Purpose: To reduce the size of the breast and relieve symptoms. Also give better shape to the breast
Length of operation: 3 hour
Anaesthesia: General anaesthetic
Inpatient stay: 2 day
Followup: 1 week, 3 months, 6 months, 1 year
Time of work: 2-3 weeks
Recovery: 4 weeks
Risks: Infection, fat necrosis, asymmetry, bottoming out, nipple sensation loss
This is a common plastic surgery operation for large breasts. The procedure involves removing excess breast tissue, thus reducing breast size. The results are generally excellent with high satisfaction rates. In this description I shall take you through the operation, hospital stay, recovery and the complications. Once you have met me for the initial consultation, I would be quite happy to see you again for a second consultation, so that you can clarify any of your doubts.
Procedure / Hospital Stay
It is advisable to stop smoking for 4 weeks and stop contraceptive pill and hormone replacement therapy for 4weeks prior to the procedure. On the day of the operation the surgeon with do skin markings over the breasts. Photographs for documentation and teaching purposes are standard and will be discussed. The procedure is done under general anaesthetic and takes about 3hours to perform. The procedure can be done by either using an anchor shaped scar or a vertical scar. The vertical scar tends to have a curtain top appearance, but settles in the longer term. My preferred technique is the vertical scar method.
While you are in hospital you will have blood tests, fluids through a drip and pain killers. The stitches are all dissolving in nature. At the end there is a bulky dressing on the breasts and a drain in each side. You will feel quite bruised and swollen after the operation and this settles in due course. We take precautions to prevent clots in your calves by putting on stockings and giving you a blood thinning injection. The hospital stay is conventionally 2-4 days and depends on your recovery and drain removal.
Recovery After Surgery
At discharge, the dressings stays on and you need to attend the dressing clinic in a weeks time. The dressing is taken down and you should start wearing a sports bra, day and night for 2 months. You will be given some pain killers to take home. Further dressings may or may not be required depending on the wound. You will be seen again in 3 months time. Photographs will be taken at this stage.
You should avoid smoking for 4 weeks after the procedure. Recovery is individual, but most patients get back to work and driving in 3-4 weeks time. Swimming is usually possible at about 8-10 weeks time. You can wear a normal bra at around 2- 3 months after surgery. The breast size and shape is best assessed at 6 months after surgery.
Overall results are excellent but there are some well know limitations, risks and complications which you should be aware about. Scars, infection and blood clots are risks of any procedure. One can loose some nipple sensation and there is an insignificant risk of losing the nipple. The breast tissue can occasionally react to surgery by forming lumpy areas, called fat necrosis. This generally settles with time.
Breast are never static and will change with age, weight changes and pregnancy. The aim of the procedure is to give you similar breast on both sides, but pre-existing asymmetry is likely to persist, albeit to a minor degree. The procedure may not completely relieve back pain and neck pain, because these could be due to preexisting arthritis. Breast reduction does not interfere with future detection of breast lumps but may occasionally prevent you from breast feeding. Do discuss these issues with me. There is a small incidence of requiring further surgery for prominent scars, but this can be done using local anaesthetic as an outpatient procedure.
My Breast Reduction – A Personal Journey
My decision to take the steps towards a breast reduction took a very long time indeed! After giving birth four times in six years my 34DD breasts took on a very uncomfortable 36GG shape!! I began to have major discomfort in my lower back and became very self conscious about my body shape. Over the years I had become accustomed to people believing they had a right to make very personal comments in very public places. I had put off the first move for many years as I constantly told myself my children were too young and needed me (which happened to be true!) Finally in the summer of 2008 whilst on a two week family holiday my very supportive husband persuaded me that the time had come to make a decision. For every tentative problem I would present (How would you all manage? What would people think? They would just think I was being vain! I would need so much time off work!...) he gave me a positive answer – the time had come to face my very personal journey.
The referral by the GP and my first consultation with Mr. Azad came in relatively quick succession. I found Mr. Azad to be supportive and, joy of joys; he gave me a positive answer to my request. Over the Christmas period I had plenty of time to think about things and I do believe anybody wanting a reduction really should think carefully as it is major surgery with a necessary recovery time.
I went into hospital for my operation on Sunday 22nd Feb 2009 and was first on the operating list the following morning. The visit by Mr. Azad and his team on the actual morning was very reassuring and I felt confident going into theatre. The next thing I remember was coming around in recovery and being taken back onto the ward, then my husband coming to visit that afternoon. As I suffer from vertigo I was warned the anaesthetic may affect this – and it did!! For me personally the sickness after the surgery was far worse than any of the initial pain. Pain relief was given with reassuring frequency and on discharge I felt confident I could manage this.
My recovery rate at home was certainly down to the care of my extended family. This I had put in place before the surgery. I also have a very good friend who is a nurse and she would reassure me when I had any anxieties. I took a total of four weeks off my teaching post and felt ready to return to work. I suffered no severe pain or infections and can only say this surgery has revolutionised my life!! Friends and family constantly tell me how well I look. Those who do not know me so well look quizzical and ask if I have lost a lot of weight!
For all my soul searching (and I once more stress this was an important part of my journey), I can only say I feel so very positive about myself. To look at oneself in the mirror and see someone very different looking back was a very strange experience in the early days. But I only have positive things to say about the care, concern and outcome of my reduction!
TF (Patient of breast reduction)
- Ensure that you wash your hair and shave your armpit the night before or morning of surgery.
- Ensure that you have bought a couple of sports bras of the anticipated size. You will need this after the first week at the first dressing change.
- Simple pain like a combination of codeine and paracetamol are best. Avoid using ibuprofen or diclofenac, because they thin the blood and can cause more bleeding and bruising after surgery.
- Any bleeding, discharge, undue pain or unusual breast hardness after surgery; please contact the team or contact numbers given straightaway.
- The dressing which acts like a brassiere is completely removed only a week after surgery and you can go into your elasticated sports bra. This must be worn day and night for 3 months. The bra provides external support and reduces discomfort. It helps as well in letting the swelling settle down earlier.
- During the first week after surgery keep your wound dry as water can seep below the dressing and cause maceration. It is a good idea to make a bra from cling film and then take a shower.
- It is common to have swelling and bruising after any form of breast surgery. This will settle in due course.
- It is quite important to use and move your shoulder after breast surgery. The anticipation of discomfort can make one stiffen at the shoulder and for this reason gentle shoulder movements should be started straight away.
- Do not drive during the first couple of weeks after surgery.
- It is advisable to avoid unnecessary activity, stretching or any strenuous exercise for at least the first few weeks. Aerobics and swimming can be done at 3 months post surgery.
- For sedentary occupations, you can return to work in 2-3 weeks. You will know when you are ready and do listen to your body which will tell you what to do.
- Massage with a good bland moisturizing cream (E45/Doublebase/Diprobase) helps the scars to settle down. This should be started about 2 weeks after surgery.
- Protect the scars from the sun by using sunblock for at least 2 years. This prevents them from getting pigmented.
- Ultimate breast size and shape is best assessed only 6 months after surgery. You can however go in for definitive lingerie at about 3 months when the breasts are reasonably settled.
- If the scars are getting lumpy they may need additional treatment. Please contact Dr Sanjay Azad.