A Discussion about Breast Reduction (Mammoplasty)

What is Breast Reduction?

Recently you consulted me about an operation to reduce the size of your breasts. The purpose of this letter is to review the operation, what to expect before and after surgery, and the possible complications of surgery.

Some women with larger breasts become large at puberty when they first begin to develop. Others become much larger with the birth of children and never return to their previous size. Some become larger as they grow older. Most women with large breasts (macromastia) have real physical complaints related to the weight of their breasts. Many women have chronic neck, shoulder or back pain and feel that their breasts are out of proportion to the rest of their bodies. Most complain of shoulder notching from the weight on their shoulder straps. Many have problems with the skin under their breasts, either because of the skin constantly folding upon itself or being chaffed by the bra. Carpal tunnel syndrome and chronic headaches have also been related to macromastia. Exercise can be very awkward. In addition to these physical complaints, many women have difficulty finding clothes that fit well and are not able to wear the styles they would like. Some women dislike the appearance of very large breasts, especially the sagging that usually accompanies this size. Many of my patients seek reduction after breast cancer treatment, either because the non-cancer side does not match the lumpectomy/radiation side, which is much smaller, or because with passage of time, the normal breast has outgrown the reconstructed breast on the other side.

A breast reduction improves the size and shape of the breasts. Many women feel a major improvement in back and shoulder discomfort and other pre-operative symptoms. A breast reduction also reduces the risk of breast cancer and long-term, makes breast self-examinations and mammograms more accurate.

Reduction mammoplasty is an operation which reduces breast size and sagging. In this operation, both skin and breast tissue are removed, and the breast is reshaped into a more normal position on the chest. Usually, the areola (the darker skin around the nipple) is also made smaller. The suture lines (incisions) which result from this surgery are around the areola in a circle and extend down from each nipple and under each breast (in the crease) in an upside-down T. Occasionally, if a patient has minimal breast droop, the incision may be around the areola with only a vertical scar below. Every suture line becomes a scar when it is fully healed. The operation cannot be done invisibly, and scars cannot be removed or avoided entirely. The appearance of scars depends on many things, but most of all, it depends on how an individual patient heals. Patients who tend to form keloids (thick heavy scars) may develop these in any breast incision. A patient who heals well with flat pale scars will usually form acceptable scars after breast surgery, but fairly wide scars can be common after this operation. It usually does not improve stretch marks.

Please purchase and bring a wish bra that you would like to fit into after surgery to your pre-op appointment and with you the day of surgery. This will give Dr. Blanchet an idea of what size you would like to be.

In some patients, especially if a large amount of breast tissue is to be removed, a moderate amount of blood loss is unavoidable. Patients may need to take iron pills (SlowFe) at home for a few weeks.

What Happens After?

Occasionally, but not always, a small plastic drainage tube is placed in each breast at the end of the operation to collect any blood or fluid which may form during the first days after surgery. Most patients tolerate these drains quite well, and they are usually removed in a few days. Although reduction mammoplasty is a substantial operation, it is not a particularly painful one.

You may shower on the third day after surgery and resume moderate activities. Heavy lifting and pushing or aerobic exercise are not advised for about a month. There may be a small to moderate amount of clear or yellowish drainage or crusting, especially at the base of the T over the stitch line. This is normal. Occasionally, a patient will develop a raw area which may take a longer time to heal. This is especially true in very large reductions and in smokers, but does not usually affect the final result. Patients may sleep on their back or side as they prefer. As long as they are comfortable, the surgery should not be harmed.

For a variable length of time after surgery, the breasts are swollen. Much of the swelling is gone by three to six weeks afterwards, and the final reshaping process will take several months. Both of your breasts are probably not exactly the same size before surgery, and I cannot guarantee perfect symmetry after surgery.

Patients sometimes ask about nursing after reduction mammoplasty. This is often not possible because many of the ducts leading to the nipple are disrupted during the operation.

As with any surgery, there are possible complications from this operation. Excessive bleeding may occur during or after the procedure. Infections are rare, but do occur occasionally. In this case, antibiotics are given, and the healing process usually takes longer. Very rarely, stitches may have to be opened to allow drainage of infection. These areas are then allowed to heal on their own, and they usually do over a period of time. Nipples may become numb as a result of reduction mammoplasty. If this happens, it is usually temporary, but it could be permanent. Even more rarely, it has been reported in the literature that the nipple and areola may lose their blood supply and be lost entirely. This happens in less than 1 in 800 cases, and I personally have not seen it in my practice. In the unusual event that this does happen, a new nipple and areola can be made using skin from other parts of the body. This is usually only a consideration with massive breasts or in smokers. Your risk of all wound healing complications increases significantly if you are overweight. Please be aware of this.

I require smokers to abstain from tobacco for 1 month before and after surgery. Nicotine screening may be necessary the day of your surgery. IF THE TEST IS POSITIVE, YOUR SURGERY WILL BE CANCELLED.

Gravity will eventually catch up with your breasts again, and you will develop some degree of droop in your breasts over time. However, the drooping will not be as much as before surgery because there is less breast tissue to weigh the breasts down. If you gain a significant amount of weight, your breasts may enlarge again.

This information may appear overwhelming in that it describes the possible unfortunate complications of this procedure. However, the vast majority of patients have successful, uncomplicated surgery. Almost all patients are extremely pleased with the results of their surgery. They feel and look better and are glad that they had the surgery done.

It will be a pleasure to discuss reduction mammoplasty with you. Please do not hesitate to contact me if you have further questions (804-320-8545).