Breast Reduction

Breast Reduction Candidates

Breast reduction is a good option for you if:

• You are physically healthy.
• You have realistic expectations.
• You don't smoke.
• You are bothered by the feeling that your breasts are too large.
• Your breasts limit your physical activity.
• You experience back, neck and shoulder pain caused by the weight of your breasts.
• You have regular indentations from bra straps that support heavy, pendulous breasts.
• You have skin irritation beneath the breast crease.
• Your breasts hang low and have stretched skin.
• Your nipples rest below the breast crease when your breasts are unsupported.
• You have enlarged areolas caused by stretched skin.

Your Breast Reduction Consultation

By choosing a member of the American Society of Plastic Surgeons (ASPS) for your breast reduction procedure, you can be assured that you are choosing a highly-trained, board-certified plastic surgeon. ASPS Member Surgeons must meet rigorous standards for training, ethics, physician practice and research in plastic surgery.

The success and safety of your breast reduction depends on your complete candidness during your consultation. You will be asked a number of questions about your health, desires and lifestyle. Be prepared to discuss:

• Why you want the surgery, your expectations and desired outcome.
• Medical conditions, drug allergies and medical treatments.
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
• Previous surgeries.
• Family history of breast cancer and results of any mammograms or previous biopsies.

Your breast reduction surgeon may also:

• Evaluate your general health and any pre-existing health conditions or risk factors.
• Examine your breasts and possibly take detailed measurements of their size and shape, skin quality and placement of your nipples and areolas.
• Take photographs for your medical record.
• Discuss your breast enhancement options and recommend a course of treatment.
• Discuss the likely outcomes of your breast reduction procedure and any risks or potential complications.
• Discuss the use of anesthesia during your procedure for breast reduction.

At your consultation, it is very important to address all of your questions directly with your plastic surgeon. It's natural to feel some anxiety prior to breast reduction, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with your plastic surgeon.

Breast Reduction Risks and Safety Information

The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits of breast reduction will achieve your goals and if the risks and potential complications are acceptable.

The risks of breast reduction and breast reduction complications include:

• Unfavorable scarring.
• Infection.
• Changes in nipple or breast sensation, which may be temporary or permanent.
• Anesthesia risks.
• Bleeding (hematoma).
• Blood clots.
• Poor wound healing.
• Breast contour and shape irregularities.
• Skin discoloration, permanent pigmentation changes, swelling and bruising.
• Damage to deeper structures (such as nerves, blood vessels, muscles and lungs), which may be temporary or permanent.
• Breast asymmetry.
• Fluid accumulation.
• Excessive firmness of the breast.
• Potential inability to breastfeed.
• Potential loss of skin/tissue of breast where incisions meet each other.
• Potential, partial or total loss of nipple and areola.
• Deep vein thrombosis, cardiac and pulmonary complications.
• Pain, which may persist.
• Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents.
• Fatty tissue deep in the skin could die (fat necrosis).
• Possibility of revisional surgery.

You should know that:

• Breast reduction can interfere with certain diagnostic procedures.
• Breast and nipple piercing can cause an infection.
• Your ability to breastfeed following breast reduction may be limited. Talk to your doctor if you are planning to nurse a baby.
• Breast reduction can be performed at any age, but is best done when the breasts are fully developed.
• Changes in the breasts during pregnancy and significant weight fluctuations can alter the outcomes of previous breast reduction surgery.

Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand your breast reduction procedure and the risks and potential complications.

Preparing for Breast Reduction

After researching the basics, many patients want to know what to expect before breast reduction surgery.

Prior to surgery, you may be asked to:

• Get lab testing or a medical evaluation.
• Take certain medications or adjust your current medications.
• Get a baseline mammogram before surgery and another after surgery to help detect any future changes in your breast tissue.
• Stop smoking well in advance of breast reduction surgery.
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements, as they can increase bleeding.

Special instructions you receive will cover what to do on the day of surgery as well as post-operative care and follow-up.

Your plastic surgeon will discuss where your procedure will be performed. Breast reduction may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center or hospital. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety. If your breast reduction is performed as an outpatient procedure, be sure to arrange for someone to drive you to and from surgery and stay with you the following night.

Breast Reduction Procedure

Breast reduction surgery is usually performed through incisions on the breasts with surgical removal of the excess fat, glandular tissue and skin.

In some cases, excess fat may be removed through Liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction may be used alone.

The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon's advice.

Anesthesia choices for breast reduction surgery include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Breast Reduction Incisions

Breast reduction incision options include:

• A circular pattern around the areola. The incision lines that remain are visible and permanent scars, though usually well-concealed beneath a swimsuit or bra.
• A keyhole- or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease.
• An inverted T- or anchor-shaped incision pattern.

Breast Reduction Recovery

Following your physician's instructions is key to the success of your surgery and recovery. Your doctor will give you specific instructions on how to care for yourself and minimize breast reduction surgery risks. These instructions may include:

• How to care for your breasts following surgery.
• Medications to apply or take orally to aid healing and reduce the risk of infection.
• Specific concerns to look for at the surgical site or in your general health.
• When to follow-up with your plastic surgeon.

When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluids that may collect.

After you go home, seek medical attention immediately if you experience shortness of breath, chest pains or unusual heart beats. Should any of these complications occur, you may require hospitalization and additional treatment.

It's important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing.

Be sure to ask your plastic surgeon specific questions about what you can expect during your breast reduction recovery period.

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery, and when will they be removed?
• Are stitches removed, and when?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

Breast Reduction Results

The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.

The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction. Your better-proportioned figure will likely enhance your self image and boost your self-confidence.

Over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations it may not be possible to achieve optimal results with a single breast reduction procedure and another surgery may be necessary.

Breast Reduction Words to Know

• Areola: Pigmented skin surrounding the nipple.
• Breast reduction: Also known as reduction mammaplasty, the surgical removal of breast tissue to reduce the size of breasts.
• General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Hematoma: Blood pooling beneath the skin.
• Intravenous sedation: Sedatives administered by injection to help you relax.
• Liposuction: Also called lipoplasty or suction lipectomy, a procedure that vacuums out fat from beneath the skin's surface to reduce fullness.
• Local anesthesia: A drug injected directly to the site of an incision to relieve pain during an operation.
• Mammogram: An x-ray image of the breast.
• MRI (Magnetic Resonance Imaging): A painless test to view tissue, similar to an x-ray.
• Reduction mammaplasty: The surgical removal of breast tissue to reduce the size of breasts, also known as breast reduction surgery.
• Sutures: Stitches used to hold skin and tissue together.