Breast Reduction with AA Plastic Surgery
Many women are embarrassed by the weight or volume of excessively large and pendulous breasts. This may run in the family, follow the adolescent growth spurt, or accumulate slowly over the years, with or without having children or breast-feeding. The breasts may simply get in the way, invite undue attention, or lead to a constellation of gravitational issues such as upper back, neck or shoulder ache, bra straps digging in, and odour, rashes or infections where skin rubs against skin (Intertrigo) at the bottom of the breasts.
Although professional bra fitting is always advisable, discomfort may persist and lead to self-consciousness at public gyms and swimming pools, and inability to engage fully in exercise or in certain professions. Losing weight can help (ideally BMI should be less than 30), but the breasts themselves may remain heavy and disfiguring. If this is the case, breast reduction is an excellent option, and will also appropriately reduce the diameter of the coloured disc around the nipple (called areola). Women who have thought about it for years and then undergo surgery invariably comment that they should have had the operation long ago. The techniques have been refined to consistently produce safe, symmetrical and predictable outcomes in the vast majority of women, whilst simultaneously uplifting and enhancing the youthfulness of the breasts.
Breast Reduction Information
Nevertheless, breast reduction is major surgery under General (full) Anaesthesia requiring at least 2 weeks off work and driving, sometimes more. During surgery the circulation to the nipple-areola is maintained by keeping it attached to the body on a stalk, the excess fat is removed (and biopsied to check for cancer), the remaining gland is stitched together into a pleasing shape, and then the skin is re-draped over the gland after appropriate trimming. Depending on the starting size and amount to be removed, the scars can take 1 of 3 forms:
(a) Around the nipple only (Circum-areolar, peri-areolar or Benelli scar): appropriate for small reductions and uplifts. All breast reductions will have this circular scar camouflaged discreetly at the junction of the coloured areola with normal skin.
(b) A further vertical scar from the nipple to bottom of breast (Lollipop scar): useful for moderate reductions and uplifts, usually in younger patients with elastic skin.
(c) A still further horizontal scar in the fold at the bottom of the breast (anchor or inverted-T scar): needed for all larger reductions and uplifts where a lot of extra skin has to be removed. Rarely in the very largest of reductions, the nipple cannot be reliably kept alive on a stalk and will need to be detached and put back as a skin graft.
Since all scars are permanent, I obviously limit them to the bare minimum necessary. Scars generally fade nicely with time and massage, but can rarely become thick, lumpy, itchy or stretched out, and then require further attention. Occasionally pointy end-scars (dog-ears) in the anchor operation may require a minor tidy up under Local Anaesthetic months after surgery; this is not charged for at all if surgery was undertaken as a hospital package.
As expected, nipple-sensation can be altered in the initial months after surgery, but generally returns to normal or near normal within 6 months. Permanent numbness is rare except after the nipple graft operation. The ability to breast-feed after reduction surgery is unpredictable, and despite a number of successful breast-feeding reports, it is best to assume that this may not be possible.
Complications have been significantly reduced by pre-operative control of smoking, obesity and contraceptive pills predisposing to blood clots in the legs (DVT or VTE). Infection and bleeding are uncommon, and it is quite rare to have to return to theatre or transfuse blood after this type of surgery. Occasionally stitch breakdown (especially at the T of the anchor scar) will need dressings to heal, but loss of areas of skin or nipple is rare. Likewise, lumpiness (firm, hard or painful lumps- fat necrosis) is rare. If it does occur, it can require further surgery and interfere with future mammograms. Otherwise breast reduction does not interfere with the detection of breast cancer; self-examination and mammograms can be normally carried out.
Breast Reduction with AA Plastic Surgery – Before and After Results
The operation relies heavily on careful tailor-markings prior to surgery, and the desired and mutually agreed final cup size is always aimed for but cannot be completely guaranteed. In fact, minor differences between the 2 breasts of an individual are common both before and after surgery. Special situations arise in adolescent patients, in significant breast asymmetry, and in pendulous (droopy) breasts with sufficient volume needing only uplifting (Mastopexy). These circumstances can be quite complex and involve a combination of enlargement (implant) and reduction techniques tailored to the individual.
Breast reduction is associated with the usual postoperative discomfort, and no significant pain is expected. Surgery involves a 1 to 3-night stay depending on the magnitude of surgery and individual recuperation. A well-fitting sports bra will be provided as it greatly aids recovery, and many women can drive, board an aeroplane or resume light office work after 2 weeks. However, please be aware that it is normal to feel tired and to need help at home for up to 6 weeks. After this period, all normal activities including swimming, contact sport and normal underclothing (including underwired brassieres) can be resumed.
For further information on Breast Reduction please consult the following excellent short descriptive links:
BAPRAS (British Association of Plastic Reconstructive & Aesthetic Surgeons) patient information page at BAPRAS
BAAPS (British Association of Aesthetic Plastic Surgeons) information page at BAAPS