Breast reduction

Reduction mammaplasty is an operation intended for women who want to decrease the size of their breasts. Apart from decreasing the volume of the breasts, the procedure also includes modification of their shape and also correction of inappropriately large areolae.

Who is a suitable candidate for breast reduction?

Any woman with excessively large breasts and whose breast tissue has a clean bill of health is a suitable candidate for breast reduction. This procedure is not suitable for women who are breastfeeding, or those who have recently finished breastfeeding. Profound obesity is also a contraindication for the procedure. If the patient is planning to get pregnant within the next two years, it would also be sensible to defer the operation.

How does consultation take place?

The overall state of health and any possible contraindications to the procedure are ascertained in terms of consultation. The patient’s ideas about the size of the breasts after the operation are discussed in detail. Decision is made as to the technique which will be used during the operation and what the resulting scope of the scarring will be. The most frequently used techniques are: vertical reduction mammoplasty with resulting scars around the areolae and down to the groove under the breast (lollipop shape), conventional reduction mammoplasty with scars around the areolae, down to the groove under the breast and in the groove under the breast (anchor shape), periareolar reduction mammoplasty with scars only around the areolae, as well as a technique with an isolated scar around the areolae and in the groove under the breast or a technique transferring the areolae like a transplant. The first two types of operation are the most frequently used. It is always necessary to inform the doctor of all medicines which the patient uses. This especially relates to medicines which affect coagulation.

Essential pre-operative examination

Apart from standard pre-operative examination, which is performed by a general practitioner approximately seven to ten days before the procedure, it is also necessary to undergo mammalogical examination, which consists in obtaining history, where any possible risk factors with regards to disease of the mammary glands is ascertained. This is followed by visual and tactile physical examination, ultrasound examination of the breasts and examination using a mammograph in indicated cases.

Hospitalisation

Reduction operations on the breasts are performed under general anaesthesia whilst the patient is hospitalised, the length of which does not normally exceed two days after the operation. Photo documentation is created before the operation and the operative plan is marked out on the patient’s body. Prevention of thromboembolic diseases by injection of preparations and equipping the patient with elastic tights goes without saying. The actual operation takes about two and a half hours. After the procedure, the patient spends several hours in a recovery room and after stabilisation, is moved to a standard ward. The patient receives an elastic bra on the first day after the operation. Drains are removed the first or second day after the operation. If there are no complications and the patient feels subjectively well, she may be released.

Post-operative care

Post-operative pain is not usually great and reacts well to regular analgesics. Too much physical activity is not recommended in the period immediately after the operation. Showering is possible after two to three days. The elastic bra is worn for four to six weeks. Subsidence of swelling and forming of the breasts after the operation takes a few weeks or months. The condition of the breasts is already fully stabilised after six weeks in the majority of cases and after this, restrictions are no longer necessary. Care for the scars constitutes an important part of the post-operative regime. Once the stitches have been removed, the scars are lubricated and massaged, and silicone patches may be applied to ensure quicker maturation. After breast reduction, the patient should regularly visit her surgeon for check-ups, even if she is fully satisfied with the result of the operation and there are no complications whatsoever.

Complications

Complications are not completely unheard of in the case of reduction mammoplasty. Early post-operative complications include hematomas or accumulation of blood in the wound. Small amounts of blood are not a problem. Blood which is not channelled away by the drain is spontaneously absorbed and no surgical intervention is required. In the case of larger hematomas, the wound must be checked, the blood removed and the source of the bleeding treated if necessary. From the list of later complications, we must mention an extended period of healing of the wounds, which may exhibit itself in the wound opening, marginal loss of skin, especially under the breast in the case of conventional techniques. One heightened complication in terms of healing is the creation of fat necroses – rigid, sometimes painful knots in the breast caused by the fatty tissue not receiving sufficient blood. Smaller necroses may spontaneously correct themselves over the course of a few months. If the scope is greater, correction is usually only possible surgically. The most feared complication, luckily one that is relatively rare, is the areolae dying with the need to perform subsequent reconstruction. Other possible complications include sensitivity of the breasts and especially the areolae after the operation. In the vast majority of cases, these changes are temporary and subside fully within a few weeks or months. In some cases however, the change in sensitivity can be permanent. In principle it applies that the larger the breasts are before the operation and the greater reduction performed, the greater the likelihood of complications is to be expected. This also includes various levels of asymmetry after the procedure and the possible creation of hypertrophic scars (wide rigid scars that protrude above the level of the skin).