Breast reduction surgery

Breast reduction is a surgical procedure used to reduce the size and weight of large breasts. Also called reduction mammoplasty, the procedure involves removing excess breast tissue as well as relocating the nipple and reshaping the breast. Although the procedure is sometimes done in men, we'll focus on the reduction of female breasts.


Indications
Breast reduction surgery is used to:
relieve pain in the shoulders, breasts, neck and back from the weight of large breasts

help prevent bra strap grooving and skin irritation under heavy breasts

modify a breast to match surgical alterations in the opposite breast

improve appearance and body image

Patient preparation
Your doctor will ask detailed questions about your medical history and your expectations from the surgery, as well as explain the procedure and describe any possible complications. Measurements and photographs of your breasts will be taken to serve as a point of reference. Your doctor may want to have a unit of blood on hand during surgery. If you'd like to donate your own blood ahead of time, it must be done at least one month before the procedure. Ask your doctor for details.
Shortly before surgery, you will probably have a mammogram (a specialized, low-dose X-ray of the inner structures of the breast). This preoperative mammogram will be useful for comparison to later mammograms. Your doctor may also order blood and urine tests, as well as an electrocardiogram (a recording of the electrical activity of the heart) or other studies. The type of tests you have will depend on your medical history and health status.

If you smoke, youly be asked to avoid smoking for a certain period of time before surgery because smoking decreases blood flow to the skin. You may need to avoid eating or drinking anything after midnight the day before surgery -- the doctor or anesthesiologist will give you the details. Make sure to inform the doctor about all the medications you take, including prescription and over-the-counter medications, as well as dietary or nutritional supplements.

To ensure proper healing, your doctor may suggest limitations on exercise, driving, returning to work, lifting your arms and heavy lifting after surgery. To help you prepare for your recovery, it's best to discuss these restrictions ahead of time. Finally, arrange to have someone help you at home after surgery.


Procedure
Although every surgery has its own standard procedure, your individual health history could play a role in any variation to the procedure. Discuss these issues with your doctor.
Breast reduction surgery is typically done by a plastic or reconstructive surgeon as an inpatient procedure under general anesthesia, which induces a temporary loss of consciousness. In some cases, it's done on an outpatient basis.

Although techniques vary, the most common approach is to begin by making a cut around the nipple and areola (the darker area of skin surrounding the nipple). From the nipple, the incision continues down the underside of the breast. The surgeon then removes excess tissue, fat and skin and repositions the nipple and areola higher on the breast. If necessary, the areola may also be reduced and liposuction may be used to remove excess fat from the armpit area. Sometimes drains are placed in the incision to prevent fluid or blood from collecting under the incision and causing complications.

Once surgery is complete, the incisions are closed with stitches and the breasts are bound with a dressing and surgical bra. The surgery typically takes two to four hours.


Postprocedure care
You'll probably be uncomfortable after the surgery, especially when you move around or cough. Expect the pain, swelling and bruising to begin to fade within a few days. In the meantime, pain medication and ice packs can be helpful. You may be able to go home the day of the surgery or the following day. Your dressing and drains will be removed a few days after surgery, but you'll probably need to wear a surgical bra around the clock for about a month.
The stitches will probably dissolve on their own or be removed seven to 10 days after the surgery. To ensure proper healing, follow your doctor's recommendations on exercise, driving, returning to work, lifting your arms and heavy lifting.

Your first menstrual period after the procedure may be quite painful due to breast swelling, and you may notice shooting pains in your breasts for a few months. Recovery can take up to two or three months. It may be a few more months before sensation returns and your breasts take on their final shape. Your doctor may recommend another mammogram about six months after surgery, to be used for comparison with future mammograms.

Call the doctor immediately if you notice increased bleeding or drainage in the surgical area or any signs of infection, which include:

increased redness, swelling, pain or tenderness
drainage of pus
fever
warmth to the touch in the surgical area
red streaks coming from the surgical area
feeling ill

Benefits
Breast reduction surgery can relieve pain in the shoulders, breasts, neck and back. The reduction can also help prevent bra strap grooving and skin irritation under heavy breasts. Many women enjoy an improved body image after the surgery.

Risks
Risks of breast reduction surgery may include:
postoperative bleeding
infection
delayed wound healing, especially for women who smoke or have diabetes
decrease or loss of nipple sensation
reactions to the anesthesia
possible asymmetry of breasts
collection of blood and fluid pockets, known as seromas
fat necrosis (the death of tissue in fatty areas, which may cause lumps in the breast and changes on your mammogram)
death of nipple tissue
Youtheyoften near age 18.


Pregnancy-specific information
The shape of your breasts may change with pregnancy. If youour doctor before surgery.

Senior-specific information
Age itself isn't a risk factor for needing breast reduction surgery. Your medical history and current health status may place you at higher risk for complications, however. Consult your doctor if you have any particular concerns.