Breast Reduction Surgery
This information is of a general nature only and is for public information and education. Your individual problem needs to be assessed by your family doctor who will advise you on appropriate further steps.
Women seek breast reduction surgery for a number of reasons. In some, the breasts increase in size rapidly after the onset of puberty, necessitating reduction surgery of this "virginal hypertrophy". In others, there is a gradual increase in size which causes physical discomfort or social embarrassment. In yet others, there is a very significant increase in breast size with pregnancy and lactation which does not revert to the prepregnant size after the cessation of lactation.
Principles of breast reduction surgery
The breast is made up of skin, glandular tissue, fat and the nipple-areolar complex. Reduction involves, reduction of the breast tissue and fat, raising and repositioning of the nipple-areolar complex and skin reduction. The nipple is taken to its new position by a "pedicle" or block of tissue with its own blood supply and this tissue may be based inferiorly, superiorly or from both sides.
Methods of breast reduction
While there are many types of operations for breast reduction, probably the procedure done most often is an "inferior pedicle" type, as first described by Robbins, where the nipple-areolar complex is lifted to its new site on an inferior pedicle. This is a safe, time proven method which gives consistent results. The scars from the surgery include a circular scar around the areola (the coloured skin around the nipple) and an inverted "T" shape scar with the vertical limb of the "T" running downwards on the breast and the horizontal limb running across the lower part of the breast and on to the chest towards the midline and the outer part of the chest wall.
A method gaining popularity is the "Vertical Mammoplasty". In this procedure, the circular areolar scar is similar to that of the inferior pedicle procedure but the inverted vertical limb of the "T" runs downwards and curves outwards but stays on the breast itself and there is no horizontal scar. This does produce a much shorter scar. In addition, the shape of the reduced breast is maintained better in the long term. However, the disadvantages of the method are the shape of the breast for the first few weeks and the need for revision surgery in patients needing larger reductions.
Post operative care and restrictions
As reduction surgery is done under general anaesthesia and is a long operation, patients are usually admitted for inpatient stay after the surgery, from two to four days. The patient will need assistance at home for up to three weeks, and will be unable to do most normal activities during this period. Careful preoperative planning is required to avoid unnecessary stress and strain after the surgery. It is also best to avoid strenuous physical activity during the first three months after the surgery to get the best results. A sports bra with no cups or wires is used during this period.
What can go wrong?
In the short term, like any surgery, excessive bleeding after the surgery is a risk and may need further surgery to correct the problem. Some bleeding in inevitable and indwelling drains are used to prevent any collection of blood in the wound. These drains are removed after two to four days. Nipple sensation may be affected but cannot be predicted. Breastfeeding after the procedure cannot be guaranteed but may be possible. The shape and size may not be as good as hoped for. Realistic expectations from the patient and the surgeon are needed and revision surgery is always a possibility. Breast reduction surgery is a technically demanding procedure and perfection is not to be hoped for! Fat necrosis is sometimes seen after the vertical mammoplasty and may require open drainage to remove any collection. Nipple-areolar necrosis is the most feared complication of breast reduction surgery. Fortunately, it is also quite rare. If this were to happen, secondary surgery may be needed to reconstruct the nipple-areolar complex.
