Breast Reduction

Benefits

The benefits from breast reduction surgery are the restoration of a  proportionate and youthful breast contour. Many women who have natural C-cup (or larger) sized breasts can suffer from long-term effects of gravity. Those who have undergone large augmentations can also experience the same problems. Heavier breast tissue or larger implants causes increasing stress on the skin envelope of the breasts, potentially leading to stretching of the skin and descent of the breasts. Over time, the gravity of this weight overcomes the ability of the skin to support the breasts’ shape.

Definition and Anatomy

The term “ptosis” applies to the situation when the breasts elongate and the nipples descend.  “Macromastia” refers to the situation when there is a disproportionate amount of breast tissue present. When breasts are excessively large, a similar pattern of breast elongation, skin stretching (stretch marks), and nipple descent occurs. Women can often suffer from symptoms such as pain (in the shoulders, neck, back, and the breasts themselves), permanent grooving from the bra straps, rashes and irritation in the breast folds, and inability to participate in physical activities and exercise. Women who are breast feeding or pregnant can notice some enlargement of their breasts; there can be quite dramatic changes, often leading to increases of 1 to 2 cup sizes or more. When pregnancy and/or breast feeding is completed, breast size will usually decrease; but, there can be some secondary deformity with permanent stretch marks and droopiness (ptosis) of the breast tissue and nipples.

Surgical Procedure

For symptomatic breast enlargement, reductions are appropriate to relieve the musculoskeletal pain. There isn’t a great difference in the surgical techniques between a breast lift and a breast reduction; the desired goal of surgery usually dictates what procedure is chosen. Breast lifts are designed to re-position the breast tissue and nipples superiorly and restore youthful shape and contour. Breast reductions are performed to eliminate the excessive tissue and to reshape the breast into more normal proportions – this does elevate the breasts and nipples as well. So basically the difference is in the amount of breast tissue that is to be removed. The removed breast tissue is submitted to a pathologist for evaluation to screen for any cancer.

Scars

The scars required for breast reduction are located around the areola (pigmented area around the nipple), the lower breast fold (infra-mammary fold), and a vertical incision in the lower pole of the breast. The pattern resembles an anchor. These are designed to be placed in the least conspicuous natural borders of the breast.

What to Expect

Most women who undergo reduction surgery experience tremendous relief in their musculoskeletal pain and are able to return to normal activity quickly. Post-operative discomfort can last one to two weeks. The scars respond very favorably to massage and other maneuvers; they will complete their maturation after about a year. Patients have a high satisfaction rate as they feel more confident in their breast shape, experience less pain, able to fit into clothes and bras better, and have improved activity/exercise.

Recovery

The surgery lasts approximately 3 hours and an overnight stay is typical. Drains are placed at the time of surgery and are removed the day after. Dressings are performed for the first week after surgery and a bra is encouraged to be worn for 4 weeks post-op. Swelling and bruising may occur and usually subside after a couple of weeks. Temporary alterations in nipple sensation are common – either numbness or hypersensitivity. This is usually temporary and resolves after several weeks to months.

Complications

Complications from breast reduction can be excessive or hypertrophic scarring, asymmetry, or permanent loss of nipple sensation. Fortunately, these are relatively rare events. Darker skinned patients have a higher incidence of hypertrophic scars and keloids. Some expected long-term effects are a natural settling of the breasts. In some instances, if a patient’s skin quality is poor, there can be excessive descent of the breast tissue, often termed, “bottoming out.” This may require a surgical procedure to further lift the breasts.