If you have very large, pendulous breasts, you may experience a variety of medical problems caused by their excessive weight and size:
back and neck pain
breast pain or heaviness
changes in posture
shoulder “grooving” secondary to your bra straps
skin rashes on the undersurface of your breasts
interference with exercise and other activities
the feeling of being self-conscious
difficulty finding clothing that fits properly
A breast reduction — also known as reduction mammoplasty — involves surgical removal of excess glandular tissue, fat and skin from the breasts. The breasts are made smaller, lighter, firmer and higher. The areola, the darker circle of skin surrounding the nipple, can also be reduced in size and diameter. The goal is to give you smaller, better-shaped breasts which are in proportion to the rest of your body.
A breast reduction can be performed for cosmetic improvement as well as for symptomatic relief. Women of all ages are troubled by large, sagging breasts which restrict their activities and cause them physical discomfort.
In younger patients, the surgery is performed after a young woman’s breasts are fully developed, usually no sooner than age seventeen or eighteen. Rarely, the surgery may be performed at an earlier age if the patient is suffering emotionally as well as physically from the large size of her developing breasts. In adulthood, the surgery can be performed at any age.
PRIOR TO SURGERY
At your initial consultation, Dr. Glassman will ask you to express your concerns about your appearance and to describe your symptoms. Your goal for the eventual size and shape of your breasts will be discussed. Your medical history will be reviewed and a physical examination will be conducted to determine if a breast reduction is best for you. If you are a good candidate for surgery, Dr. Glassman will explain what can be done to assist you. He will discuss the variables that may affect the procedure such as your age, the size and shape of your breasts, and the condition of your skin.
Dr. Glassman may request that you visit your private medical doctor for a check-up and for any necessary lab work and x-rays. If you have not had a recent mammogram, one will be requested.
Precise preoperative instructions are provided, and all necessary prescriptions are given to you in advance of the surgery. All aspirin, aspirin-containing products, and anti-inflammatory products must be stopped at least ten days before and for ten days after surgery. You will be provided with a complete list of which medications to avoid. Tylenol may be taken during this time. Also, you will be given a list of vitamins and homeopathic preparations to take prior to and after the surgery. This is done to promote healing and limit bruising.
Some insurance companies will pay for a breast reduction if it is medically necessary. Our office staff will help you determine if you are eligible for such benefits. Dr. Glassman will write a “predetermination letter” if required by your insurance company.
General anesthesia is given for all breast reduction cases. You will be asleep through the entire operation.
A breast reduction is generally performed as an outpatient in a private facility. It may be combined with other procedures, such as facial surgery and/or body contouring.
Before anesthesia is given, careful measurements are taken of your breasts and chest wall. A special surgical marking pen is used to apply a “map” of the surgery to the skin of your breasts.
After anesthesia is given, incisions are made in the shape of an “anchor” — a circle around the areola, a vertical line from the bottom of the areola to the crease under the breast and within the crease itself. Dr. Glassman will remove the excess glandular tissue, fat, and skin, shaping and “sculpting” the breasts to form their new size and contour. Liposuction may be used to remove excess fat from the underarm area. The nipples and areolae are moved into their new more youthful position; they remain attached to their blood vessels and nerves to make every effort to preserve their normal color, sensation and your ability to breast-feed.
Fine stitches are used to close the incisions. You will be wrapped in a supportive bandage before you are awakened. The operation takes three to four hours.
THE POSTOPERATIVE PERIOD
The first one to two hours after surgery are spent in the recovery room. When you are fully alert, you will be able to return home in the care of a friend or family member. A private nurse can be provided at your request. Some patients chose to spend the first night after surgery in an aftercare facility, where care is provided around the clock by licensed nurses. The following morning, all bandages are removed in our office. The surgical sites are inspected and cleansed, and a surgical bra or a lighter bandage is placed. Instructions are given on how to care for the incisions until the stitches are removed in two weeks.
The pain following a breast reduction is described by most patients as mild to moderate. Pain medication is prescribed, although this is usually unnecessary after the first day.
There may be mild bruising and swelling which lasts for approximately one week. Most patients may drive a car and return to work or social activities after one week. Strenuous physical exercise is avoided for three weeks following a breast reduction. You must avoid lifting or pushing anything heavy during this three week period.
It is advisable to avoid sex for the first week after surgery, since sexual arousal can cause increased swelling and bruising. Only gentle contact with your breasts is recommended for about six weeks.
RISKS AND COMPLICATIONS
As with any operation, a breast reduction has minimal risks and potential complications. However, with highly trained doctors and nurses making up the surgical team, complications are extremely rare. Like all surgery, the risk of bleeding, infection, scarring or an anesthetic problem is present.
The procedure leaves permanent scars at the incision sites. These scars may vary in color and intensity from one patient to another. All scars will be covered by your bra or bathing suit. Some patients may experience a temporary loss of feeling in their nipples or breasts. Rarely, the loss of sensation may be permanent. The vast majority of women who have had breast reductions can breast-feed; however, a very small minority may be incapable of nursing.
Other rarely occurring complications may be a slight asymmetry of the breasts or unevenly positioned nipples. Very rarely, a nipple and areola may lose its blood supply, and the tissue will die. This may require later reconstruction using skin grafts from elsewhere on the body.
Although much of the swelling and bruising will disappear in the first few weeks, it may be three months before your breasts settle into their new shape. Even after three months, their shape may fluctuate in response to your hormonal influences, weight change, and pregnancy. Your physical discomfort will be alleviated and your body will be better proportioned. Clothes will fit better, and you may be perceived by others as having lost weight. Dr. Glassman will make every effort to make your scars as inconspicuous as possible. They often remain raised and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. The scars can be placed so that you can still wear low cut clothing.
ADVANTAGES OF BREAST REDUCTION SURGERY
The permanent scars of a breast reduction may be a welcomed alternative to the physical and emotional compromise of having very large breasts.
Over many years, the weight of your excess breast tissue may have a negative influence on your posture. The skeletal changes may lead to restrictions in flexibility and mobility. Besides the obvious aesthetic compromise, your physical well-being may be adversely affected. Breast pain, neck pain and back pain are part of the syndrome of having very large breasts. The changes brought about by a breast reduction are among the most helpful and dramatic in the entire field of plastic and reconstructive surgery.