Is Breast Reduction meant for you?
Breast Reduction surgery is meant for you if you are one of the women who has large breasts along with any of the below mentioned complaints.
- Constant back and neck pain
- Deep bra strap indentations in the shoulders
- Deteriorating posture and an inability to participate in certain activities.
- Exacerbation of symptoms of spinal problems
- Social embarrassment
- Discomfort in engaging in physical exercises or social activity
- Difficulty in finding well fitting clothes.
- Skin rashes/fungal infections under the breast
- Dissatisfaction with the breasts’ appearance and symmetry.
An initial consultation with Dr.Birraj will understand your aesthetic goals and evaluate your specificneeds and expectations from breast reduction surgery. A detailed Breast and chest examination and measurements will also be done atthis time. You will be fully educated about the benefits and risks of the procedure, types of skin incisions which will be best suitable for you and the likely outcomes of the operation.Your breast reduction treatment plan will focus on achieving a more desirable breast size, contour, and position with natural-looking results. At this stage photographs will also be taken for record keeping.
It is a good practice to fully disclose your health history, current medications, allergies and the use of drugs and smoking at the outset.
General Guidelines prior to Surgery:
- Stop smoking /alcohol well in advance of surgery as higher risk of complications
- Lose weight prior to surgery. If you lose weight after, it may loosen your lift.
- Obtain laboratory testing and a medical evaluation
- Pre-operative Anaesthetic assessment for fitness for surgery
- Agreement to proceed with the surgery by signing an informed Consent Form
- Maintain a stable weight for 2 months prior to the date of surgery
- Take certain medications or adjust your current medications
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they increase risk of bleeding
What size do you want to be?
The answers can range from ‘’ I want them to be a 34 C from the current 38DD’’ or ambiguous to the point of ‘’I want them smaller and higher up’’ or simply ’’ I just want this weight off my chest ‘’! How much of breast can be removed depends on a host of factors which need to be considered and discussed at length.
Surgical safety limitations to breast volume reduction.
While this may not apply to small and moderate volume reductions for Large volume reductions there is a safe limit for breast tissue removal in order for breast and nipple areola to remain alive.
Proportions must be maintained in relation to the rest of the body.
Too small breasts on a heavy middle body look unaesthetic. Conversely larger breasts may divert attention from the plus size waist.
Its the cup size which changes not the chest size
Expectation of drastic reduction from 40 DD to 36C are untenable. In breast reductionits the cup size which changes not the chest size. In rare cases of very large hypertrophy simultaneous liposuction of chest area may reduce chest size by an inch or two.
Expected Breast volume reduction
You will be given an approximate idea of the expected cup size change with the volume reduced.
Is your bra size correct ?
Most patients are wearing the wrong size bra because the right sized bra is either impossible to find or there is a mismatch between cup and chest size. I also see women wearing a bigger chest size (a 36 when they should be in a 34) because they cant find the appropriate size bra.
For patients who are unclear, I am inclined for a C border. For droopy breasts usually an A or B cup is not recommended.
Breast Reduction Surgery is done under general anaesthesia in a hospital. The “inferior pedicle” technique in breast reduction is considered the Gold Standard for most Breast Reduction patients. It removes the tissue mostly from the upper areas of the breast while preserving tissue in the central, lower area to support the blood supply of the nipple (so-called “inferior pedicle”). Most patients who undergo this technique will eventually have some degree of “bottoming out” after the procedure that, in many cases, can require a “touch-up” or second reduction—or even a breast liftto correct.
Lejour Vertical Scar Mammaplasty :In Vertical Reduction Mammaplasty technique the skin scar is badminton shaped running around the areola and extending vertically down to the inframammary fold. The advantages of this pattern of skin incision are that it leaves no scar along the inframammary fold and it reduces the risk of skin edge necrosis at the inferior aspect of the closure, where tension is greatest.The Lejour technique can shape a conical and stable breast and overall gives a better long term aesthetic result as regards shape of breast and scars with greater patient satisfaction. This technique is ideal mainly for moderately hypertrophic breasts. There is however a greater risk of seromas, hematomas and need for scar revision later.
Inverted “T” Mammaplasty :The Inverted T scar mammaplasty has been the workhorse of breast reduction surgery since the beginning and continues to enjoy that status till date. In this technique the external skin scar is “T” shaped extending down from the areola to the inframammary fold with an additional transverse scar in the inframammary fold. Moderate to very large breasts can be reduced by this technique. Complication rate is low and patient satisfaction is high. It however tends to give a bigger scar and there is a tendency for breasts to develop a “boxy” appearance over time.
Liposuction :A Liposuction is helpful as a tool in reducing minimal to moderately hypertrophic breasts with minimal ptosis.
Free Nipple graft :Nipple may have to be excised and used as a free graft for extreme cases of breastreductions. This is particularly so for extremely large reductions where the chances of impairment of blood supply of the nipple areola is very high.
The nipple areola can be based on a superior, inferior, medial or lateral dermoglandular flap in either of these techniques. Dr. Birraj prefers a superomedial pedicle breast reduction technique that removes most of the tissue on the bottom the part that gravity affects the most while preserving tissue on the top. This leaves patients with a very good shape and projection of the breast right after surgery, and the results as far as maintaining shape are much better than with the traditional, older technique.
Breast Reduction is a very safe surgical procedure that takes 3 hours to perform. Risks of surgery are minimal. In the occurrence of a postoperative hematoma, early recognition and treatment must be carried out to correct the problem.They will be strapped in a firm dressing. As the wounds are closed with absorbable sutures, stitch removal is not usually necessary.
Breast Reduction Recovery
Patients for Breast reductionsurgery are generally discharged after a day.After the surgery small thin tubes are placed to drain out any accumulated blood/fluids. These drains are usually removed in about 2 – 4 days. You may be discharged home along with the drains. Recovery time is usually one to two weeks. For the first few days you will be on regular antibiotic and pain medication. By the end of a week most patients are off all pain medication and are back to normal daily life
A support bra will be recommended for continuous wear for first 6-8 weeks. Bruising and swelling take up to 3 to 6 weeks to disappear. The breast shape goes on improving up to 6 months. All stitches are usually absorbable and will not need removing. Scars are initially visible for first 6 months but rapidly become soft, supple and fade out.
- Most desk jobs return to work at a week.
- 2 – 3 weeks off for any job which is active (lifting, aerobics instructor, nursing with patient transfers).
- Moderate exercises can be started usually around one month after the surgery.
Breast Reduction Benefits
- Reduction in size (volume) of the breasts
- Reshape and reposition the breasts (breast lift)
- Repositioning of the nipple
- Possibly correct asymmetry, if present
- Reduce/Improve psychological and social inhibitions.
- Sense of freedom