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Breast Reduction

Overview

Breast Reduction

Breast reduction surgery is typically performed for women with very large, sagging breasts that cause them physical discomfort and limit their activities. Due to the excessive weight from their breasts, women commonly experience significant back pain, neck pain, skin irritation, shoulder grooving from bra straps, and many other medical problems.

Breast reduction or reduction mammoplasty is designed to remove breast tissue and skin from the breasts in order to alleviate symptoms and create a much more aesthetically pleasing shape. Also for women with a large stretched areola, (the colored skin surrounding the nipple) this is reduced in size.

There are numerous techniques for this operation, but most involve removing excess breast tissue and skin while repositioning the nipple in a higher position. This leaves either a longer scar that encircles the areola, extends downward, and follows the natural crease below the breast, or a shorter scar that eliminates this last portion in the crease (the anchor shaped scar vs. the lollipop scar).

The least invasive technique involves liposuction of the breasts alone, which has the advantage of leaving very minimal scars, but few women are good candidates for this procedure. However, liposuction can be combined with other techniques to obtain a better overall result. The newer short scar can be applied to most breasts but depends on your individual circumstances and will require an evaluation from your surgeon to determine if you are a candidate.

Who are good candidates for breast reduction surgery?

A breast reduction can alleviate physical discomfort and enhance your appearance. The best candidates are healthy women who are not excessively overweight and are experiencing many of the classic physical symptoms associated with having excessively large and sagging breasts.

For those woman who feel that their breasts are too large but are not having any of these symptoms, they still may be a great candidate and benefit from the cosmetic improvement with this operation if that is what they are looking for.

Women who need mostly a lift and possibly a small reduction are good candidates for a breast lift or mastopexy, which is technically quite similar to a breast reduction (See Breast Lift section).

Also if you are planning on having more children, it is probably best to postpone your breast reduction. This is due to the fact that pregnancy may stretch your breasts again and negate the results of your surgery. Also some women have difficulty with breast feeding after this surgery.

It is important to understand that all women have some asymmetry of their breasts which is normal. Sometimes this can be improved by altering the operation for each breast but it is not possible to achieve perfect symmetry. In fact it should be assumed that you will have some residual asymmetry with any type of breast operation.

Again, good candidates for breast reduction surgery understand the procedure well along with the alternative operations and have realistic expectations.

Breast Reduction

What is my initial
consultation at Dr. Elyassnia's
office in San Francisco like?

During the first meeting, your surgeon will determine if you are a good candidate for surgery while at the same time you will decide if he or she is right for you. This starts with a full health history with a focus on prior breast illnesses. All women greater than 35-40 years of age or younger women with a strong family history of breast cancer need to have a mammogram within one year prior to surgery. It is important to tell your surgeon if you smoke and if you take any medications, supplements, or other drugs as these can have a big impact on your surgery.

During the exam, your surgeon will do a general evaluation of your breast tissue, skin tone, and make specific measurements. Of particular importance is the level of the nipple and areola, which will be moved higher during the procedure. Finally photographs are taken of all patients; these assist with the planning and evaluation of your surgery.

Based on this thorough assessment, the surgeon will describe not only what approach is best for you, but also the various alternatives and all of the risks and limitations associated with each of these. It is very important to listen carefully to the various limitations of each approach and to openly discuss your expectations with your surgeon. Many times a poorly informed patient or surgeon is the direct cause of an unsatisfactory result even when there are no complications with surgery.

The surgeon should also go over the details of the procedure including the type of anesthesia used, the facility where surgery will take place, and the costs involved. Your insurance company may cover the costs involved if they deem it to be medically necessary. They sometimes require that you are not significantly overweight and that a certain minimum amount of breast tissue is removed. Check your policy; a pre-approval may need to be obtained.

At the end of the consultation you may decide to go ahead with surgery and schedule a date, but if you are unsure or don’t feel fully informed don’t hesitate to ask your doctor any questions. A second meeting may be necessary and should always be available as an option.

What is the day of my breast reduction surgery like?

You will need to begin fasting 8 hours prior to your procedure, which means you cannot eat or drink anything at all during this period including chewing gum or water. If you have been instructed to take any medications in the morning this is permitted with a few sips of water.

Breast reduction surgery is done under general anesthesia, which means you will be completely asleep and feel nothing during surgery. The surgery usually takes about three to four hours to complete.

Your incisions will be covered with surgical tape and other forms of dressings and a surgical bra may be applied over your breasts to help with healing and support.

After surgery, you will stay in the recovery suite until you are ready to go home or to our overnight facility.

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How do I prepare for breast reduction surgery?

Within 1 month of surgery, all patients over the age of 50 or with medical problems should have a medical evaluation by their physician or primary care provider. Depending on your health, this may require blood tests, an EKG, etc.

Also, all women over 35-40 years of age or younger women with a strong family history of breast cancer should have a mammogram within 1 year of the date of surgery. You will be given a list of medications, vitamins, and supplements to refrain from taking at least two weeks before and after surgery. You should also stop smoking for at least 1 month before and after surgery.

Breast reduction can be an outpatient procedure or sometimes require a 1 night stay in our overnight facility or hospital. If you and your surgeon have decided that you will go home, you will need to arrange for someone to drive you.

It is a good idea to have someone at home who can help you out for a few days during your recovery. Although it can be quite variable, most patients require one week off from work so this needs to be arranged as well.

Your surgeon will give you a prescription for the medications you will need after surgery so these can be obtained ahead of time and occasionally various postoperative garments need to be obtained as well.

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What is the reovery process for breast reduction surgery?

Your breasts will be bruised and swollen. You will feel some pain for the first few days following surgery, but your pain shouldn’t be severe and can be controlled with your prescribed medication.

You are encouraged to walk around as soon as you are able and it is normal to be more sore after activity. You will be given directions as to how to care for any dressings and most patients are able to shower 1-2 days after surgery.

Occasionally a small tube for drainage is placed during surgery in each breast and brought out through the skin. When this is used, it is usually removed within one week after surgery. Any sutures will be removed in a week, but it will be important to wear a support bra for 4 weeks around the clock after surgery.

Most people are able to return to work after one week, but this depends on your job. You will have to refrain from any exercise for 2-3 weeks and heavy exercise for 4-6 weeks. After 2 months you will be able to resume any previous activities.

Much of the swelling and bruising resolves in 2-3 weeks, but it takes about 3-4 months until all of the swelling resolves and your breasts settle into their final shape. This shape can still change with future weight gain, pregnancy, etc.

Your scars will also be firm and red for several months. They will actually appear to be getting worse before they begin to fade, although they will never go away completely. This process takes 6-12 months or longer. Although your surgeon makes every attempt to keep your scars as inconspicuous as possible, sometimes patients have problems with healing, which is quite unpredictable.

It is important to follow up with your surgeon as directed so that any potential complications can be detected and treated early. For the most part these are rare and you will spend most of your time enjoying your new look!

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What are the
risks of breast reduction surgery?

All surgical procedures carry some uncertainty and risk and this operation is no different. Although there are many possible complications, the good news is that the combined risk of having any major complication is still rare. The following represents some of the major complications but is not meant to be comprehensive.

As with any surgical procedure, excessive bleeding can occur which would cause swelling, pain, and excessive bruising on one side. This is quite rare and could require another operation to treat the problem.

Another rare complication is infection. This can usually be treated with oral antibiotics but may lead to widened or noticeable scars.

Some women report a loss of sensation of the breast skin or nipples. When this occurs the symptoms usually disappear over time but can be permanent.

As mentioned previously this operation does leave permanent scars that can be noticeable when the breasts are uncovered. One of the more common risks with this procedure is poor healing resulting in wide unsatisfactory scars. Problems such as this are more common in smokers. The appearance of scars will improve, but this can take a year or longer. Occasionally revision surgery may be needed that can help improve but not eliminate the scars.

Breast Reduction

Rarely, the nipple and/or areola may lose its blood supply partially or completely resulting in death of a portion or all of this tissue. Depending on the situation, this could require a nipple/areola reconstruction.

While complications are rare, it is important to discuss all the potential risks with your surgeon so that you can make a well-informed decision.