Treatments

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.