Women’s Breast Reduction

What Happens during Surgery?

Breast reduction surgery is a two- or three-hour operation usually carried out under general anesthesia.  In men, it can take just an hour to perform.  It requires mostly just a one-night stay in hospital though it is possible to be discharged later on the same day.

The surgeon marks your breast for the incisions which generally form a keyhole shape around the areola, and then run in two lines down to the crease below your breast.  The excess skin, fat or glandular tissue is then removed rather as it is in liposuction; in some instances, the surgeon may remove tissue and skin from the area towards and under the armpit. 

The nipple is then repositioned.  It is usually still attached to its blood supply though is some surgery it will have been removed and skin grafted back in place. The surgeon will endeavour not to take this route as it means you will lose nipple sensitivity.  This is something you need to discuss at consultation stage in detail. 

Drains may be placed in your breast to tap off any excess fluids.  Then the skin from the top part of the breast is drawn downwards and sutured to reshape the breast.  The two vertical incisions running from nipple to crease are sealed as a single wound.  Scars will be visible around the areola and in the crease below the breast.

Recovery / Convalescence

What to expect immediately

After the surgery, you will have bandages and possibly drains in your breasts.  These are usually removed after 48 hours. 

You will experience swelling and discomfort, and some pain when the anesthetic wears off.  You will be prescribed pain killers and can take at home later on the usual over-the-counter medication such as Ibuprufen or Paracetamol.  Any pain, swelling or bruising is usually temporary though it may last up to two to three weeks.  You may be prescribed antibiotics in the first weeks to prevent risk of infection (sometimes, the milk ducts can become infected).

If you leave hospital with a special support dressing this will be removed at around one week following your operation; otherwise, you may be able to leave hospital wearing your own support bra and will need to wear it for six weeks (it helps prevent straining the wounds).  Do not wear an under-wired bra for several months.  Stitches may be dissolvable or permanent; if the latter, you will have them removed around a week after surgery. 

You should refrain from any strenuous activities especially lifting or sports for six weeks.  You will be advised of when you can take up exercise again, but do allow plenty of time for rest and recuperation.  You will receive advice too on how to get in and out of bed comfortably in the immediate aftermath of your operation.  It is advisable also to take sufficient time off work to convalesce; possibly two weeks. 

You can aid your recovery by: 

• Applying ice packs (or packets of frozen vegetables wrapped in towels) to your chest immediately after surgery.
• Rest and sleep with your upper torso elevated.
• Keep breast skin supple by applying moisturizer, though carefully avoid the wounds
• Do not do any exercise or take up activities that can strain you – avoid bending and lifting for instance
• Do not get your chest wet in the shower or bath until the drains are removed
• Wear loose, light clothing preferably in natural fibres

Longer term care

You need to be patient to see the full results of your breast reduction as it will take time for them to adjust to their new shape.  Scarring may take between six months and a year to fade, but you should be able to wear swimwear and more revealing clothing without the signs of your surgery showing well before that date.  Occasionally, you may find that the ends of the scars heal as raised red bumps (keloids), which may need minor corrective surgery.

Ensure you keep in touch with your surgeon so you are informed about when you can take up exercise, swim and perform other activities. 

Safety

Breast reduction is a very common and highly successful procedure, but as with all cosmetic surgery, there are risks from the surgery itself and from any complication which might arise.  You may also feel that the outcome is not what you intended.  There are no guarantees in cosmetic surgery, but rest assured that the majority of people find the benefits of breast reduction are long term and they feel physically and psychologically better having opted for it.   Most complications are temporary and relate to infection (in breast ducts or scar tissue) or are due to pain and swelling. 

There are some long-term and permanent complications you need to be aware of and discuss at consultation stage. 

All cosmetic surgery carries the risk of:

• Infection
• Allergic reaction to anesthetics or analgesics
• Lack of wound healing (excessive bleeding – hematoma)
• Blood clot (possibly deep vein thrombosis, or cardiac or pulmonary risk)
• Fluid accumulation
• Ongoing, excessive pain
• The need for further, possibly corrective, surgery
• Absorbable sutures causing skin ruptures and uneven healing of the scar tissue

What are the risks in Breast Reduction surgery?

Scarring

Scars occur around the nipple, from the nipple to under the breast, and, possibly also from the breast to armpit.  They should fade to be barely noticeable within around six months to a year.  At first, scars will be pink and slightly raised.  If you notice they heal over the longer term in ridges (keloids), consult your surgeon as you may need minor corrective surgery.  You may also find that your breasts are red and hot and some leakage occurs from the scars.  Consult your surgeon should you see this sign as you may need antibiotics.

Uneven or lop-sided breast

You may find that you have asymmetric breasts after the operation.  Breasts may be differing shapes and sizes.  Nipples may not be aligned.  This may require further surgery to correct.  However, it does take time to see the results of your surgery and you will need to ensure swelling, pain and bruising has subsided before you form an opinion on the look of your breasts.  If in any doubt, ask your surgeon.

Sensitivity of Breasts

It is common to have a different sense of feeling in your nipples after the operation.  Various parts of your breast will feel either more or less sensitive than before.  If you experience numbness, this can be permanent due to the severing of nerve endings that may have occurred during surgery.  In rare cases, part of the nipple’s underlying fat tissue may die, and you will lose sensation.  This is more likely to happen if you are a heavy smoker or have poor circulation, as the blood supply will not be sufficient to ‘feed’ the nipple area.

Breast Feeding

It may not be possible to breast feed after your operation.  You will need to discuss clearly with your surgeon at your consultation the likelihood of breast feeding post your operation.