Breast reduction (mammoplasty)

Breasts that are too large and out of proportion to body weight and build can be a source of great embarrassment, considerable discomfort and marked physical disability. A breast reduction operation, when performed by an experienced plastic surgeon, can be a liberating and life transforming turning point no matter what age. Posture improves, discomfort can vanish and confidence can blossom. Choosing clothes which was once a frustrating chore becomes a source of pleasure and inspiration.

The operation is no minor undertaking but the positive life enhancement is a dramatic reward. It is occasionally performed on one side only to balance a smaller breast but it is otherwise two operations performed simultaneously on two breasts. The geometry and the aesthetics of the breast are complex and the surgeon must work with the stretchy excess skin and the underlying mobile breast tissue to shape a new breast with as little scarring as possible. At the same time, as much consideration as possible is given to shape, sensation and breast function.

Prices start from £6,848

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Assessment

At your assessment with a surgeon, you will be guided through the important aspects of this surgery. These notes are intended to be used in conjunction with that consultation and to further your full understanding of the procedure.

Preparation for surgery

Please read and observe all the recommendations in the section on General Advice. These precautions greatly reduce the risks of complications. In particular, you must not smoke in the preceding six weeks or in the six weeks after the operation. The risk of complications is markedly increased by smoking.

If possible, ensure that your weight is as close to your desired weight as possible. If you lose weight after the operation this may cause loss of firmness in the breast.

Remember not to use bath oil or moisturizer after bathing before your surgery as this can interfere with the durability of the reference points which will be marked on your skin just before you go for surgery.

Procedure

Immediately prior to surgery, those important key landmarks must be established and marked on the skin to guide the surgeon during surgery. Incisions are made around the skin to be removed and around the nipple/areola which will remain attached to the breast and is to be repositioned. The skin is then elevated to allow the underlying bulky breast tissue to be resected. This is carefully weighed to ensure as close a match as possible and then sent for examination by a pathologist. It is very rare for anything unexpected to be found.

Great care is taken to respect the blood supply of both the skin, the nipple/areola and the underlying breast tissue. When a good volume reduction has been achieved, the many bleeding points are meticulously sealed, drains inserted as further assurance and the skin closed in a neat pattern using a mixture of dissolving sutures and perhaps removable sutures. The operation will last at least 3 hours.

There are several different possible approaches to the reduction technique and the best suited for your particular needs will be chosen. We aim in breast reductions to preserve the nipple’s connection to the body, its blood supply and nerve supply. This will permit normal breast function as in breastfeeding and normal sensation. This may not always be possible especially in the very large breasts, where the nipple can only be safely repositioned on the new breast by grafting.

Aftercare

Pain and discomfort are usually easily controlled with paracetamol from an early stage.

A supportive dressing, which should be kept dry and clean, will be in place for one week. This will be reduced and refreshed at your first outpatient follow-up appointment in one week. Shallow bathing rather than showering is advised. As soon as the dressings permit, you will be required to wear a supportive sports bra day and night for six weeks following surgery.

After suture removal (if required), the scar lines will be supported by surgical paper tape for 6 weeks following surgery and thereafter the scars can be gently massaged using oil or cream, for five minutes twice a day until the scars fade. The scars should be protected from sun exposure for the first year and thereafter, sunblock should be used.

You are encouraged to remain mobile in the weeks following surgery but physical exercise, including heavy housework (particularly vacuuming and ironing), dog walking and the repeated lifting of heavy objects should be avoided for the first three weeks. Strenuous exercise such as jogging, exercise classes, gym workouts and heavy housework should be avoided for 6 weeks. Healing tissues benefit from rest and need to heal strongly before they are stressed.

Implications

Depending on your occupation, you may return to work after two weeks but the limitations on physical activity apply. Driving is not advised for 2 weeks and your motor insurance may be invalid if you drive in that period.

There will be the inevitable bruising and swelling which will take around 3 weeks to settle but there may be some lumpiness and tenderness in the breasts for several weeks following surgery. The final bra size may take several months to establish.

While the placement of the scars is as neat and discreet as possible, they are an inevitable but worthwhile consequence of this transforming surgery. The scarring is tucked under the breast and in a vertical line descending from the nipple/areola which is itself circumscribed with a line of scar. The final appearance has much to do with an individual’s tendency to scar formation. It is normal that it takes many months for the scars to settle.

While every effort is made to preserve nipple sensation, the variations in anatomy mean that it cannot be guaranteed. Feeling, absent immediately after the operation, may return over the next few months but may take as long as 1- 2 years. Sensory loss may be permanent. Where free nipple grafting is required for accurate nipple placement, the sensation will not be preserved. In many heavy breasts, the sensation can be enhanced after breast reduction.

Expectations

The breast shape can be held in aesthetic high regard by both sexes. Your BPS surgeon also understands this and strives to give you the very best shape within the constraints of original size and nature of the breast. Some breasts are soft and very flexible and seem to be composed mainly of structured fat tissue mixed with a little breast tissue. Other breasts are very heavy and dense and composed entirely of more rigid firm breast tissue.

The outcome for most breast reductions are pleasing to both surgeon and patient but rather like a bespoke suit, the skin can on occasions need minor adjustment to tailor it perfectly. This requires secondary surgery which is often under local anaesthetic as an outpatient. Costs are incurred by this surgery but will be kept to a minimum.

The final size of your new breasts is a judgement made by your surgeon after discussion with you at your consultation. The final size may take several months to settle and there is also a degree of volume loss in the postoperative period that differs between patients. In a few young patients who have experienced steady and disproportionate breast enlargement, there can be further enlargement after surgery which may require revision at a later date.

Despite the magnitude of breast reduction surgery, it is an operation with one of the highest patient satisfaction outcomes.

Complications

The most important factor in the design and performance of a breast reduction is the blood supply and as we repeat so often, the patient can make their significant contribution by not smoking prior to and after the operation. This one factor contributes to many complications. Avoidance of drugs, medicines and tablets containing aspirin and indomethacin and gingko biloba is also very important.

Each individual’s blood supply is different both in architecture and magnitude of the vessels. Youth, genetics, pregnancy and breastfeeding can all produce differences in the blood supply. It is an inevitable requirement that some of this blood supply is cut during surgery and it is important that an adequate supply remains. Unfortunately, perhaps due to spasm of the remaining vessels this supply may be inadequate to nourish the remaining tissues and if this occurs, there may be areas of skin at the end of the supply line that do not survive. The two areas most at risk are the corners of the skin scar T junction at the bottom of the breast and the nipple itself. This may just delay healing or require some secondary adjustment.

Occasional persistent lumpiness in the reduced breast can be due to a condition described as fat necrosis. This is also attributed to blood supply issues but the connection is less clear. Different individuals are more or less prone to this and usually, with patience, it will resolve but it may take many months. The nodules of fat necrosis can develop flecks of calcification leading to confusion at mammography examinations.rm a firm lump which may take many months to resolve. The lump appears to have diminished blood supply and it can develop flecks of calcification leading to confusion at mammography examinations.