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Base-line information you need to know about
breasts in order to make the informed choices
if you are considering cosmetic surgery
to your breasts
It is important to
realise several facts:
- Most women have
one breast larger than the other.
- Most women have
one breast that sits lower on the chest
wall than the other.
- Breasts are composed
of a mixture of fat and glandular tissue.
The glandular tissue (the part which secretes
breast milk) weighs more than the fat,
so the larger the proportion of glandular
tissue your breasts have, the heavier
they are and the more they will droop
without support.
- Breast fat increases
and decreases in tandem with variations
in body fat generally.
- Breast glandular
tissue increases and decreases in tandem
with variations in female hormones (for
instance before and after menstruation
and pregnancy).
Armed with these pieces
of information, you will find it much easier
to decide whether this operation is for
you, and which variant of this operation
will suit you best.
Breast reduction
Breast reduction is
an operation in which breast tissue (mixture
of fat and glandular tissue) and excess
breast and areolar skin are removed from
the breast mounds to leave you with smaller,
firmer breasts.
Commonly asked questions
about breast reduction
Am I
a good candidate for breast reduction surgery?
This is best decided
during a consultation, but generally speaking
this operation is beneficial for women in
good physical and mental health, who have
reasonable expectations of surgery that
will decrease the size of their breasts
in order to try and improve various problems,
which may include:
- Aching in your upper
back and neck
- bra strap grooves
in the skin of your shoulders
- inability to exercise
due to the weight and size of your breasts
- embarrassment during
day-to-day social interactions (comments;
leering; men talking to your breasts rather
than you)
- an inability to
find clothing that fits you
- having one breast
which is markedly larger than the other
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Will
I be able to breast feed after having my
breasts reduced?
After breast reduction
surgery there is at least a theoretically-increased
risk that breast feeding may not be possible.
Whether or not there is an increased incidence
of women becoming unable to breast feed
after breast reduction surgery is contentious.
Several studies suggest the ability to breast
feed after reduction surgery is equivalent
to an age-matched population of women who
have not had surgery. The techniques I use
should maximise your ability to breast feed,
if your breasts were going to be able to
feed anyway. I always advise that you should
expect not to be able to, but that you may
well be pleasantly surprised. If the ability
to breast feed is vital to you, you should
complete your family before having surgery.
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Can surgery
affect my nipples?
Nipple sensation may
decrease (in up to 10% and most likely with
large reductions) or transiently increase
and become extra sensitive (again, paradoxically
more likely in larger reductions for different
reasons).
Altered nipple sensation results from nerve
damage. Decreased sensation occurs when
nerves that travel through the breast are
damaged. Techniques used for reduction endeavour
to avoid this, but in a proportion of cases
this is an unpredictable outcome. Nipple
sensation may increase in patients who had
very little sensation before their surgery
and this may be because the nerves transmitting
sensory information to the brain had been
overly stretched by the weight of heavy
breasts and recover after reduction and
then “over signal” to the brain
for a while until they adjust.
The blood supply to the nipple and areolar
skin may be compromised and part or all
of one or both nipple-areolar complexes
may die as a rare complication of breast
reduction surgery. Complete or partial loss
of one or both nipple-areolar complexes
is a rare complication. It is more likely,
in larger reductions and so in those at
risk, the decision is usually taken to surgically
remove the area and re-place it as a graft,
which paradoxically this gives the nipple-areolar
complex a better chance of complete survival
in patients undergoing large reductions.
Nipple-areolar complex loss is also more
likely in people who smoke or have disease
affecting the small blood vessels to the
skin
Finally, the colour of nipple-areolar complexes
may lighten or darken after surgery: this
is more likely in dark skinned races or
after infection.
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Will
breast reduction affect my risk of getting
breast cancer?
No. It has been suggested
that smaller breasts have less glandular
tissue and therefore, fewer cells which
might mutate to form a cancer. There is
no good science to back the suggestion.
For women with a genetic tendency towards
breast cancer (carriers of the BRCA1 &
2 genes), then skin-sparing mastectomy may
be indicated rather than breast reduction.
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Will
breast reduction affect me when I need to
participate in breast screening?
Cancer screening may
be more complicated after reduction surgery
in so far as damage to fat and alteration
of the breasts’ architecture may make
interpreting mammograms harder. Generally,
if women over 35-years-old have base-line
mammography before surgery and then again
after their breast reduction has settled
at say, 6 months after the operation, to
give a Radiologists the potential for comparison
later, there is unlikely to be a problem.
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What
should I expect from my consultation?
During your consultation,
I will take a full medical history. I will
ask you specifically about any breast disease
you have suffered, as well as any previous
surgery you may have undergone and about
your family’s history of breast diseases
such as cancer. If you have had mammograms,
I will need to know the results. I will
also ask about your desired breast size
and shape and anything else related to the
appearance of your breasts that you feel
is important.
I will examine you completely, then focus
on your breasts to assess their size, symmetry
and shape and the quality of their skin
envelope. I will then take standardised
photographs in order to help plan and discuss
your operation. Finally I will measure you
for a sports-type bra which you will choose
and bring with you to be used as a comfortable
dressing over your surgical dressings in
the days immediately after your surgery.
By all means bring pictures from magazines
to show me examples of women who seem to
have breasts of a size that equate with
your desired breast size - these will be
useful in discussion.
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How is
the surgery performed?
All the techniques
I use for breast reduction have aspects
in common and these are:
- Removal of both
excess breast tissue and excess breast
and areolar skin
- Moving the nipple
and remaining areolar skin to a new position
on the breast.
The common aim of
all techniques is to produce as predictable,
stable and aesthetic a breast shape for
you as possible.
The aspects of these techniques that I vary
depending on your breasts’ size, shape,
symmetry, skin tone and degree of ptosis
(droop) are:
- Incisions - which
I will make as minimal as is compatible
with providing you with a predictable,
stable and aesthetic a breast shape.
- Nipple -areolar
attachment - I will always endeavour to
maintain the nipple and areolar skin attached
to breast tissue beneath it, but on occasions
(for instance, when very large volume
reduction is necessary or very droopy
breasts are being reduced) it may be necessary
to surgically remove the nipple and areolar
skin and re-attach it as a skin graft
(which generally results in lost nipple
sensation).
- On occasion I may
use liposuction to remove fat from the
armpit area.
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What
does my operation involve?
Before surgery, you
will meet and be assessed by your anaesthetist
who will prescribe medications for your
comfort and to lessen anxiety if need be.
On the evening before, or the morning of
your operation I will review what we have
discussed and planned previously and we
will both sign your operative consent forms.
Then I will measure and draw guidance marks
for surgery on your chest and breasts with
you sitting upright.
The operation is performed under General
Anaesthesia - you will be asleep. The operation
usually takes 3 hours or so, depending on
the technique used. After surgery, you will
awake in a recovery area and soon afterwards
you will be returned to your room. A drain
is placed under the incision in each breast
to remove the normal healing fluid that
the body produces and stop it accumulating
within your reduced breasts. These drains
will be removed when the drainage is minimal
- usually after a day or two and once they
have been removed you can shower normally.
Most patients go home a day or two after
surgery on simple pain relieving medications
and a short course of antibiotics.
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What
about my recovery and return to normal activities?
You will feel tired
and somewhat sore for a week or two following
your surgery, but you will be able to move
around and function relatively normally.
You will have buried, soluble stitching
which will dissolve and doesn’t need
to be taken out.
Generally, you can return to work if your
occupation is sedentary, after 3 - 4 weeks,
but if your work involves heavy lifting
or is strenuous in other ways, for instance
women police officers, 6 - 8 weeks might
be a more realistic period off work. So
long as you can do so with due care and
attention, you can begin driving 3 - 4 weeks
after surgery.
You should restrict yourself to light exercise
for 2 - 3 weeks - avoiding lifting anything
over 5Kg and aerobic exercise for at least
3 weeks.
Your breasts will be swollen for at least
6 - 8 weeks, but at that stage your new
breasts will have attained almost their
final appearance. Your final operative result
will continue to mature for 3-6 months and
your scars will continue to mature for up
to a year.
New scars benefit from friction-free massage
(using vaseline, for instance, to lubricate
the massaging process). Beginning to massage
scars two to three weeks after surgery,
will help them mature, soften and flatten
faster than if left to their own devices.
New scars should be protected from sunlight
for 2 years to avoid them pigmenting differently
from the surrounding skin and becoming a
different colour permanently. Factor 15
sun block should be applied whenever they
are exposed - even to a British winter sun.
In the longer term, final size, shape, symmetry
and aesthetic result of breasts after reduction
surgery will vary according to individual
factors which are due to genes, life style,
life events and gravity. After surgery,
lack of support, alterations in weight or
hormonal variation may alter your breasts’
appearance and symmetry markedly.
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