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Breast Reduction Contrary to some people's belief, large breasts are not a godsend. They frequently cause functional problems with neck, shoulder, and back discomfort and poor posture, breast pain and heaviness, breathing difficulties due to breast weight, deep shoulder grooves, and moisture and skin rashes under and between the breasts.
Large pendulous breasts are often unattractive because gravity causes them to lose their shape and the nipples are lowered. It is also difficult to find clothes and bras that fit and to enjoy physical activity. Beyond these physical problems, psychological stress may be suffered, due to the attention large breasts attract.
Women who undergo breast reductions are among the happiest with the results of their surgery. Imagine how removing 2-3 pounds or more from the chest improves the posture and appearance and creates a better self-image.
A breast reduction can reduce the breast volume, raise the nipples to the correct height, and reshape the breast to produce an esthetically pleasing breast posture, and correct gross asymmetry.
A variety of techniques are available to reduce breast size. The specific technique varies from surgeon to surgeon and depends on breast size and shape, the patient's age and associated medical problems, and the results desired. The essential steps are as follows:
* The surgeon marks the patient's breasts in a sitting position. Next, a general anesthetic is administered.
* A keyhole incision is made around the nipple and down to the inframammary fold. The nipple areolar complex and its underlying breast tissue with the accompanying blood supply and nerves are preserved in order to maintain sensation and circulation to the nipple.
* Excess breast tissue and skin within the incisions is then removed. The nipple-areolar complex is raised to the planned height, and the incisions are closed.
* Normally, the incisions heal within two weeks, and no further dressings are necessary. Women, who smoke, however, tend to heal more slowly. Women are cautioned not to smoke for ideally 5 months but minimally 2 days prior to surgery and a week or 2 following surgery.
* In most cases swelling and bruising from the surgery is resolved by the tenth to fourteenth day, at which time the sutures are removed.
* Approximately 50% of women can still breast-feed when this technique is used.
The amount of breast tissue to be removed is determined prior to surgery by both the woman and her surgeon. It is essential that the surgeon understand what the expectations are in order to avoid dissatisfaction with the results. Some women desire that only a small amount of the breast volume be removed, others prefer much smaller breasts.
Any surgical procedure that involves the cutting of tissue leaves a scar. The way the incision heals and the scar forms are genetically determined. Normally, however, the scar fade to white lines which look similar to stretch marks within 12-18 months.
The following are possible complications that may occur after breast reduction:
SCARRING - Troublesome scars can be cosmetically improved by injecting cortisone into the scar to flatten, and using lasers to remove redness and resurfacing uneven lumps and bumps.
HEMATOMA - This is a collection of blood. A sudden increase in swelling, pain, and tightness in one or both breasts is an indication that there is a hematoma within the breast. It is important to realize that hematomas are a potential complication of most types of surgery and are not a reflection of the quality of the surgery. Rather, the early recognition and appropriate treatment of the hematoma is an indication of a surgeon's skill.
NIPPLE COMPLICATIONS - Loss of sensation in the nipple is rare and unpredictable.
The inability to breast-feed is a potential problem and occurs in approximately 50% of cases.
There is also a risk, although rare, that the nipple and areolar complex will die due to insufficient blood supply following the removal of adjacent breast tissue.
FAT NECROSIS - An area of fat that has died as a result of poor blood supply is called fat necrosis. It is characterized by a firm, hard lump in the breast and often some redness of the overlying skin. The body temperature usually increases for a few days mimicking infection. If the necrosis is small, it usually resolves spontaneously over a period of weeks. If the affected area is larger it may require surgical removal of the dead fat, which could result in size asymmetry when healing is complete.
INFECTION - Infection rarely occurs in breast reductions and therefore, antibiotics are not usually prescribed as a precautionary measure after surgery.
The outcome of breast reduction surgery may be unsatisfactory for the following reasons:
BREAST ASYMMETRY - Most women have some degree of natural breast asymmetry, and exact symmetry following breast reduction is difficult to achieve. If gross asymmetry occurs following surgery, some revisional surgery will likely be necessary.
POOR NIPPLE POSITION - The nipple position is established while the patient is in a sitting position. The position is usually correlated with chest size and overall body height. If the nipple is positioned slightly lower than normal, it can always be raised to a higher position, if
necessary. If the nipple is too high, it is difficult to correct and invariably results in additional scarring on the breast.
INADEQUATE BREAST REDUCTION - If enough of the breast has not been reduced, it may be due to a lack of communication between surgeon and patient. Revisional surgery with further reduction is easily performed. Too much reduction of the breast is rare and can only be corrected with a breast augmentation.
SKIN PUCKERS - The breast ends at the inframammary fold in the region where the arm normally touches the chest wall. In some overweight women, there is considerable fat in this area, which becomes more prominent after the breast is reduced thus causing a skin pucker.
The breast reduction procedure usually takes 2 to 3 hours.
Breasts do not have many nerves; so most discomfort is experienced at the incisions. Moderate discomfort for the first few days after surgery is normal and painkillers are provided. The discomfort gradually subsides as bruising and swelling decrease.
A normal level of activity can be resumed within one week, depending on the discomfort. Normally a return to work is possible after 1 to 2 weeks. Heavy lifting or any activity that causes discomfort should be avoided for six weeks. |
