If breast asymmetry was present prior to the surgery, the objective would be to improve this asymmetry as a part of the procedure. Following the surgery the breasts will appear pert; 3-4 months following the surgery they will look more natural and will behave accordingly. In the majority of patients wearing a bra although is advised, however, it remains a personal preference not to wear one.
In my 19 years of practice as a consultant plastic surgeon I still do not discuss the cup size following the surgery, as accurately predicting a cup size in my opinion is not scientific and could be misleading. There are too many variables to give an accurate answer regarding a post surgery breasts’ cup in such a scenario. It is, nonetheless, important for me to clearly understand the patient’s requirements and plan to achieve them, respecting that this may not always be possible and if so then to explain to the patient the reasons why
Pain following breasts reduction surgery is usually managed at the time of surgery and as such is mild to moderate in the next 48-72 hours after the surgery. I encourage patients to take painkillers regularly over the first few days following the breasts reduction.
It is also important to say that buying expensive bras or bikinis following the surgery is not advisable until the initial swelling has improved and the conformity of the breasts has settled, which is ~3 months following the surgery.
Following breast reduction surgery I would expect the recovery period to be ~3 weeks in the majority of patients. You are likely to return to driving and work at ~3 weeks. The stitches, which are dissolvable, are trimmed and the wound is checked at 10-12 days after the operation.
It is important to explain that the practice of surgery is not an exact science and no results can be guaranteed; however, it just as important to emphasise that patient care and safety in addition to achieving excellent outcomes are of utmost importance to any plastic surgeon.
Hence, as a part of your surgical journey, an integral part of your care is the process of informed consent. The informed consent is not just a piece of paper you sign; however, it is a process, which commences from the first time you attend clinic until discharge.
Information about breast reduction surgery during your pre-surgery consultations should include discussion about the scars- extent and locations, benefits of the surgery, in addition to potential risks and complications associated with the surgery. Expected outcomes of the surgery are also discussed.
Surgical Incisions:
The incisions are around the nipple areolae and vertically downward, including a transverse scar at the level of the fold in the region where the bra wire sits, known medically as the inframammary fold. This scar pattern is traditionally called Wise pattern, named after its innovator. In some cases and techniques the transverse scar is disposed off and the remaining scars may be given the name “lollypop”, as it looks like one.
It is important to say that the visible scars, when sitting or standing without a bra, are the scars around the areolae, and the upper aspect of the vertical scar.
The benefits of the surgery:
Breasts reduction surgery to reduce the breasts size helps improve a patient’s quality of life, and has a high satisfaction rate. It reduces symptoms relating to poor posture, and chaffing under the breasts. Further improvements include smaller and easier purchasing bras.
The breasts volume and weight reduction means that the shoulder straps dig into the skin less. Patients following breasts reduction experience improved ability to exercise with more freedom. Patients following this surgery also report improved self-confidence. The surgery help achieve better body form harmony and proportions.
Potential risks and complications:
Any surgery has associated risks and potential complications. Such potential adverse effects may include bleeding in a small percentage of patients leading to a collection of blood known as haematoma warranting a return to the operating theatre. Infection, which may occur in 1-2% of patients and some cases antibiotics are prescribed. Keloid/hypertrophic scarring, which are thick lumpy itchy scars. These types of scars may occur in 3-5% of patients. Seroma, (a collection of fluid under the skin) can occur so can visible asymmetry, the latter is more common in asymmetrical breasts.
Deep vein thrombosis (clots in the leg), pulmonary complications, on occasions life threatening complication, allergic reactions and anaesthesia related complications may occur, however, these are very rare; nonetheless, they should be discussed during the presurgical consultations.
prior to the surgery. Neither the breast’s cup/ size nor the cleavage proportions or the symmetry of the breasts could be guaranteed.
Other risks and potential complications include the loss of the skin of the nipple areola complex. This can occur in 1-2% of patients. If this happens it mean a longer recovery period with repeat dressings and possibly further surgical interventions. This is more common in more susceptible patients with conditions like chronic obstructive airway disease. Wound dehiscence is an uncommon occurrence following breast reduction surgery; however, if it occurs it is treated conservatively with dressings and tends to settle well.
In 2-3% of patients painful lumps may appear after surgery known as fat necrosis. This latter process in a large number of patients is self- limiting but may take a number of months to resolve. Fat necrosis tends to be more common in the larger fatty breasts especially in the older patients with other comorbid conditions like diabetes.
Swelling is expected after this surgery, which will take up to three to four months to settle, but in some individuals it may take much longer. Fullness in the breasts cleavage area and/or the outer aspect may occur. This swelling is classically called “dog ears” and tends to be more common in the larger and wider breasts. In rare occasions, these “dog ears” may need to be excised if not resolved, usually after one year.
Numbness of the breasts’ skin and nipples is expected after this surgery, in most cases the sensation may return to the nipples. Breast-feeding ability is unlikely to be achievable in 50% of patients after this procedure; however, this only applies to patients of childbearing age.
The wound is expected to stay dry until the first dressing when further instructions would be given. The hospital stay is usually 1 day and drains are used, which are normally removed after 24 hours, however, in some patients they may have to stay longer.
Prior to breasts reduction surgery and in women aged 40 years and above it is recommended to undergo a baseline mammogram. It is also important that smoking ceases 4 weeks prior to the surgery and for a minimum of 3 weeks following the operation. The combined contraceptive pill will have to stop one cycle prior to the surgery and recommence 3 weeks following the surgery, and other precautions must be taken. HRT will have to stop 4 weeks prior to the surgery and recommence 3 weeks after. Majority of herbal remedies will need to stop 3-4 weeks prior to the surgery as they could increase bleeding and bruising.
The information contained in the above paragraphs is by no means exhaustive, and are not to cause concern, however this information is for your benefit in clarifying matters. It is important that you ask questions during your preoperative consultations, and after your surgery. This will further clarify any queries you may have. It is also important to reiterate that most of these risks and potential complications are uncommon in the majority and some are very rare.
