Breast Reduction Surgery

Breast Reduction is a surgical procedure that involves removal of breast tissue and reshaping of the breast. The procedure is also called Reduction Mammaplasty.

Large breasted women can frequently develop significant symptoms from their large breast size. These may include neck and shoulder discomfort, shoulder grooving from the bra straps, sore breasts and rashes along the inframammary folds, particularly in the warmer months, and low self-esteem. In the appropriate setting, a bilateral breast reduction can significantly improve such symptoms.

Main Reasons for Reduction Mammaplasty

To reduce breast size in a woman whose breasts are heavy and pendulous, or too large for her body frame.
To improve posture and ease pain in the back, neck and shoulders caused by the weight of heavy breasts
Allows greater range of physical activity which may be restricted because of the size and weight of breasts
Reduce skin irritation in breast folds
Raise position of downward pointing nipples and areolas
Restore confidence in a women who is emotionally affected by her large breast size

Breast reduction involves two aspects, elevation of the nipple/areola complex and removal of breast tissue in order to make a smaller, lighter breast. Although there are obvious cosmetic aspects to the operation, it is considered a medical procedure and essentially converts a large, uncomfortable but scarless breast, into a more comfortable, smaller breast with scars. In many women, the scars will heal well and not be overtly unsightly. The procedure does, however, carry some risk such as changes in nipple sensation, excessive scarring, and / or breast and nipple asymmetry (usually minor). It is likely to affect the ability to breast feed.

Despite the resultant scars on the breast, most women are extremely happy with the surgery if offered in the right circumstances, and often the procedure is life changing.

Although it is important to decide on the size and shape you would like, it is not possible to guarantee the exact outcome or cup size. The size and shape of your breasts before surgery will influence the surgical procedure and outcome. Other factors such as weight gain, weight loss and hormonal factors will continue to affect the breast tissue. If you plan to lose a large amount of weight, it is best to stabilise your weight before your surgery.

Surgical Techniques

The procedure takes approximately 2-3 hours and is performed under general anaesthesia. It is recommended patients stay overnight in hospital to aid recovery. The procedure involves incisions around the areola, vertically down from the lower edge of areola to the crease under the breast and a variable horizontal incision along the lower breast crease (inframammary fold). Excess skin, fat and breast tissue are removed, the nipple and areola are moved into a higher position. Nipples and areolas usually remain attached to their blood and nerve supply on a pedicle while they are repositioned. However, if breasts are extremely large and nipples are near the level of the waist, the nipples and areolas may be completely removed before they can be repositioned at a higher level. This is called a free nipple graft.This will result in permanent loss of sensation in the nipple and areola, and inability to breast feed. All surgical procedures leave permanent scars. These will be red initially and take six to twelve months to fade, and care and advice will be given to minimise their appearance.

Risks of Surgery

As with all surgery, there are possible complications and you need to be aware of these to make an informed decision. Despite the highest standards of surgical practice, complications can occur.

Anaesthesia - Modern Anaesthesia is safe and effective, but does have risks. Rarely, these risks are life threatening. Any concern regarding your anaesthesia should be discussed with your Anaesthetist prior to your procedure.
Wound infection- Although not common, this occurs in less than 10 % of cases and may require treatment such as antibiotics or local dressings
Wound breakdown- This may occur due to poor or slow healing of the skin and breast tissue, or excessive stress on the wounds. Wound breakdown will significantly delay healing and may increase scarring.
Bruising and swelling -This can take two to three days to develop, and may take a few weeks to fade. It may extend over your chest and abdomen or back.
Bleeding (haematoma)- This may occur despite all care taken in surgery. Occasionally a second operation may be required to drain a blood clot.
Scarring - There will be scars on each breast. Although all care is taken to minimise scarring, scars can become raised and thick. While most scars fade and flatten over six months to one year, some may become "keloid" and remian raised, thick, itchy and red.
Asymmetry - The shape and size can not be guaranteed between breasts. It is possible some difference will occur between size of breasts and positions of nipples.
Loss of sensation in nipple and areola- This is usually temporary, but sensation may take several months to return to normal. Occasionally this may be permanent, such as when a free nipple graft is performed.
Loss of nipple and areola tissue- Very rarely, the nipple and areola tissue can lose its blood supply resulting in complete or partial loss of the areola or nipple tissue. This would result in distortion and scarring at the site. Reconstruction by a skin graft may be possible to improve this.
Breast feeding - It is likely to be difficult or impossible to breast feed after breast reduction surgery.
Heart and circulation problems - Although rare, a blood clot ( thrombosis ) can develop, usually in a leg vein. A clot can move to the lungs or heart where it can be life threatening. A chest infection is another possible risk after general anaesthetic. Early mobilisation / leg exercises should help reduce the risk.

Smoking contributes to wound breakdown and delayed healing, as well as causing other health problems. If you are unable to cease permanently, smokers should be aware that any smoking immediately prior to or after the procedure may have an adverse effect on healing and final cosmetic result.

After Surgery

Most patients stay in hospital 1-2 nights. On discharge you need a friend or relative to drive you from the hospital.

Pain - During the first few days pain and discomfort are common, particularly when moving. Gradually pain should ease to become discomfort, which will typically fade in a week or two. Pain is easily managed with intramuscular injections whilst in hospital, and oral analgesics at home.
Drains- A plastic tube (drain) may be inserted into each breast to drain off any excess fluid. They remain in place until the drainage is minimal, usually only 1-2 days. A nurse will remove the drains. Usually these are removed prior to your discharge from hospital.
Bra- A surgical bra will be supplied . It should be worn at all times ( day and night) for 6 weeks. As swelling caused by surgery subsides, size and shape of breasts will change. It may take several months before your breasts acquire a more natural shape and position. Appropriate support is important during this healing time.
Stitches ( Sutures)- Stitches are usually dissolvable. If you are having a Free Nipple Graft there will be sutures to remove around the nipple. These are usually removed 7-10 days after surgery by the nurse.
Activity- It is very important to take things very easy for the first two weeks, but you should mobilise for short periods to improve circulation and to gradually increase activity. Getting out of bed after surgery and gently mobilising will reduce the risk of post-operative complications including thrombosis (clots) and chest infections. Performing leg exercises, deep breathing and coughing exercises after surgery will also reduce your risk. Wear your supplied TED stockings for 2 weeks whilst resting and sleeping. Strenuous activities and heavy lifting must be avoided for 4 weeks. Strain on incision lines can lead to wound breakdown. Most women can return to work after 2 weeks if their work is not too physically strenuous. You may return to gentle sporting activities after 6 weeks, and should wear a supportive sports bra. Any complications following surgery would alter this advice.
Driving- Do not drive for at least 2 weeks, or until your range of movement and reflexes have returned to normal to allow for any sudden movements. This can place strain on your incisions.
Wound and dressings- Leave dressings in place until your first visit back at Dr de Viana's office. This is usually 5-7 days after your surgery. A small amount of visible ooze is normal, however excessive oozing (soaking the dressing) and leaking should be reported to our office. Any redness around the wound or dressing, or any unmanageable pain , or any fevers ( temperature greater than 38 degrees ) should also be reported.
Breast lumps - These may be noticed a few weeks after surgery, these are most likely due to small collections of fluid or blood. Any lumps should also be reported to Dr de Viana.

Scar Management

Surgical tapes (eg Hypafix or Omnifix) can be applied to flatten scars and reduce stretching of suture lines. The tape can stay on for up to 7 days and it is recommended to continue with the taping for 6 weeks. Remove the tape if you feel that you are experiencing an allergic reaction or excessive irritation to the tape. Beyond 6 weeks continued application of silicone gel (eg Strataderm) for 2-3 months may further reduce bad scarring and keloid formation. Scars will take 6-12 months to fade and for this period of time they will remain red and raised.

After Hours Care

If you have medical concerns outside of our office hours, please attend Pindara Accident and Emergency Department, or your nearest emergency medical facility.

Final Result

Whilst Dr de Viana will make every effort to make your breasts look equal and to your desired appearance, and take every precaution to reduce your risk of complications, no guarantee can be given of the final cosmetic result. Differences in shape, size and symmetry may remain, and / or complications may occur. It is important that you take time to read all the information supplied, and ask all the questions you have, and understand a realistic expectation of what can be achieved with cosmetic surgery.

Once you have decided to have surgery, it will be necessary for you to sign a consent form. You should not sign this form if you have unanswered questions or feel unsure of your decision. If for any reason you feel unsure about the advice being given, ask further questions, or seek an alternative opinion.