Breast reduction is a surgical procedure to reduce the size and volume of the breast. It also reshapes and lifts the breast including bringing the nipple to a higher position.
Many women with large breasts suffer from backache, neck pain and discomfort from bra straps. They may also feel very self-conscious and have difficulty exercising and finding clothing to fit properly. Rashes can develop in the creases under the breasts. Breast reduction surgery can help alleviate these symptoms. Breast asymmetries can be improved by breast reduction surgery in both those in whom there is a significant natural asymmetry and those who have asymmetries created by breast reconstruction to one breast following cancer treatment.
If you have a breast lump that is under investigation, these investigations should be completed prior to embarking on breast reduction surgery. Should breast cancer be suspected, breast reduction surgery should be carried out in conjunction with a breast oncological surgeon or postponed until after this is fully treated. If you are in the process of losing weight or significantly overweight then surgery should be postponed until you achieve your goal weight. Smoking will increase your risk of complications after surgery including wound problems and impairing blood supply to your nipples. It should be stopped at least six weeks before surgery. The oral contraceptive pill may also need to be stopped prior to surgery as it can increase the risks of deep venous thrombosis following surgery.
Breast reduction surgery involves a general anaesthetic and usually one to two nights in hospital. In some circumstances it may be possible to have surgery as a day case. Skin and breast tissue are removed from below and around the nipple and the breast is then sutured back together and reshaped. There may be a surgical drain placed which is usually removed the next day. There will be a scar around your nipple and extending down from the nipple to the crease where your breast meets your chest wall (vertical scar). Often it is necessary to extend the scar under the breast as well in an inverted T pattern or anchor pattern. Any breast tissue removed will be sent for histological analysis.
Sometimes breast reduction is combined with liposuction to improve the breast shape particularly if there is a lot of fatty fullness going under the arms. The scale of the breast reduction should be discussed beforehand as if very radical reduction surgery is requested it may have effects on the aesthetic outcome of the breast in terms of shape and appearance. In some cases due to the position of the nipple beforehand, it is necessary to completely detach the nipple and replace it as a nipple graft. There is no absolute guarantee of a particular cup size afterwards but it will be as close as possible to the size discussed beforehand.
A supportive post-surgical or sports bra (non-underwired) should be worn day and night for up to six weeks. You are advised to sleep on your back for at least two weeks. You should not undertake vigorous exercise or heavy lifting for six weeks. The scars will be red at first but will slowly fade. Your scars and your breasts may feel lumpy and tender at first but this will improve over time and may be helped by massage. If your surgery was done with the vertical scar technique, there is usually some wrinkling of the skin and the breasts can sit a bit higher than usual in the beginning. These issues are temporary and will resolve as you recover.
Breast reduction surgery will leave visible scars around the nipple and lower half of the breast. These usually fade quit well over time but in some people can be raised or lumpy, so called hypertrophic scars. They can also stretch in some patients.
Although most patients suffering from back pain get good relief from this surgery, large breasts may not be the sole cause for your back pain and therefore not all the discomfort or pain may go after surgery. While many patients can breast feed after breast reduction surgery, in some it may not be possible. Occasionally the lower half of the breast drops below the level of the nipple or “bottoms out”. This does not happen often. Most if not all women do not have identical breasts. There are differences between both sides. Asymmetries can be present after surgery too. These are usually small and do not detract from the result. Sometimes minor “tweaks” are carried out some months later to try and reduce any asymmetries.
If the surgery is done after your breasts have stopped growing, the effects of surgery should last a considerable time. However if you lose or gain significant amounts of weight, your breasts will also decrease or increase in size. Pregnancy will also cause changes to the size and shape of your breasts. As the body ages there is a tendency for breast tissue to droop. Breast reduction surgery lifts the breast but over time this will gradually still affect the breast as part of the aging process. Wearing a well fitting supportive bra helps to maintain the effects of surgery for longer.
“I was very pleased with Ms Nugent – she explained everything in detail and was available when I had a concern. I was very comfortable at the Nuffield and was very pleased with the aftercare and outcome. I would recommend Ms Nugent.” Breast reduction surgery at Nuffield Health Tunbridge Wells Hospital 2016
“Really excellent service from beginning to end. Nora is an amazing surgeon and wonderful individual.” GC, Breast reduction surgery at the Montefiore Hospital 2016