Many women have large and pendulous breasts that may adversely affect their sense of beauty and femininity. Not only can overly large breasts cause psychological symptoms and make women self-conscious and uncomfortable with their body-image, but heavy breasts can cause physical symptoms as well. Back and neck pain, painful grooves on the shoulders from bra straps, and even tingling fingers can all occur from excess breast weight on the chest. Some women with large, pendulous breasts have rashes, yeast infections, and non-healing skin wounds where their breasts rub on their chest or abdomen. The constant moisture and rubbing of the bra against this area can be very troublesome, especially in the hotter summer months.
Breast reduction surgery is a highly successful procedure that removes fat, glandular tissue and skin from the breast to alleviate the physical symptoms of pain and skin irritation. However, the surgeons at Park Meadows Cosmetic Surgery also endeavor to restore a woman's sense of femininity and natural beauty by restoring the breasts to a more elevated, youthful, and aesthetically pleasing shape that is balanced with the patient's body.
Thus, a truly successful breast reduction not only reduces the size of the large breasts, but also lifts them to a higher position, reduces the size of large areola (the circular colored part of the nipple), and provides a more youthful feminine and balanced shape. View images of our Breast Reduction Surgery patients in our Before & After Gallery.
BREAST REDUCTION INCISION TYPES
Is Breast Reduction Right for Me?
If you are a woman with large, pendulous breasts, who suffers from the physical and emotional symptoms described above, then you are a candidate to be evaluated for a breast reduction. However, every woman is different, and your surgeon at Park Meadows Cosmetic Surgery will examine your breasts and review your general medical history to help determine if you are a good candidate for surgery.
Usually surgery is an option once the breasts have fully matured (after puberty); however, there are rare cases where extremely large breasts in young women can be reduced before full maturity. The best surgical candidates are those women who are also mature enough to understand the procedure and have realistic expectations about the results. Women who have a strong desire to breast feed after surgery are strongly cautioned that any breast surgery has a risk of altering her ability to breast feed successfully.
Preparing for Your Breast Reduction Surgery
The surgeons at Park Meadows Cosmetic Surgery will usually require you to have a current mammogram (breast X-ray) before your surgery, especially if you are older than 40. Any breast surgery can alter your mammogram, so it is helpful to have a preoperative X-ray on record to compare if questions arise. You will also get a set of pre-operative instructions describing how you should prepare for surgery.
Certain medications and nutritional supplements can thin the blood and need to be stopped two weeks prior to surgery. The need for a blood transfusion because of breast reduction surgery is extremely unusual, but is slightly more common in patients with very large breasts. Some patients may be advised to donate a unit of their own blood several weeks prior to surgery if the need is expected.
Breast Reduction Surgery
There are several techniques for breast reduction; however, all of them address the excess breast gland, the excess breast skin, and the abnormally low nipple position. Your surgeon will discuss which technique is best for you. The most common technique for very large breasts will leave a scar around your nipple, straight down the breast below the nipple, and under the breast hidden in the breast fold.
Some women are good candidates for “limited scar” or “short scar” techniques that can eliminate either the scar in the fold of the breast or the vertical scar from the areola down to the breast fold (inframammary fold).
Scars resulting from breast reduction can be treated and reduced with embrace® adhesive sheets. These silicone sheets relieve skin tension, which is the root cause of pronounced scarring. They also soothe and hydrate the scar with silicone gel.
Liposuction may be used to remove excess fat from the armpit area or in very select cases to perform the procedure.
Stitches are usually buried and dissolve. The patient will usually never see them or have the unpleasant experience of having multiple sutures removed in the office.
All Surgery Carries Some Uncertainty & Risk.
Reduction mammaplasty is not a simple operation because the surgeon has to remove excess fat, glandular tissue, and skin and recreate a lifted, aesthetically pleasing breast in a patient who may never have had smaller, more elevated breasts. However, the operation is normally safe when performed by a qualified surgeon.
Nevertheless, as with any surgery, there is always a risk of complications. These include excess bleeding, infection, poor skin healing, poor breast healing. Because it is necessary to make incisions around the areola and nipple to move them to a higher location, the nipple can be at risk. In very rare circumstances, the skin of the nipple can loose its blood supply. If this happens, the nipple can die and cause permanent scarring. This can be corrected to a large extent after healing by rebuilding the nipple (as is done for patients with breast cancer), but permanent scars of the nipple itself are still a rare risk of breast reduction, especially very large procedures.
Smokers are at higher risk for many of these complications. It is important to stop smoking at least a month before surgery.
Delayed Wound Healing and Dehiscence: In some instances, the incision site takes longer to heal than normal. Cigarette smoking, poor nutritional status and a compromised immune system can all cause delayed wound healing or wound separation.
Scars: A surgeon cannot lift and reshape the breast without making incisions except in very select patients who may have their breasts reduced by liposuction alone. Any incision will produce a permanent scar. Your surgeon will discuss with you one of several options depending on your breast shape and size. However, most scars heal well and almost all patients are happy to trade these incisions for a life free of back and neck pain and an improved sense of femininity and self-confidence. In the rare incidence, a scar will be thick and unattractive. If this is the case with your scars, your surgeon will provide several options to fix or improve them. Regardless, your scars should all be hidden behind a bathing suit top or a bra.
Asymmetry: There is a saying, “Breasts are sisters, not twins.” That is to say that every woman has some natural asymmetry in their breasts. Your surgeon will endeavor to correct any natural differences in your breasts and make your breasts match in size and shape. However, in any type of breast surgery, there can be slight differences in nipple position, breast shape, fullness, and healing that are impossible to predict. If large differences occur after surgery, your surgeon is committed to provide you with the most pleasing result he thinks he can provide.
Breast Sensation: Breast and nipple sensation can be changed by any breast surgery and especially breast reduction surgery. Many women experience better breast and nipple sensation because their heavy breasts are smaller and no longer pull on the nerves that supply the skin a nipple. Some women experience reduced breast and nipple sensation because the nerves to the skin can be cut during surgery. These changes are usually temporary, but can be permanent and may affect your sexual response or your ability to nurse a baby. Many women will have no change in their sensation.
Breast Feeding: A women’s ability to breast feed can be permanently affected with any breast surgery. It is important to remember about 10% of normal women can not breast feed even without surgery. Having a Breast Reduction will increase this risk. Often women will be able to breast feed but will have to supplement with a bottle because their milk supply will not be adequate In rare cases for extremely large reductions, the nipple will have to be removed and replaced as a “free nipple graft” which will totally disconnect the milk ducts from the nipple. These patients will not be able to breast feed at all.
Pain: If you experience severe pain not relieved by pain medicine notify your surgeon immediately. Some discomfort is expected after surgery and you will receive a prescription for pain medication. The intensity and duration of pain after breast reduction will vary among women. Prolonged or intense pain can be due to scarring around a nerve.
Infection: A small number of women develop an infection. This typically can occur several days to several weeks after the procedure. If an infection does not respond to oral antibiotics, a patient may need intravenous antibiotics in the hospital. Hospitalization is very rare.
Hematoma and Seroma: A hematoma is a collection of blood under the skin, and a seroma is a collection of the watery portion of the blood under the skin. Hematomas or seromas typically develop within the first few days after surgery; however, they may occur at any time after injury to the breast. The body can reabsorb small hematomas or seromas. Larger ones require the placement of surgical drains for proper healing. A small scar can develop at the surgical drain site.
Delayed wound healing and dehiscence: In some instances, the incision site takes longer to heal than normal. Cigarette smoking, poor nutritional status and a compromised immune system can all cause delayed wound healing or wound separation.
After Your Breast Reduction
You will be given a comprehensive set of post-operative instructions prior to your breast reduction surgery. You will have steri-strips covering your incisions. Some patients will have tape or bandages covering the breasts to help shape or support the breast after surgery. You will be given a post-surgical bra to wear for approximately 6 weeks. Many women find they can alternate this with a non-underwire supportive exercise bra after 2 weeks.
Some patients will need drains in the breast for a short time. If you have drains, you and your family will be instructed on how to care for them. Most women are able to return to work 10 to 14 days after surgery if they do not have a very active job that requires heavy physical lifting or activity. It can take up to 6 months for the breasts to “settle” and achieve their final shape.
Patients can experience random, shooting, discomforts or pain after surgery. This is normal and typically improves within several months. Some women will notice changes in their breast and nipple sensation after surgery. Some women are more sensitive, while others are less sensitive. These sensations tend to even out over time, but in a few cases can be permanent.
In the vast majority of cases, your breasts can be reshaped in 1 surgery. However, in some women, healing can be unpredictable resulting in significant differences in breast shape, symmetry, or nipple position. In some cases a second smaller “touch up” surgery is required to give you the best result possible.
Preparing for Surgery
At least 1 month before surgery
Stop smoking at least 1 month prior to your procedure. Smoking reduces circulation to the skin, impedes healing, and can lead to major postoperative complications.
2 weeks prior to surgery
Stop all medications that can thin the blood 1-2 weeks prior to surgery. These include drugs such as Aspirin, Coumadin, Lovenox, Ibuprofen, Vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery. Please see the last page of this pamphlet for a list of drugs that must be stopped.
Report any signs of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications.
1 week prior to surgery
Do not eat or drink anything after midnight before your surgery. This includes water, ice, or hard candy. The only exception is that you may take your blood pressure or heart medication with a sip of water the morning of surgery.
The day before surgery
Plan to wear loose fitting clothes to the procedure, preferable with a zipper in the front. Do not wear jewelry or bring valuables with you, except for your ID and insurance card. You may wash your surgical site with regular soap the day before and morning of surgery. You must arrange to have a responsible adult drive you home after your procedure.
What to Expect the Day of Surgery
When you arrive, you will be escorted to a preoperative evaluation area where you will be asked to change into a gown and will be given foot covers. Your surgeon and the anesthesiologist will meet with you before you enter the operating room suite. During this time, the surgical consent form will be reviewed with you in detail and special markings may be made on your skin at the surgical site. You will have the opportunity to ask any last minute questions.
Once in the operating room, you will be transferred to our padded operating room table. A nurse will start an intravenous drip in your arm and connect you to monitoring devices. The anesthesiologist will give you medication through your intravenous drip to make you feel drowsy.
When your surgery is completed and your dressings are in place, you will be moved to the recovery room. During this period a recovery room nurse will assure your comfort and continue to monitor you closely.
Your stay in the recovery room will last approximately 1 to 1 1/2 hours. Most patients are fully awake within 30 to 60 minutes after their surgery, but they may not remember much about their time in the recovery room due to some of the anesthesia medication. Once you are ready for discharge, a postoperative appointment will be scheduled and your discharge instructions will be reviewed.
You must have a responsible adult drive you home from the surgery center. This individual should have your prescription filled at the pharmacy prior to taking you home. A responsible adult must stay with you the first night after your surgery because you have been sedated.
Diet: Start with clear liquids and toast or crackers. If those are well tolerated, progress to a regular diet.
Driving: No driving for 48 hours after your procedure or while taking pain medicine.
Activity: You may walk and climb stairs immediately after surgery. After 4 weeks you may resume light activity such as brisk walking. During the first 6 weeks do not lift anything heavier than a gallon of milk. After 6 weeks you may resume more strenuous aerobic work and lifting activities as tolerated.
Work: Depending on your career and your rate of healing you should be able to return to work within 1-2 weeks of surgery. Your surgeon will be able to give you a better estimate depending on your physical and professional profile.
Wound Care: Keep your dressings clean, dry, and intact for the first 48 hours. Then remove the top dressing, and leave the paper tapes in place; these will fall off in approximately 2-3 weeks. If you go home with a drain, empty and record its daily output. Once the drain is removed, you need to keep a dressing over the drain site for 1 to 2 days or until the drain site heals.
Swelling: Moderate swelling and bruising should be expected during the first 2 to 3 weeks after surgery. During this period wear a bra without under-wires that provides support at all times (except when showering) to minimize swelling and discomfort. Mild swelling will continue for 2 to 3 months. Women may notice additional swelling and discomfort during menstruation.
Bathing: If you do not have a drain you may shower 48 hours after you remove your dressing. If you go home with a drain, you may shower once it is removed, but do not directly spray the drain and incision sites. Pat dry after you shower. Your surgeon will typically remove your drain 2 to 5 days after surgery. Do not submerge the incision in a bath or swimming pool for 4 to 6 weeks.
Medications: Ask your surgeon when you should resume your blood thinning medications. All other prescription medications may be resumed immediately. While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. Take the full course of antibiotics given by your surgeon to help prevent infection.
Smoking and Alcohol: Do not smoke for the first month after surgery as it impedes wound healing and can lead to serious wound complications. Alcohol consumption is dangerous while taking pain medicine because it has a tendency to worsen bleeding.
Post-Operative Appointment: Your surgeon will schedule follow-up visits at appropriate intervals. Please keep all these appointments so that your progress may be followed closely.
Special Considerations: Call your surgeon immediately if you experience any of the following: excessive pain, bleeding, redness at the incision site, or fever over 101° F.
Final Results: It may take up to a year before the breasts reach their final contour and shape. This may seem like a long time, but the ability to wear more stylish clothes and perform a wider range of activities is very rewarding and worth the wait.
To learn more about breast reduction, contact our board certified plastic surgeons at Park Meadows Cosmetic Surgery in Lone Tree serving Denver and all of Colorado. Schedule a free cosmetic consultation and take a tour of our state-of-the-art facility, or call (720) 457-4471 with any questions about our breast surgery services.