Breast Reduction: Making Breasts Smaller And Lighter
What is a breast reduction?
A breast reduction is a procedure the decreases the size/volume of the breast by removing breast tissue.
- Macromastia – Large breasts usually leading to signs and symptoms
- Pedicle – The area of the breast kept intact during surgery to maintain blood flow to the breast and nipple areolar complex.
- Areola – Colored, circular portion located on the breast.
- Nipple – Raised tissue at the center of the areola.
- Nipple Areola Complex – Also known as “N.A.C.” This is the areola plus the nipple as 1 unit.
- Free Nipple Graft – Removing the nipple as a skin graft and then skin grafting it back onto the breast immediately after the reduction is completed.
- Infra-mammary Fold – The crease located under the breast.
- Ptosis – Plastic surgery term for when nipple is below the infra-mammary crease.
- Pseudoptosis – Plastic surgery term for when the nipple is at the infra-mammary crease but the breast tissue is hanging below the infra-mammary crease.
- Intertrigo – Rash that can present in folds of skin but in the case of the breast it will show up in the areas where the abdomen and breast come in contact with each other.
How do I know if I need a breast reduction?
The most straightforward answer to this question is…If you just feel like your breasts are simply too larger and you wish they could be smaller then the operation you need is most likely a breast reduction. Many patients with large breasts tend to have symptoms that can be very bothersome and these patients especially benefit from breast reductions.
What are some symptoms patients with large breasts can experience?
- Neck pain
- Back pain
- Shoulder notching
- Rashes under the breasts (intertrigo)
- Numbness or tingling of the hands
- Difficulty fitting in clothing
Will all symptoms resolve after a breast reduction?
Most symptoms will either significantly improve or completely resolve after a breast reduction, however, there is no guarantee. Shoulder notching/grooving typically does not improve at all after breast reduction but neck pain, back pain and intertrigo are the most common symptoms that improve.
What are the most common types of breast reductions?
1. Wise Pattern/anchor pattern breast reduction
- Circular incision around the areola, vertical incision down the breast towards the infra-mammary fold and horizontal incision hidden in the crease under the breast (infra-mammary fold)
- The size of the areola is reduced
- Medium to large breast reductions can be performed with this operation
2. Vertical lift
- Circular incision around the areola and vertical incision down the breast towards the infra-mammary fold (looks like lollipop)
- The size of the areola is reduced
- Small to medium breast reductions can be performed with this operation
3. Breast reduction with free nipple graft
- Incisions are similar to wise pattern as mentioned above
- Size of areola usually reduced
- Very large breast reductions can be performed with this operation
- Nipple areola complex is removed as a skin graft and then immediately skin grafted onto the breasts once the reduction is complete.
What are the different pedicles?
1. Inferior pedicle
Blood supply comes from the bottom, middle portion of the breast
2. Superomedial pedicle
Blood supple come from the upper, inside quadrant of the breast
3. Central pedicle
Blood supple comes from the central aspect of the breast
What is the most common type of breast reduction you perform?
Most commonly I perform a wise pattern breast reduction with a central pedicle. When performing this operation I internally shape the breast for a more cosmetic appearing breast post operatively. However, the type of operation I do is always tailored to the patient and based on their anatomy and their examination.
What happens to the nipple and areola after a breast reduction?
The areola will be decreased in size and no changes are made to the actual nipple itself. The nipple areolar complex is left connected to the underlying breast tissue but just moved upwards (unless the breast reduction is including a free nipple graft.)
How do I know if I need a free nipple graft?
A free nipple graft is performed in patients with very large breasts who want a significant reduction in breast volume. Also, patients with very long breasts usually have to undergo this type of breast reduction.
Will I have sensation to my nipple?
The larger the breast reduction, the higher the risk of loosing some, or all sensation to the nipple. Loosing all sensation to the nipple however, is a very rare occurrence. Now, patients that undergo free nipple grafts are a different story. They will NOT have sensation to the nipple anymore because it is like a skin graft and no longer has any nerve connections.
Will I be able to breast feed after having a breast reduction?
This depends on the amount of breast tissue that has to be removed. The more breast tissue removed, the less likely one will be able to breast feed. The ducts are still connected to the nipple so this usually has to do with the decreased/insufficient production of breast milk. Now, with a free nipple graft, breast-feeding is NOT possible due to the milk ducts being completely disconnected from the nipple.
What about scarring?The incisions of a wise pattern reduction are similar to an anchor…they go around the nipple, down the breast and under the breast. The scars tend to fade with time and are not as obvious as people tend to think they will be. Some patients however, may be prone to hypertrophic scarring or to forming keloids. Therefore, if there is a history of either occurring then once must proceed with caution and understand the risk of these occurring again are high, even with the utmost of care.
What are other important factors to consider when considering a breast reduction?
At Timeless Cosmetic Surgery, patient safety is of the utmost importance; therefore, an essential factor determining who can undergo a breast reduction is your overall health. After performing a thorough gathering of your health history, if there is any question about overall health, a medical clearance will be requested during which your primary care physician will do an overall assessment to determine whether it is safe to undergo this procedure.
Why is having a breast lift safer with Dr. Mehta?
I perform all my surgical procedures under IV sedation (twilight) and do not use general anesthesia. No breathing tube (endotracheal tube) is needed because you are able to maintain all your protective reflexes, breath completely on your own and your blood flows better. The post-operative risks of using IV sedation (the way I do my surgeries) compared to general anesthesia are MUCH less including but not limited to decreased risk of nausea, vomiting and MOST importantly a significantly DECREASED risk of forming blood clots. Your heart, lungs and blood pressure will be monitored during the entire operative procedure and no pain will be felt during the procedure. Studies have shown IV sedation to be much safer than general anesthesia.
Will I need to stay in the hospital?
All my patients are able to safely go home the day of surgery as long as they have a responsible caregiver at home. Outpatient surgery has been shown to have many advantages over hospitalization and tends to lead to better post-operative recovery, early ambulation and less risk of infection. I believe being taken care of by a loved one allows for more personalized care. This is also financially beneficial for patients because hospital stays are very costly.
Is it safe to go home after breast reduction?
It can be VERY safe to recover at home after breast reduction as long as you have a responsible caretaker to be with you for at least the first 72 hours. I believe a loved one will take much better care of you in your own home, than someone who doesn’t know you taking care of you in a hospital. Also, it is VERY likely that there are fewer germs in your home then in a hospital setting.
What if I need to speak to someone after hours?
Immediately after surgery you and your caregiver will be given my personal cell phone number to call on weeknights and weekends with any questions or concerns.
Will I have drains?
NO! The techniques I use for breast reduction does not require the use of drains.
How do I prepare for a breast lift?
Detailed post-operative instructions will be given during your pre-operative evaluation, which usually takes place about 2 weeks before your planned procedure. Here are some general helpful guidelines:
- VERY IMPORTANT!!!! Stop all herbal medication, Aspirin products (Alleve, Ibuprofen, Advil etc…), vitamin E and fish oil/Krill oil at least 1 month before surgery as long as it is approved by your physician.
- VERY IMPORTANT!!!! Stop ALL tobacco products AT LEAST 6 weeks before your surgery to decrease the risk of healing complications associated with smoking. (This includes patches and gum)
- VERY IMPORTANT!!!! Stop all hormone based medications if approved by your physician at least 1 month before surgery. If stopping birth control please use non-hormonal methods for continued birth control.
- If you are above the age of 40, you may need a mammogram before your surgery dependent upon when your last mammogram was performed.
- Arrange for someone to look after you for at least the first 48-72 hours after surgery. (This can be a dependable and capable family member, friend or a hired caretaker)
- Arrange transportation for your clinic appointments and for your family members because you will not be able to drive for at least 1 week.
- Help will be needed for housework and for small children because heavy lifting or strenuous activity will not be allowed for 6 weeks.
- 4×4 gauze
- Milk of magnesia
- Light foods and plenty of fluids are recommended after surgery with the following as examples: Electrolyte replacement drinks, soups, yogurt with acidophilus/lactobacillus, jello, pudding, crackers etc…
What will be provided for me?
- During your pre-operative evaluation (approx 2 weeks before surgery) you will be given prescriptions for a muscle relaxer, pain medication, antibiotic, stool softener and anti-nausea medications.
- Along with other medications during surgery you will get the appropriate dose of IV antibiotics.
- Immediately after surgery you will be provided with and dressed in the appropriate garments needed during your recovery period.
- Immediately after surgery you and your caregiver will be given my personal cell phone number to call on weeknights and weekends with any questions or concerns.
How long is the recovery?
- No driving for at least 1 week or while on pain medication/muscle relaxants.
- At least 1 week off work.
- No heavy lifting or strenuous activity for 4-6 weeks.
- No sexual activity for 4-6 weeks.
- No working out for 6 weeks.
How often will I need to be seen for follow up?
Patient care is of the utmost importance to my staff and I. Therefore, I tend to keep a very close eye on my patients to make sure the recovery goes as smoothly as possible so that any issues can be prevented or taken care of as soon as possible. I will call you the same night of your surgery, once you are at home, to make sure everything is going well and that you and your caretaker have no questions or concerns. The following is a general schedule of appointments but can be changed at any time:
- Once a week for the 1st 2-3 weeks
- Once a month for the next 2 months
- At your 6 month mark from surgery
- At your 1 year mark from surgery
- Once a year after your 1 year mark
There is no charge for follow up appointments. If for any reason you feel like you need to be seen in between appointments or sooner than your scheduled appointment you can always call the office and the girls will fit you in.
Are there risks for this surgery?
With any surgical procedure there are risks, however, these risks are very rare and one usually is at higher risk of getting into a car accident than these risks. Some of the most common, but still infrequently occurring risks include, but are not limited to:
- Fluid collections (seroma)
- Blood collection (hematoma)
- Poor wound healing
- Changes in nipple sensation
As stated before, many precautions are taken by my staff and I to prevent these things from occurring in the first place.