breast reduction

Breast reduction surgery: For some, it’s a good option with exceptional results

Question: Dear Dr. Crutchfield, my sister recently had breast reduction surgery. She said she is delighted with the results. What is breast reduction surgery and why would anyone have it done? Breast reduction surgery is the process of having skin, tissue and fat surgically removed from the breasts to reduce their size physically. The medical name of the procedure is “reduction mammaplasty.” Breast reduction surgery is often considered to reduce the stress and pain on the shoulders, neck and back caused by having abnormally large breasts. It can be done to decrease one’s breast size so they look more proportional to their body. Reduction mammaplasty can also improve a person’s self-esteem and self-image and allow them to comfortably engage in many physical activities, including various sports. Breast reduction surgery is a serious surgery and should be considered with a skilled physician and board-certified plastic surgeon. The surgery has benefits, as well as possible complications and risks. It is essential to come to a sound understanding with your surgeon about realistic expectations and outcomes of the procedure. Breast reduction surgery can be done at any age, including teen years. It is preferable to do so when the breasts are fully developed, but if there is enough reason to have the procedure done as a teen, a second surgery can be done later in life when the breasts are fully developed. Men can also have breast reduction surgery, but for different reasons. The rest of this discussion will focus on breast reduction surgery for women. Reasons to consider surgery Reduction mammaplasty may be considered if a woman has large breasts and they are causing:
  • Back pain
  • Neck pain
  • Shoulder pain
  • Inability to participate in certain physical activities and sports
  • Chronic skin problems under the breasts
  • Difficulty in getting bras that fit
  • Poor self-esteem
In certain circumstances, reduction mammaplasty may not be appropriate. These include:
  • Persons with significant health problems such as heart disease or diabetes
  • If one is extremely overweight
  • If one wishes to avoid scars or has a history of keloid formation
  • If one smokes heavily (this is a relative contraindication)
Reduction mammaplasty may be postponed if one is considering childbirth with subsequent nursing. Nursing after mammaplasty can be difficult and challenging. There are special surgical techniques to increase the possibility of nursing, but they are not 100 percent successful. Many who consider mammaplasty will wait until after they are done having children. Also, reduction mammaplasty may be postponed if you are considering a significant weight-loss program. Sometimes the weight-loss program may cause enough of a reduction that surgery is easier; or, more commonly, the operation will be most effective when breasts are at a stable, smaller size. Risks include:
  • Bruising
  • Bleeding
  • Swelling
  • Infection
  • Discoloration
  • Scarring
  • Inability to breastfeed or difficulty doing so
  • Loss of sensation in the area around the nipples
The procedure Before the surgery, your doctor will perform a complete physical examination with bloodwork. Additionally, they may take photos of the breasts and order an imaging study (mammogram). You should stop medications that will cause increased bleeding (such as aspirin or similar NSAIDs). Your doctor will review with you the risks, goals and expectations of the surgery, including scarring and numbness. The procedure is done under general anesthesia. The exact location of the tissue removal will vary depending on how much tissue needs to be removed and the preference of the surgeon. The surgeon will use a particular pattern that allows the breasts to maintain a natural shape and keep an optimal positioning of the nipples. The surgeon will also recommend how long you will be in the hospital. Sometimes one can go home the day of surgery, and sometimes it is better to stay in the hospital for a short while (one or two days) after the procedure. You will also be started on pain medications and antibiotics to reduce the chance of infection. After reduction mammaplasty, your breasts will be swollen and tender. Your doctor may recommend special dressings and compression garments. Plan on plenty of ice and loose, comfortable shirts. You should plan on taking at least a week off of work or school. You should also plan on no strenuous activities for at last one month after reduction mammaplasty. You can see results of reduction surgery right away, but keep in mind that full healing, including swelling and maximum scar resolution, can take many months, even up to one and a half years. Breast reduction surgery can successfully relieve pain, stress and discomfort; allow one to engage in previously prohibited activities and sports; and offer one a higher degree of self-esteem. If a physician deems it medically necessary, the cost of the procedure is usually covered by health insurance. If you think you are a candidate for breast reduction surgery, talk to your doctor. Many of my patients have told me it was one of their best decisions.