Breast Reduction Mammaplasty
Women with very large, pendulous breasts may experience a variety of medical
problems caused by the excessive weight-from back and neck pain and skin
irritation to skeletal deformities and breathing problems. Bra straps may
leave indentations in their shoulders. And unusually large breasts can make
a woman-or a teenage girl-feel extremely self-conscious.
Breast
reduction, known as reduction mammaplasty, is designed for such women. The
procedure removes fat, glandular tissue, and skin from the breasts, making
them smaller, lighter, and firmer. It can also reduce the size of the areola,
the darker skin surrounding the nipple. The goal is to give the woman smaller,
better-shaped breasts in proportion with the rest of her body. Breast reduction
is usually performed for physical relief rather than simply cosmetic improvement.
Most women who have the surgery are troubled by very large, sagging breasts
that restrict their activities and cause them physical discomfort.
In most cases, breast reduction isn't performed until a woman's breasts
are fully developed; however, it can be done earlier if large breasts are
causing serious physical discomfort. The best candidates are those who are
mature enough to fully understand the procedure and have realistic expectations
about the results. Breast reduction is not recommended for women who intend
to breast-feed.
Breast
reduction is not a simple operation, but it's normally safe when performed
by a qualified plastic surgeon. Nevertheless, as with any surgery, there
is always a possibility of complications, including bleeding, infection,
or reaction to the anesthesia. Some patients develop small sores around
their nipples after surgery; these can be treated with antibiotic creams.
You can reduce your risks by closely following your physician's advice both
before and after surgery. The procedure does leave noticeable, permanent
scars, although they'll be covered by your bra or bathing suit. (Poor healing
and wider scars are more common in smokers.) The procedure can also leave
you with slightly mismatched breasts or unevenly positioned nipples. Future
breast-feeding may not be possible, since the surgery removes many of the
milk ducts leading to the nipples. Some patients may experience a permanent
loss of feeling in their nipples or breasts. Rarely, the nipple and areola
may lose their blood supply and the tissue will die.
Your
surgeon may require you to have a mammogram (breast x-ray) before surgery.
You'll also get specific instructions on how to prepare for surgery, including
guidelines on eating and drinking, smoking, and taking or avoiding certain
vitamins and medications. Some surgeons suggest that their patients diet
before the operation. Breast reduction doesn't usually require a blood transfusion.
However, if a large amount of breast tissue will be removed, your physician
may advise you to have a unit of blood drawn ahead of time. That way, if
a transfusion should be needed, your own blood can be used. Breast reduction
surgery may be performed in a hospital, an outpatient surgery center or
an office-based surgical suite. If you are admitted to the hospital, your
stay will be a short one. The surgery itself usually takes two to four hours,
but may take longer in some cases. Breast reduction is nearly always performed
under general anesthesia. You'll be asleep through the entire operation.
Techniques for breast reduction vary, but 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. The surgeon
removes excess glandular tissue, fat, and skin, and moves the nipple and
areola into their new position. He or she then brings the skin from both
sides of the breast down and around the areola, shaping the new contour
of the breast. Liposuction may be used to remove excess fat from the armpit
area. In most cases, the nipples remain attached to their blood vessels
and nerves. However, if the breasts are very large or pendulous, the nipples
and areolas may have to be completely removed and grafted into a higher
position. Stitches are usually located around the areola, in a vertical
line extending downward, and along the lower crease of the breast. In some
cases, techniques can be used that eliminate the vertical part of the scar.
And occasionally, when only fat needs to be removed, liposuction alone can
be used to reduce breast size, leaving minimal scars.
After
surgery, you will be wrapped in an elastic bandage or a surgical bra over
gauze dressings. A small tube may be placed in each breast to drain off
blood and fluids for the first day or two. You may feel some pain for the
first couple of days-especially when you move around or cough-and some discomfort
for a week or more. Your surgeon will prescribe medication to lessen the
pain. The bandages will be removed a day or two after surgery, though you
will continue wearing the surgical bra around the clock for several weeks,
until the swelling and bruising subside. Your stitches will be removed in
one to three weeks. If your breast skin is very dry following surgery, you
can apply a moisturizer several times a day, but be sure to keep the suture
area dry. You can expect some loss of feeling in your nipples and breast
skin, caused by the swelling after surgery. This usually fades over the
next six weeks or so. In some patients, however, it may last a year or more,
and occasionally it may be permanent. Although you may be up and about in
a day or two, your breasts may still ache occasionally for a couple of weeks.
You should avoid lifting or pushing anything heavy for three or four weeks.
You may be instructed to avoid sex for a week or more, since sexual arousal
can cause your incisions to swell, and to avoid anything but gentle contact
with your breasts for about six weeks. A small amount of fluid draining
from your surgical wound, or some crusting, is normal. If you have any unusual
symptoms, such as bleeding or severe pain, do not hesitate to call your
doctor.
Although much of the swelling and bruising will disappear in the first few
weeks, it may be six months to a year before your breasts settle into their
new shape. Even then, their shape may fluctuate in response to your hormonal
shifts, weight changes, and pregnancy.
Of all plastic surgery procedures, breast reduction results in the quickest
body-image changes. You will be rid of the physical discomfort of large
breasts, your body will look better proportioned, and clothes will fit you
better. However, as much as you may have desired these changes, you'll need
time to adjust to your new image-as will your family and friends. Be patient
with yourself, and with them. Keep in mind why you had this surgery, and
chances are that, like most women, you will be pleased with the results.
