Breast Reduction
Heavy breasts can lead to physical discomfort, a variety of medical problems, shoulder indentations due to tight bra straps, and extreme self-consciousness.
Incisions outline the area of skin, breast tissue, and fat to be removed and the new position for the nipple.
Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast it's new contour.
Scars around the areola, below it, and in the crease under the breast are permanent, but can be easily concealed by clothing.
With smaller, better proportioned breasts, you'll feel more comfortable and your clothes will fit better.
If You're Considering Breast Reduction...
Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.
Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.
If you're considering breast reduction, this will give you a basic understanding of the procedure- when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
The Best Candidates for Breast Reduction
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.
In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.
All Surgery Carries Some Uncertainty and Risk
Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.
The procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)
Planning Your Surgery
In your initial consultation, we will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, you the doctor may also recommend a breast lift.
Be sure to discuss your expectations frankly with the surgeon. He or she will be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask the surgeon for a copy of the manufacturer's insert that comes with the implant he or she will use -- just so you are fully informed about it. And, be sure to tell the surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs.
Our surgeon will also explain the type of anesthesia to be used and the type of facility where your surgery will be performed. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.
Preparing For Your Surgery
Our team will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. A mammogram may be recommended prior to your procedure to ensure breast health and serve as a baseline for future comparison.
In addition to explaining your surgical procedure, the plastic surgeon will discuss anesthesia, the recovery process and your obligations as a patient. We will also discuss where your procedure will be performed. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications of your surgery. There may be a waiting period of several days to weeks from the time of your consent to the day of surgery.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Types of Anesthesia
Breast augmentation can be performed with a general anesthesia, so you'll sleep through the entire operation.
The Surgery
The method of inserting and positioning your implant will depend on your anatomy and the surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. In addition, a saline implant may be placed through an incision at the navel. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.
Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (submammary or subglandular placement) or may be placed beneath the pectoral muscle and on top of the chest wall (submuscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage may be applied over your breasts to help with healing. The surgery usually takes one to two hours to complete. You'll want to discuss the pros and cons of these alternatives with the doctor before surgery to make sure you fully understand the implications of the procedure he or she recommends for you.
After Your Surgery
You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by the doctor.
Within several days, the gauze dressings, if you have them, will be removed, and if you have been given a surgical bra you should wear it as directed by the surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.
Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.
Getting Back to Normal
You should be able to return to work within 24 hours to a few days, depending on the level of activity required for your job.
Follow the surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.
Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. We do offer scar reduction treatments.
Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammography technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
Your New Look
For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.
Even if you believe your implants are functioning well, it is important that you follow-up as directed with our plastic surgeon to assess the condition of your breast implants. In addition, whether you choose to have breast implants or not, it is essential to your health that you practice a monthly breast self-exam and schedule regular diagnostic breast screenings.
Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success.
All Surgery Carries Some Uncertainty and Risk
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.
As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.
A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.
Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.
Breast implants do not generally interfere with a woman's ability to breast feed, or present a health hazard during pregnancy to a woman or her baby. However, pregnancy and the associated changes to a woman's body may alter the results of any breast surgery, including surgery to place breast implants. Therefore, it is important to discuss the options of breast implant surgery with the plastic surgeon if you are interested in becoming pregnant and breast feeding in the future.
Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak.
- If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be absorbed and naturally expelled by the body.
- If a silicone-gel filled implant leak or break, the elastic silicone gel may remain within the implant shell, or may escape into the breast implant pocket (a capsule of tissue that surrounds the implant). A leaking implant filled with silicone gel may not deflate and may not be noticeable except through imaging techniques such as an MRI. For this reason, a woman with silicone breast implants is advised to visit her plastic surgeon annually to assess that her implants are functioning well. An ultrasound exam or MRI screening can assess the condition of breast implants; after 3 years it is recommended that all silicone implants be properly screened.
Following the placement of breast implants mammography is technically more difficult. Obtaining the best possible results requires specialized techniques and additional views. You must be candid about your implants when undergoing any diagnostic breast exam. In many cases, an ultrasound exam or MRI may be recommended in addition to mammography.
While the majority of women do not experience these complications, you should discuss each of them with the physician to make sure you understand the risks and consequences of breast augmentation.
