Breast Reduction

WHAT DOES THE SURGERY INVOLVE?

On the day of surgery, markings are made on the breasts showing the new nipple position and the amount of breast to be removed. Under general anaesthesia the lowest part of the breast gland is removed, leaving the nipple attached to the chest wall by a strip of tissue called the pedicle, allowing the blood supply to be preserved. The remaining breast glandular tissue is then carefully sutured together over two suction drains with dissolving stitches, which dissolve over the next two to three weeks. Usually an uplift is performed at the same time to fill out the inner and upper parts of the breasts if they have become empty or hollow, and dressings are applied. The surgical technique used most frequently by James McDiarmid is a modification of the inferior pedicle technique. This is probably the most common technique used today for breast reduction as it is both reliable and safe. Blood loss is minimised by using local vasoconstrictor infiltration before the commencement of surgery and it is now almost unheard of for a patient to require blood transfusion following this surgery.

Very occasionally other techniques of breast reduction are used and very large reductions may require the nipples to be removed and then replaced as full thickness skin grafts (so called free nipple grafting), if there is any possibility that the nipples may not survive on the proposed pedicle. Also if only a slight reduction is desired, liposuction of the breast can reduce breast volume to a more acceptable proportion with tiny scars only. Short scar or vertical scar techniques are also alternatives in certain patients but are rarely used in our practice as the inferior pedicle technique is more reliable and safer. In our opinion the vertical scar technique produces a very abnormal looking breast shape which the overzealous surgeon often finds more pleasing than the patient. Over shortening the scars is a false economy and the most critical issue is the long term shape and nipple position, neither of which are satisfactorily dealt with by the far less predictable vertical scar technique in our opinion.

WHAT ARE THE SCARS LIKE?

The latest dissolving stitches are used to close the wounds as they provoke almost no inflammatory reaction as they are dissolved and therefore minimise any scarring. The scars run along the skin crease under the breast (inframammary fold) and vertically from this fold to the areola (ring of colour around the nipple) and then curve around it. They usually heal nicely with little redness and start to fade within a few weeks, but as with any scar it may take several months to look its best. In an absolute minority of patients the scars may become red and itchy and form hypertrophic (enlarged) or keloid (fibrous) scars. This may require treatment with silicone patches or steroid injections.

HOW PAINFUL IS IT?

The majority of the discomfort settles within 24 hours, during this time patients are in hospital and can have very powerful painkillers if necessary. Patients are offered a short course of painkiller tablets on discharge from hospital.

WHAT HAPPENS AFTER THE SURGERY?

Usually on day two the wound drains are removed and patients can be discharged from hospital. The wounds are protected with a soft dressing for two weeks after which time the dressings are removed in the clinic and patients can usually return to bathing or showering normally. At three months post-peratively a further routine follow up appointment is made to check that everything is healing well and post-operative photographs are taken.

WHAT ABOUT BREAST CANCER?

The breast tissue removed from both breasts is routinely checked for cancerous cells whatever your age and whether or not you have a family history of breast cancer. It is extremely unusual to detect cancers in this way but there is no harm in being careful.

WILL I BE ABLE TO BREAST FEED AFTERWARDS?

Although a minority of women are able to breast feed after breast reduction surgery it is safest to assume that breast feeding will not be possible.

WHAT ABOUT NIPPLE SENSATION?

It is best to assume that the nipples will be numb following this surgery although this is not always the case especially if the inferior pedicle technique is used.

WHAT COULD GO WRONG?

Breast reduction surgery is a procedure which probably gives the greatest degree of patient satisfaction out of any procedure in plastic surgery . When performed well, the liberation it confers from heavy breasts can be a positive, life-changing event. Complications are rare but can occur. Infection and bleeding are possible complications of any operation. A single dose of intravenous antibiotics is given to all patients undergoing breast reduction surgery at the induction of anaesthesia as this has been shown to drastically reduce the infection rate in breast surgery.

Asymmetry of shape or size between the breasts is very unlikely to be an issue as Mr McDiarmid performs the surgery on both sides himself.

The ultimate size of the reduced breast is determined by the contact area of the breast base on the chest wall. It is never possible to produce a pert B-cup breast if the previous breast base was very large with a very large area of attachment to the chest wall as the minimal volume of breast tissue spread over a large surface area would produce a breast with very poor projection and an unaesthetic result. A C-cup is commonly achievable but the ultimate cup is determinable within reason and this is discussed in detail at the consultation.

Very occasionally the circulation to the nipple may become impaired and part or all of one of the nipples may be lost. This occurs extremely rarely in older patients, patients who persist in smoking and those undergoing massive breast reductions. Breast reduction is one of the procedures in Plastic Surgery where stopping smoking is an imperative for successful healing.