Breast reduction

Large breasts that are disproportionate to the body can cause severe discomfort and limit a woman’s activity level and quality of life. The weight of the excess breast tissue can impair the ability to lead a normal active life. Also, it has been proven that the emotional distress and self-consciousness often associated with having very large breasts is as important an issue to many women as the physical discomfort and pain.

Breast reduction is the surgical removal of excess breast tissue in order to reduce the size of the breasts. Specifically, reduction mammaplasty or breast reduction surgery removes excess breast fat, gland and skin in order to achieve a breast size that in proportion with your body and to alleviate the discomfort associated with overly large breasts. This procedure improves not only the functional status of women but also their emotional status and overall wellbeing.

Introduction and basic information about breast reduction

What Is breast reduction surgery?

Large breasts that are disproportionate to the body can cause severe discomfort and limit a woman’s activity level and quality of life. The weight of the excess breast tissue can impair the ability to lead a normal active life. Also, it has been proven that the emotional distress and self-consciousness often associated with having very large breasts is as important an issue to many women as the physical discomfort and pain.

Breast reduction is the surgical removal of excess breast tissue in order to reduce the size of the breasts. Specifically, reduction mammaplasty or breast reduction surgery removes excess breast fat, gland and skin in order to achieve a breast size that in proportion with your body and to alleviate the discomfort associated with overly large breasts. This procedure improves not only the functional status of women but also their emotional status and overall wellbeing.

Is breast reduction indicated for me?

Breast reduction is a good option for you if:

You fell your breasts are too large and they cause discomfort
You experience back, neck or shoulder pain by your breasts weight
You have indentations from the bra straps due to the breast weight
You have skin irritation at the lower breast crease
Your breast size limits your everyday life
Your breasts hang very low and the skin is sagging
Your nipples rest way below your breast crease
You have large distended areolas

Also, as breast reduction is major surgery it is strongly recommended that:

You are physically healthy
You don’t smoke
Your breasts are definitely fully developed
You have realistic expectations

Can I get a breast reduction If I plan on having children?

Generally, breast reduction surgery can potentially impair breast function, which means that although you should be able to breastfeed your child, it is generally expected for women to produce a smaller amount of milk and in some cases no milk at all. Also, the weight gain and changes to your breast tissue that occur during pregnancy can reverse the benefits of your breast reduction in terms of breast shape as they frequently become more droopy afterwards.

Before surgery information

What you should know before your breast reduction surgery

You’ll be asked a number of questions about your health, desires and lifestyle. Be prepared to discuss:

Why you want the surgery, your expectations and desired outcome
Medical conditions, drug allergies and medical treatments
Use of current medications, vitamins, herbal supplements, alcohol and tobacco
Previous surgeries
Family history of breast cancer and results of any mammograms or previous biopsies

Common preparation steps before surgery include:

A medical evaluation and lab tests.
A baseline mammogram.
Quitting smoking if you currently smoke for at least 4 weeks before and after surgery.
Learn how to handle post-operative care and scheduling any necessary follow-up appointments.
You should arrange transportation and care well ahead of time. You should not drive yourself to or from surgery and it’s important to have someone with you for at least one night following the procedure.

What happens during the consultation for a breast reduction?

Your consultation, evaluation and preparation for breast reduction.

On your first appointment you will need to allow about one hour. We will show you animations of how the breast reduction procedure is procedure is performed as well as many before/after pictures from patients that have consented for their pictures to be shown during consultation. We will measure your chest and breasts and discuss with you the surgical technique as well as what may or may not be achievable for your anatomy. We will also explain what complications are associated with breast reduction and how we prevent them and deal with them in the rare occasion that they occur. This helps you to make a fully informed decision. Depending on your anatomy, we may be able to use imaging software, which produces graphic simulations of your potential appearance after surgery.

We need to obtain information about your medical history, previous surgeries or medications that you are on. You will be asked whether you have a family history of breast disease and about your recent mammogram if you had one. If you decide you would like to proceed with surgery then you can come back for a second appointment to ask any further questions. You will receive a prescriptions for pain medications or antibiotics. You can come back for another visit before your surgery if you feel you have more questions or concerns.

If you smoke, you must stop smoking at least 3-4 weeks before surgery and for several weeks after surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for at least 7-10 days before surgery. We will provide you with additional preoperative instructions including the basic preoperative tests that are routinely performed before surgery (blood tests and electrocardiogram usually).

What are the basic instructions and tests needed before a breast reduction?

You may be asked to:

Get lab testing or a specific medical evaluation by a specialist, depending on your medical issues
Take certain medications or adjust your current medications
Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
Stop smoking well in advance of breast reduction surgery
Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Specific instructions provided by us will will guide you what to do on the day of surgery and during your post-operative care and follow-up period.

Surgery information

Surgical technique: how exactly is breast reduction surgery performed?

Breast reduction surgery is usually performed through incisions on your breasts and then the excess fat, glandular tissue and skin are removed. At the HAPSI we have extensive experience the safest most modern techniques available today.

The most common techniques used at the HAPSI are:

the “lollipop scar” Vertical breast reduction
the “anchor scar” Inferior pedicle technique

The details of these techniques are individualized for each woman and the exact architecture for your breasts will be determined by your individual composition of gland and fat, the amount of extra skin, the degree of reduction desired and your surgeon’s advice in terms of which approach is safe and can provide a natural, predictable shape.

In some cases, excess fat may be removed through liposuction only but this is not a common technique as it is indicated mainly for women with large breasts but no extra skin or breast ptosis. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used for breast reduction.

Light anesthesia medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and light general anesthesia which is more common. Your HAPSI doctor will recommend the best choice for you.

Breast reduction usually takes approximately 3 hours.

VERTICAL BREAST REDUCTION TECHNIQUE (“lollipop incision”)
This technique is used in moderately large breasts and not in cases of significant or severe macromastia.
As shown in the picture, a keyhole incision around the nipple is created and then vertically down to the breast crease. Then the excess breast gland and fat are removed. The nipple remains attached to a segment of breast tissue at the upper area (superior pedicle) in order to get blood supply and remain viable. Skin is also removed from the lower breast and the nipple is then repositioned in a higher position. The areola is reduced by excising skin at the perimeter, if necessary.

The incisions are brought together to reshape the now smaller breast. Sutures are placed in layers deep within the breast tissue to create and support the new form and also more superficially in order to minimize the tension on the skin level as this prevents intense scarring. Finally special surgical papertape (steri-strips) are placed in order to cover the skin incision. The scar has a “lollipop shape” around the nipple and down to the breast crease. The incision lines are permanent, but in most cases will fade and significantly improve over time.

Breast reduction

INFERIOR PEDICLE BREAST REDUCTION TECHNIQUE (“anchor incision”)
This technique is the most frequently used technique as it is indicated in significant or severe macromastia.

As shown in the picture, an anchor-type incision around the nipple is created that then follows a course vertically down to the breast crease and then horizontally along the low breast crease. Then the excess breast gland and fat are removed. The nipple remains attached to a segment of breast tissue at the lower area (inferior pedicle) in order to get blood supply and remain viable. Significant amount of skin is removed from the breast and the nipple is then repositioned in a higher position. Usually it is necessary to reduce the areola size by excising skin at the perimeter.

The incisions are brought together to reshape the now much smaller breast. Sutures are placed in layers deep within the breast tissue to create and support the new form and also more superficially in order to minimize the tension on the skin level as this prevents intense scarring. Finally special surgical papertape (steri-strips) are placed in order to cover the skin incision. The extensive scar has an “anchor shape” around the nipple, down to the breast crease and horizontally at the breast crease. The incision lines are permanent, but in most cases will fade and significantly improve over time.

Breast reduction 2

Will breast reduction leave permanent scars?

Yes. All breast surgery leaves scarring and the scars especially after an “anchor” inferior pedicle breast reduction are actually significant. The scars are hidden around the areola, then extend on the breast vertically downwards and for the “anchor” technique they also extend horizontally in the crease under the breast. In general, trying to avoid incisions in breast reduction when they are necessary will lead to an unsatisfactory breast shape result due to persistent tissue sagging and skin excess. Scars are permanent but will fade over time and most women feel that the improvement in the quality of life from the removal of the breast weight far outweighs the disadvantage of the scarring.

The scar types in breast reduction are shown in the picture below:

A Vertical & B Inferior pedicle

After surgery / Recovery information

How much pain will I have after a Breast Reduction?

After a breast reduction you can expect to go home the following morning. Due to the modern surgical and anesthetic techniques used today, pain relief needed by most patients is usually limited to anti-inflammatory pain medications. Some patients however require stronger tablets which we prescribe for usage only “as needed” (these are rarely used by most patients). Generally there is moderate pain and discomfort for the first 2-3 days and many women describe the type of pain similar to the discomfort that they feel after a very intense workout of their chest muscles. After the first couple of days, the discomfort becomes more of a slight “pulling” or “heaviness” sensation. In all techniques, the pain of the surgery is generally short-lived after which most patients are definitely fine by using only anti-inflammatory medications.

Are there surgical drains placed during a breast reduction?

Yes, usually surgical tubes (drains) are needed after a breast reduction and specifically one small soft tube is placed on each breast which exits at the outer breast close to your armpit area. There is usually a moderate amount of postoperative fluid that needs to be drained by your body and not placing drains would expose you to a high risk for seroma (fluid accumulation) or infection. The surgical drains are easy to handle and you will be instructed in detail about them. The drains are usually removed 4-6 days after your surgery with a simple office procedure that is pain free.

How is the recovery after I leave the Hospital?

When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or sports bra may be worn to minimize swelling and support the breasts so you feel more comfortable and secure. Most patients are able to do most of their regular activities in 5-6 days and can expect to be back at work in 8-10 days. The wounds are closed with absorbable sutures and special surgical paper tape (steris-trips). We strongly advise you to wear a soft sports bra at all times for at least 4-6 weeks after surgery. If you have any concerns or if you are worried about anything please call us promptly or visit our office. You will be seen again the day after surgery, then 3 days later and for the drains removal and then ten days to two weeks after the procedure. Ideally we should see you again at 4 weeks, 2 months, 3 months, 6 months and 1 year after surgery. You will then require an annual check up.

How will the breasts look during recovery?

For the first month the breasts are generally swollen and the breasts ride a bit high. It may take two to three weeks for the breasts to drop down into the surgical pocket and for your breasts to look more natural. However, you should be socially presentable 10 days after surgery, even with light clothing. Sometimes there is some bruising that usually resolves within the first week after surgery. Also the incisions are a bit red in the beginning and it may take several weeks to months for the red line of the incision to become pink and then a pale white line which is barely visible in most cases. It is important that the surgical incisions are not subjected to excessive force, pulling or other motion during the healing period. We will give you specific instructions on how to take care of the area and to minimize the surgery risks.

When can I shower?

You should keep the scars dry for the first 10 days until the incision has sealed and completed the initial phase of healing.

What type of exercise will I be able to do? Drive?

Light activities can be resumed almost immediately and you should be able to drive only 7 days after surgery in most cases. You can go back to low impact exercise such as walking and bike riding 14 days after surgery. However, all intense exercise like swimming and bouncing exercises like running should be avoided for at least 8 weeks. This allows for the normal scar tissue to form at the breasts and minimize the risk of them dropping more than desired.

What exactly is the follow-up care after a breast reduction?

You will be seen again the day after surgery, then after 3 days and then ten days to two weeks following the procedure. Ideally we should follow-up on your progress again at 4 weeks, 2 months, 3 months, 6 months and 1 year after surgery. You will then require an annual check up.

You will wear sports bras at all times for at least 4-6 weeks and then day only for 8 more weeks to support and gently compress the breasts as they are healing. We encourage you to come in and see us if you are worried about anything.

Risks of Breast Reduction

What are the risks of Breast Reduction Surgery?

Complications from breast reduction surgery are rare and by far most patients that undergo this procedure experience a very safe medical process and enjoy a long-term result without any problems. However, complications can occur and we explain them in detail during your consultation visit. This is why you need to be extremely careful when select your plastic surgeon. Doing your homework in terms of surgeon selection is by far the most important choice you will make.

American-Board Certified surgeons spend a very large part of their surgical training and maintenance in learning on how to adequately prevent, diagnose and effectively manage the various complications of surgery. The rigorous evaluation and examination of doctors by the American Board of Plastic Surgery requires that all US-certified doctors undergo in-depth continuing medical education focused specifically on patient safety and clinical complication management. ABPS surgeons have profound knowledge on how to avoid complications and deal with them in the best way. And this is why choosing an American-Board certified surgeon can make a big difference for you.

Your safety is our first priority. We work very diligently and meticulously in order to prevent complications and we utilize the most updated medical knowledge and current surgical techniques for this purpose.

Your HAPSI plastic surgeon will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications. The risks of breast reduction and breast reduction complications include:

Unfavorable scarring. This is the most significant risk as large incisions are frequently needed in order to perform a breast reduction surgery.
Infection
Changes in nipple or breast sensation, which may be temporary or permanent
Anesthesia risks
Bleeding (hematoma)
Blood clots
Poor wound healing
Breast contour and shape irregularities
Skin discoloration, permanent pigmentation changes, swelling and bruising
Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
Breast asymmetry
Fluid accumulation
Excessive firmness of the breast
Potential inability to breastfeed
Potential loss of skin/tissue of breast where incisions meet each other
Potential, partial or total loss of nipple and areola
Deep vein thrombosis, cardiac and pulmonary complications
Pain, which may persist
Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
Fatty tissue deep in the skin could die (fat necrosis)
Possibility of revisional surgery

YOU SHOULD ALSO KNOW THAT:

Breast reduction surgery can interfere with certain diagnostic procedures like mammography. Frequently calcifications due to internal scarring are observed. However, an experienced radiologist should be able to distinguish if the lesions are suspicious.
Your ability to breastfeed following reduction mammaplasty may be limited. Talk to your HAPSI doctor if you are planning to nurse a baby.
Changes in the breasts during pregnancy and with significant weight fluctuations can alter the outcomes of a breast reduction surgery.

Long-term information

How long do the results of a Breast Reduction last?

Breast reduction results last for a long time. You will feel that your quality of life has improved significantly after the pain and discomfort of your large breasts are gone. Also, for many years to come your breasts will always look much better than they would if you didn’t have the procedure. However, aging and gravity continue and they do cause the breasts to change over time in terms of their tone, elasticity and shape. Several factors such as weight gain and loss, pregnancy and/or breast feeding, your genetics and your tissue characteristics will influence the longevity of the results. Not wearing a supportive bra will also lead to earlier drooping. It’s especially important to wear a bra while exercising or jogging if you want to maximize your breast reduction results. Finally, as pregnancy and other weight changes negatively affect breast lift results, it is better to avoid having this procedure until your weight has stabilized.

Does breast reduction affect mammograms and breastfeeding?

Mammograms should be continued after breast reduction for women in the appropriate age range (usually over 40). It is very important that you advise the technician if you had a breast reduction. Mammogram’s imaging process is generally not affected and modern mammography techniques are able to visualize your entire breast without problems. However, frequently calcifications due to internal scarring are observed inside the breast but an experienced radiologist should be able to distinguish if the lesions are suspicious.

Usually there is some effect on breastfeeding and the ability to produce milk after breast reduction. The amount of milk produced may be affected or may be completely compromised. We use all techniques for maintenance of your breast ducts and functional gland in order to decrease the possibility of this happening.

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T +30 210 6854799

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T +30 210 6854399

SAFETY · NATURAL RESULTS · EXTRAORDINARY CARE

Breast reduction

Introduction and basic information about breast reduction

Before surgery information

Surgery information

A Vertical & B Inferior pedicle

After surgery / Recovery information

Risks of Breast Reduction

YOU SHOULD ALSO KNOW THAT:

Long-term information

Surgical services

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SAFETY · NATURAL RESULTS · EXTRAORDINARY CARE