There are lots of reasons why women choose to have a breast reduction. The most common is to the physical stress and back pain caused by the excessive weight of large breasts. Breast reduction can solve these problems and also improve the size and shape of your breasts, making them more proportional to the rest of your body. Some just want their clothes to fit better.

The first thing to do is to talk to your GP who will refer you to the consultant plastic surgeon of your choice. By talking to your GP and Mr Meagher you are more likely to get the results you want from the surgery.

Breast reduction can bring:

• More confidence and self-esteem
• A better-proportioned figure
• More clothing options

Why people choose breast reduction

The main reasons why people choose to have a breast reduction are:

1. To improve the shape of the breasts
2. To relieve neck, shoulder and back problems that may be caused by the weight of large breasts
3. To correct a size difference between the 2 breasts
4. To improve the breasts’ appearance
5. To correct skin problems around the breast
6. To increase clothing options
7. To help overcome psychological issues and social inhibitions

The surgery

Breast reduction is a major surgical procedure, performed in hospital under general anaesthetic. The operation will:

1. Reduce the size (volume) of the breasts
2. Reshape and reposition the breasts (breast lift)
3. Reposition the nipple
4. Correct any imbalance in symmetry

Alleviating back pain

Most patients notice a significant improvement in back pain. But this is an indirect benefit of the surgery, possibly due to better posture and lighter breasts. No surgeon will guarantee that back pain can be cured or improved, as the cause may be quite separate to the breast problem.

Breast asymmetry

All women have varying degrees of asymmetry (differences in size or shape between their breasts). This can be caused by:

1. Breast volume
2. Breast shape
3. Chest wall placement of each breast
4. Nipple-areolar size and shape
5. Nipple-areolar position on the breast mound

You will have some degree of breast asymmetry after your surgery no matter how carefully the surgery is performed, despite precise measurements and removal of unwanted tissue.

Mastopexy (breast lift)

Most women who would like a breast lift (mastopexy) are quite happy with the actual volume of their breasts. Everything looks fine in a good quality bra but the shape of the natural unsupported breast is displeasing. Mr Meagher can help reshape your breasts and, if you wish, also perform a breast augmentation (either simultaneously or as a staged procedure).

Reasons not to operate

Mr Meagher would advise against a breast lift if:

1. You have had multiple surgical procedures on your breasts in the past
2. There is undiagnosed breast lump(s) or known breast cancer
3. You suffer from obesity
4. There is a likely or planned future pregnancy
5. You suffer from any medical conditions prohibiting elective surgery
6. You have unrealistic expectations
7. You smoke, which can cause a 300% increase in complications

Unavoidable consequences

A breast reduction is an invasive operation and so there are a number of consequences that most patients will experience, including:

1. Scars
2. Swelling
3. Sensory loss over the breast
4. Possible restrictions with breastfeeding
5. Bruising at the incision sites and weeping at the incision sites for a few days

Breast Scarring

The scars vary depending on how much work is involved. The most common scar is the ‘anchor’ shape but we try to get away with minimal scar techniques such as the ‘vertical’ scar or ‘purse string’ (nipple) scar. These are usually for patients undergoing a small or moderate reduction and are not suitable for the larger or more droopy breast.

Breast cancer

There is no relationship between breast reduction and the development of breast cancer. The surgery neither increases or prevents the risk of breast cancer.However all tissue removed at surgery is routinely sent for analysis.

Mammograms

We recommend that you wait about 6 months after your surgery before you get a mammogram as it may be painful and disrupt the result. If you do develop a lump requiring investigation an ultrasound is usually the first step. If you are over 40 years of age and have not had a mammogram for over 2 years, have one before the operation.

Pregnancy and breastfeeding

Your breast reduction surgery will not have any impact on a future pregnancy. But a pregnancy may well cause an increase in breast size and stretching of the breast skin. After the pregnancy the breasts may sag and undo some of the benefits of the surgery. If you’re of child bearing age, think about the possibility of pregnancy. You may want to put off the operation until your family is complete.

A breast reduction will probably reduce your ability to breastfeed. It depends on the amount of reduction, the surgical technique and your own natural ability. Again, if you want to retain the possibility of breastfeeding you should consider deferring surgery until your family is complete.

Before the operation

To ensure that everything goes as well as possible, there are a number of things you should do before the procedure:

1. Maintain an appropriate weight for 9-12 months
2. Don’t drink alcohol for 7 days
3. Stop smoking 2-3 months beforehand
4. Don’t take anti inflammatory medicines (Aspirin™, etc) for 14 days due to the increased risk of increased blood loss during surgery
5. Tell us about all medicines you are taking and for what condition
6. Stop taking the oral contraceptive pill at least 6 weeks prior to surgery and use alternative means of contraception

The most important thing to do is to talk with Mr Meagher so that there is a clear understanding of your desires and expectations, in light of any biological prerequisites. We want you to be well informed and have realistic expectations of the results.

Before we discuss your new breast shape and size in detail, we will evaluate your current physical health and health history and also explain the procedure. Because breast reduction surgery is an elective procedure, we will carefully discuss the benefits and risks.

Mr Meagher will take dimensions of your breast and surrounding tissue to determine the best surgical approach.

Mr Meagher will write to you after the first consultation If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed by signing a consent form.

He will also take photographs as a record and to help plan your surgery.

During the operation

On the day of your surgery, Mr Meagher will draw marks on your breast and chest to show where the incisions will be made.

He will decide which technique to use to move the nipple-areolar complex (nipple area):

1. To move the nipple and areola as a free tissue graft (rarely used)
2. To leave the nipple and areola attached to a dermoglandular pedicle of tissue (through which circulation is maintained)

The most commonly used Wise or ‘keyhole’ pattern of skin incision helps to remove unneeded vertical and horizontal skin. This leaves an anchor type scar with the lower scar often hidden in the fold below the breast.

Once he has isolated the nipple and areola, the excess skin and breast tissue is removed. Bleeding is controlled and the breast is re-assembled with stitches. The nipple and areolar complex are then inserted again and the skin incisions are closed. There can be some difficulties in breast-feeding with some approaches where all glandular breast attachments have been separated from the nipple.

A mastopexy or breast lift is carried out in much the same way but the nipple and areola are always left attached to the breast substance and only excess skin is removed. The skin incisions may vary (periareolar) and no glandular breast is removed. It is simply reshaped and anchored (using pillar techniques and in some case fascial slings) to the chest wall muscles.

After the operation

Mr Meagher recommends that you stay in hospital for 1-2 nights after surgery. The typical recovery time for a patient who has undergone breast reduction surgery is 3-4 weeks. You should wear a supportive bra (without an under wire) during the recovery period. You will probably get some swelling, as you would with most surgical operations but this will usually subsides after 4 -6 weeks. There may be some pain at first and in some cases prescriptive painkillers may be required for a short period.

It’s a good idea to not return to or start work for 2-3 weeks after the operation while exercise and even house work should be kept to a minimum during the first 7 days of recovery. For most patients sports or more strenuous activities can be resumed after 6 weeks. Driving depends on the individual. You have to wear a seat belt and you should be comfortable and fully mobile if you are to be in control of the car.

It usually takes 6-9 months for the scars to begin to fade in colour and become less obvious. The sensation of the skin around the breast will have changed and can take 9-12 months to return to its pre-operation feeling. Remember that achieving the final breast shape is not a quick process and may take months.

Potential complications

The vast majority of breast procedures don’t create any side effects or complications. However, there are risks associated with any type of operation and breast surgery is no exception. Mr Meagher will explain the possible risks, which are rare, but may include wound infection, hematoma (blood collection), seroma (fluid collection), changes in the nipple-areolar complex sensitivity, loss of portion or all of nipple and areolar complex through inadequate blood supply and fat necrosis which may feel like a breast lump after surgery.

Other unlikely complications may include respiratory problems, circulatory system collapse, disturbances of the blood clotting mechanism leading potentially to excessive bleeding and excessive clot formation.

You won’t see the final results of the procedure for up to 12 months after the operation. Try to keep scars out of excessive sun light during the total recovery time because it could lead to darkening and increased visibility of the scar tissue.