bra or bikini top. Over the months following surgery the scars will fade from being red, possibly thick and uncomfortable, to becoming much more pale and less obvious.

The nipples are likely to be very much less sensitive following surgery due to the nature of the cuts and the nerve supply and it is quite possible that numbness will extend over part of the breast as well.

Unless your operation is done at an age when your breasts are still growing, they should not regrow afterwards. They will, however, increase in size if you either put on weight or become pregnant and decrease in size if you lose weight. Even normal breasts have a tendency to droop with time and you can expect some change in shape to occur after a Reduction Mammaplasty. You can delay this tendency by supporting your breasts in well-fitting bras.

It is very important that you discuss thoroughly with your surgeon beforehand the size of breasts you wish to achieve. Many women wish for a very radical reduction but in order to achieve this the shape and aesthetic quality of the breasts may be compromised. It is also possible that there may be a degree of asymmetry. This is often less than existed before the surgery. In women with very large breasts the benefits of a significant reduction may outweigh the potential imperfections of poor shape and loss of nipple function and sensitivity. However, in women with breasts which are only slightly larger than normal very careful thought must be given to the scarring and the potential shape and size as the outcome of the surgery may not be as aesthetically pleasing as a normal breast appearance.

Any major operation with a general anaesthetic carries a small risk of chest infection particularly among people who smoke and there is also a small risk of thrombosis in the veins of the leg, particularly for patients who are taking the contraceptive pill.

Occasionally, heavy bleeding can occur after the operation is finished which may need a further operation and a blood transfusion.

Occasionally, infection from germs harbouring in the ducts of the breast can be troublesome. Infection can be treated with antibiotics but it will delay the healing process, scars are likely to be worse to start with and there may be a need to restitch them at a later date. If you have a discharge from your nipple, it is most important to tell your surgeon about it before your operation.

Occasionally, skin can become sloughy and form a scab which gradually separates to leave a broad scar. The nipple disc and the skin where the scar meets underneath the breast are parts most likely to be affected. People who smoke are at greater risk of this happening. Usually the scars settle well to end up as white lines but they will always be noticeable. However, some people have an inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time. You need to ask your consultant if you are at increased risk of developing this complication.

When reducing large breasts it may occasionally be necessary to adjust the folds of skin at the end of the scar, both between the breasts and at the sides. This can simply be carried out under local anaesthetic several months later.

There is no evidence that reduction mammaplasty causes breast cancer. Nor does it prevent your breast from being examined for cancer in the usual way.

Your surgeon is likely to recommend that you reduce weight if you are overweight and to make alternative arrangements if you are on the contraceptive pill. Smoking does seriously effect the healing of the breast wounds and should be discouraged and attempts to give it up made.

This procedure is carried out under a general anaesthetic and when you wake at the end of the operation there will be some discomfort which will last for two or three days. You will be given suitable pain killing injections or tablets.

Drainage tubes are frequently used and will be removed within a short period of time. You may need to remain in hospital for three to four days.

The stitches will normally be removed between ten to fourteen days and you will be tired and require help at home for a period of time, from two to six weeks depending on your age and general fitness.

A well-fitting bra will need to be worn following surgery but because of the post-operative swelling the final size of your breasts may not be obvious for several weeks. There is likely to be some tenderness and lumpiness of the breasts for several weeks or even months following surgery but there is no reason why you cannot sunbathe and go swimming once the scars have fully healed.

The size and shape of your breasts and how much reduction you desire are factors that will help your plastic surgeon determine the best technique for you. In some cases it will be possible to avoid the vertical incision that runs from the bottom edge of the areolas to the breast crease or the horizontal incision underneath the breast (typical components of the anchor incision). Rarely, if your breasts are extremely large, the nipples and areolas may have to be completely detached before they are shifted to a higher level. In such a case, you will have made the decision to sacrifice sensation and the possibility of breast-feeding to achieve your desired breast size. Another Breast Reduction option, which is appropriate only in a select group of women, is liposuction alone.

Liposuction for Breast Reduction

Breast liposuction may be right for you if you have fatty breasts, need a minor-to-moderate reduction, and do not need to correct sagging. Here are some considerations:

  • Results may be acceptable for women who need significant reduction but do not want the scars and loss of sensation and are willing to accept some sagging.
  • With the onset of menopause, breast tissue is gradually replaced by fat, so postmenopausal women are among the best candidates for liposuction-only Breast Reduction.
  • Patients with fibrous tissue and minimal fat in their breasts are not good candidates.
  • Ptosis (sagging), poor skin condition with little tissue elasticity, and low nipple position are also contraindications.
  • Liposuction alone may be used to treat asymmetry up to one cup size.
  • Following liposuction of the breast, the elastic qualities of the skin cause it to contract, and subsequent uplifting of the breast contour should occur to some extent.

These vary according to type of incision your aesthetic surgeon suggests for you. Your surgeon can conceal some incision lines in natural breast contours, but others will be visible on the breast surface. Although incision lines are permanent, in most cases they will fade and significantly improve over time. Aesthetic plastic surgeons make every effort to hide and minimize scars, with the goal of achieving the desired results with the shortest possible scar. Special tissue handling and suture techniques further minimize scars.

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