Women with very large, pendulous
breasts may experience a variety of medical problems caused
by the excessive weight of their breasts, from back and neck
pain and skin irritation to skeletal deformities and breathing
problems. Bra straps will leave indentations in their shoulders.
Unusually large breasts can make a woman or a teenage girl
feel extremely self-conscious.
The size of a woman's breasts
may be determined by several factors, such as inherited genes,
body weight and hormonal influences. They can, therefore,
be a problem to someone in early adolescence, or may not become
uncomfortable until middle-age following the menopause or
the use of HRT. Because of the sexual nature of breasts, the
undue prominence may attract unwanted attention from the opposite
sex. This 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.
A breast reduction, technically
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 around
the nipple. The goal is to give the woman smaller, better
shaped breasts in proportion to the rest of her body.
In most cases, breast reduction
is not performed until the 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 understand fully the procedure and have realistic
expectations about the results. Breast reduction is not recommended
for women who intend to breast-feed.
A reduction mammaplasty
may be used to correct asymmetry of the breasts, 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 a change of shape
and reduction in size, the most obvious consequences are the
scars. These are designed to be invisible when wearing normal
clothing and as far as possible are designed to lie under
the average bra or bikini top. During the months following
surgery the scars will fade from being red, possibly thick
and uncomfortable, to becoming much more pale and less obvious.
However they will always be present and visible when clothing
is not worn and the scars will vary from one woman to another.
In some they may be very thin, in others they may stretch
and become red and sometimes ugly. In the vast majority of
women the scars are acceptable and a small trade off for the
benefit of dealing with problems of large breasts.
Very few women are able
to breast-feed following reduction surgery as the nipples
are separated from the underlying milk ducts and at the time
of pregnancy the milk supply will gradually dry up, sometimes
with the assistance of hormone treatment. Breast reduction
is no contra-indication to pregnancy but young women may wish
to take the fact that they are unable to breast-feed into
account before embarking on this operative procedure.
The nipples are likely to
be less sensitive following surgery due to the nature of the
incisions and the nerve supply and and it is quite possible
that numbness will extend over part of the breast as well.
The procedure can also leave you with slightly mismatched
breasts or unevenly positioned nipples. Rarely the nipple
and areola may lose their blood supply and the tissue will
die. A nipple and areola can usually be reconstructed using
skin grafts from elsewhere on your body.
During your initial consultation,
it is important to discuss your expectations frankly with
me. Every patient and every plastic surgeon has a different
view of what is a desirable breast size and shape.
I will examine and measure
your breasts and photograph them for reference. We will discuss
the variables that may affect the procedure such as your age,
the size of your breasts, and the condition of your skin.
We will discuss where the nipple and areola will be positioned
as they will be moved during the procedure and should become
positioned approximately level with the crease beneath your
I will discuss the procedure
in detail, explaining the risks and limitations and ensure
that you understand the scarring that will result. I will
also explain the anaesthetic to be used and the costs. Some
insurance companies will pay for breast reduction if it is
medically necessary, however, they may require that a certain
amont of breast tissue is removed. You should check your policy
Preparing for your surgery
I will give you specific
instructions on how to prepare for surgery, including guidelines
on eating and drinking, smoking, and taking or avoiding certain
medications. Poor healing and wider scars are more common
in smokers. If you are overweight it is likely that I will
recommend that you reduce weight. You should also make alternative
arrangements if you are taking the contraceptive pill, for
a period of at least six weeks prior to your operation.
While you are making your
preparations, it is wise to arrange for someone to drive you
home after surgery and to help for a few days at home if needed.
Types of anaesthesia
Breast reduction is performed
under general anaesthesia. You will be asleep through the
entire operation. The operative procedure usually takes two
to three hours.
The procedure involves
an anchor shaped incision that circles the areola, extends
downwards and follows the natural curve of the crease beneath
the breast. Excess glandular tissue, fat and skin are removed
and the nipples and areola are moved into their new position.
The skin is then brought down from both sides of the breasts
down and around the areola, shaping the new contour of the
In most cases the nipples
remain attached to their blood vessels and nerves. However
if the breasts are very large or pendulous, the nipple and
areola may have to be removed and grafted in a higher position.
This is known as a free nipple graft and will result in loss
of sensation in the nipple and areolar tissue.
Stitches are located around
the areola, in a vertical line extending downwards and along
the crease under the breast. These will be buried beneath
the skin surface and will dissolve. You will have a small
drainage tube placed in each breast to drain blood and fluid
for the first day or two. You will have some pain for the
first couple of days, especially when you move around or cough,
and some discomfort for a week or more. You will be prescribed
medication to lessen the pain.
The dressings will be removed
a few days after surgery. You will be advised to wear a sports
bra during the day and night for the first four weeks, until
the swelling and bruising subside. After this time you can
wear a normal bra, underwired if you wish.
Your breasts may swell and
hurt during your first menstrual period after surgery. You
may also experience shooting pains for a few months. You can
expect some loss of feeling in your nipples and breast skin
caused by the swelling after your surgery. It usually subsides
over the next six weeks although in some patients it may last
a year and may occasionally be permanent.
What are the risks?
Any major operation under
general anaesthetic carries a small risk of a chest infection,
particularly among people who smoke and there is also a small
risk of thrombosis in the veins of the leg, particularly if
a patient is taking the contraceptive pill.
Occasionally bleeding can
occur after the operation is finished and this may require
further surgery and a blood transfusion.
from bacteria harbouring in the ducts of the breast can be
troublesome. Infection can be treated with antibiotics but
it will delay the healing process, and the scars are likely
to be worse.
Occasionally the skin can
become sloughy and form a scab which gradually separates to
leave a broad scar. The areola and the skin where the scar
meets under the breast are the areas most likely to be affected.
People who smoke are at greater risk of this happening. Usually
the scars will end up as white lines but they are always visible.
However, some people have an inborn tendency for scars to
stretch and sometimes they can stay thick, red and irritable
for a long time.
When reducing large breasts
it may occasionally be necessary to adjust the folds of skin
at each 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
breast reduction increases your risk of breast cancer. Nor
does it prevent your breast from being examined for cancer
in the usual way.
Getting back to normal
Although you will 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. Most women can return
to work and social activities in about two weeks. You will
find that you have much less stamina for several weeks and
should limit your exercises to stretching, bending and gentle
swimming until your energy returns.
It is advisable to avoid
sexual activity for a week or more, since sexual arousal can
cause the incisions to swell. You should avoid anything other
than gentle contact with your breasts for about six weeks.
A small amount of fluid
draining from your wound, or some crusting, is normal. If
you have any unusual symptoms, such as bleeding or severe
pain, you should not hesitate to contact 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 will settle into
their new shape. Even then the shape may fluctuate in response
to your hormonal patterns, weight changes and pregnancy.
Will the improvements last?
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 put on weight or become pregnant and decrease in size
if you lose weight. Breasts tend to droop with time and you
can expect some change in shape to occur after your breast
reduction. You can delay this tendency by supporting your
breasts in well-fitting bras.
Your new appearance
Every effort will be made
to keep your scars as inconspicuous as possible. It is important
to remember that breast reduction scars are extensive and
Breast reduction results
in a rapid body image change. You will be rid of much of the
physical discomfort of large breasts, your body will look
better proportioned and clothes will fit you better.
However, you will
need time to adjust to this new image, as will your family
and friends. Be patient with yourself and you are likely to
be delighted with the results.
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