Breast Reduction (Reduction Mammaplasty)
The breast reduction is an operation performed to make the appearance of women breasts more aesthetic, and to solve some health problems which the over-sized breasts brought. The problems are back pain, pain in wrists, excessive transpiration under the breasts, rash and infection. Breast reducing is one of the most performed operations of plastic surgery procedures and it is a life quality increasing surgery regardless from its reason. The reasons of having overly large breasts can be hereditary, hormonal, may be caused by over-weight or not to getting thinner after the pregnancy.
To have overly large breasts can cause to ,
Posture defects (being hunchbacked) ,
Back and neck pains ,
Apathy and power loss in hands (depends on the hand-arm nerves compression in the shoulder area) ,
Rash and bad smells under the breasts ,
Pressure marks on the shoulders because of the bra holders ,
Psychosocial problems especially in teenager period ,
Can not be able to make the sport activities because of the overly large breasts and according to this it causes to obesity.
There is no age limit for this operation. The breast reduction surgery will be made when the breasts are completely developed (it shouldn’t be grown during the last six months). But there are some exemptions. For the young girls in puberty, if the breasts are overly large, the surgery must be necessary for preventing the negative psychosocial affects. Today, 12,5% of the whole breast reduction surgeries will be performed during the puberty period. For advanced ages, the increased risks of the surgery must be compared with the necessities of the operation, and then it should be decided to perform it or not. You have to ask the following
questions before surgical operation:
If the growing of the breasts caused by a hormonal problem
If the growing of breasts continuing
If there is a painless or pain-creating bulk in the breast which can be felt by the hand
If the breast had an infection or surgical operation in the past
The technique which will be used in the surgery varies according to the size of the breasts. The techniques of the breast reduction surgeries are affecting the short- and long-term results of the operations.
Even each of the technique has its own advantages and disadvantages, the decision will be taken according to the surgeon’s preference or by a mutual agreement of the patient and surgeon. However, the following criterions must be taken into the consideration before the determination of
The placement of the breast areola and breast nipple to the new position on the upper breast area must not defect the blood circulation support or revitalization of the structure.
The techniques which are preventing the breast nipple sensitivity must be preferred.
The suckling functions must be kept according to the patient.
An aesthetic breast form must be created after the necessary amount of breast tissue has been removed.
There are various techniques which are realizing these principals. Naturally, all surgical techniques have their own advantages and disadvantages. One of them is Lejour technique.
The Lejout technique takes its name from the person who popularized this technique. Lejour describes this technique as better aesthetic results producing, safe breast reduction technique.
But this technique has disadvantages like scar revision under the breast curve, delayed wound healing, to have the planned breast form realization in a very long time and especially for excessively large breasts revitalization of the breast nipple and sense losses on the nipple. Besides that, when this technique has been applied, the vertical scar can be lengthened during the years and creates a form defect called bottom-out deformity in long term.
We prefer to use the central pedicular technique for our patients. Our aim is to form the breast tissue and breast skin separately and closing the skin like a cover without tension and minimizing the scar. If the breast is not too sagged, it will be finished with a vertical scar. If the distance between breast nipple and collar bone is too long, then it is necessary to make a “T” scar. Even that it is a “T” scar, it will be placed as it can be covered under a triangle formed bikini.
With this preferred technique a long lasting, well shaped and raised breast will be produced without harming the nipple sensitivity and suckling features. On this technique the operation will be successfully and long termed.
Even there are various breast reduction techniques, the following procedures will be performed during every kind of breast reduction surgeries:
The planned amount of the breast tissue will be removed from the breast.
The breast nipple will be moved to its normal position on the upper part of the breast. If the areola is too large, it will be reduced.
If the breasts are asymmetrical (if one of the breasts is larger, or they are not in the same level etc.) this will be corrected as much as possible.
The relation between Breast Reduction Surgery and Suckling Feature: For normal suckling, it is necessary to have the functional breast tissue which is connected to the milk channels and breast nipple, and the nipples must be sensitive. It is not possible to harm the suckling features with an operation that protects the anatomical and physiological characteristics of the breast.
When the baby excites the nipples, it creates contractions on the milk glands with a hormonal and neural cycle in which the prolactin and oxytocin hormones are playing their roles, ant the milk will be secreted. For having this suction reflex, the nipples must be sensitive. If the sensitivity of the nipple lessens, it may defects this cycle and negatively affects the milk secretion.
But during the controlled studies in the recent years, it has been determined that the insensitivity of the nipple was higher during the first month after the operation, but it increased during the following months and healed. It should be designated that the women who have overly large breasts have lower nipple sensitivity against vibration and pain.
If the nipple has been separated from the breast tissue and applied as n independent patch, the sucking will not be possible. In almost all of the breast reduction methods today, a part of the breast nipple will be kept in connection with some breast tissue, the sucking function will be protected, but the amount of the sensitivity could be lessened. The element which determines the milk amount, is the breast tissue that has been left in its place and the integrity of the tissue with nipple and milk channels should not be destroyed.
Because, the most parts of the removed amount during the breast reduction surgery, is the fatty tissue. Therefore, it has been shown that the sucking is possible after the breast reduction surgery that applied with pedicled breast nipple.
The Relation between Breast Reduction Surgery and Breast Cancer: Even that the breast cancer is a common disease of the women, there is no scientific evidence which shows the relation between breast reduction surgery and breast cancer. Moreover it might be said that the reduction of the breast volume and histopathological examination of the removed tissue (on cellular level) is decreasing the breast cancer risk.
Preparing for Surgery
If you think about undergoing such an operation, you must apply to a surgeon for am examination and you have to be informed. As different sizes of breasts will be reduced with different techniques, it is important to have a complete examination and talking about the details with your surgeon.
For example it is very important if you are smoking, if you have any hearth, vein or blood disease or if you have diabetes. As the milk channels will be incised during the surgery –different amounts in each different method- it is also important if you are planning a pregnancy after the surgery. You have to tell your doctor your desired bra size after the surgery, the disapproved points –like the size, asymmetry, overly large breast nipples- etc.
Before the surgery the blood tests for the anesthesia will be made and you will be examined by an anesthesiologist. Your surgeon and anesthesiologist will evaluate if you are medically adequate for this kind of an operation. Additionally it is better to have breast ultrasonography for the patients under 30 years of age, and mammography for the patients over 30 years of age.
You should avoid taking aspirin or similar blood diluting medicaments.
If you are a smoker, stop smoking one week before the surgery, and an additional one week after the surgery. If you have diabetes, your surgeon will decide if he/she performs this operation or not. You should not drink any alcoholic beverages during the last 48 hours before the surgery. The alcohol will decrease your body resistance and will influence the anesthetics. Most important point is not to eat anything during the last eight hours.
The drawing and plan which will be made right before the surgery on the patient in standing position has a vital importance for the result. When the patient is standing, the new position of the breast nipple, the amount of the tissue that will be removed, the form of the breast will be drawn on the breast with pencil and measuring tape.
This measurement and drawing will be made in accordance with the patient’s desired breast size, breast form, and the irregularities and form defects of the –asymmetry, overly large breast areolas and/or nipples, the degree of sagging, the size of the breast tissue- breasts. It is important to make the drawing when the patient stands; because when the patient lays down to the operation table, the breasts will be spread sideward and the form perception of surgeon will be defected. Because of this, the drawings must be made on the stand-up position.
The Operation process
The operation will be performed in the hospital under general anesthesia.
According to the size of the breasts and surgical technique, the operation will take 3-5 hours. After the surgery, all the removed tissues will be sent for the pathological examination.
If there is an undetected tumor or similar existence in the removed tissue, this will be determined in an early stage. Besides that, it has been said that some of the breast tissue will be removed during the operation and this decreases the breast cancer risk.
There are various methods for breast reduction surgery. Regardless of the method, if you compare the breast with pre-operation period, you will see a better formed breast with more aesthetic proportions.
However for having a smaller, good shaped and healthy breast, the patients might accept the scars and the risks about insensitivity on the breast nipple and decreased sucking features.
It is very hard to say the permanency of the newly given breast forms after the breast reduction surgery. This may differ in accordance with the size of the breast tissue, skin characteristics, age, genetic features, and life style. You have to remember that the breast reduction surgery –and all kinds of plastic surgeries- will not stop the aging process. The aesthetic operations will not stop the aging, they are only providing a younger and aesthetic appearance.
The main principals of the recent breast reduction surgeries are forming the breast skin and breast gland separately after removing the excessive skin, fat and breast tissue; placing the breast on its new position by protecting the revitalization of the breast nipple and sense. It is unavoidable to have some scars after the breast reduction surgery.
Generally around the areola, a scar goes vertically down to the breast nipple and ends on the breast groove in an upside down “T” form, or a scar which starts from the nipple and reaches to the under breast line in racket form (vertical scar) will be occurred. This scar is even disturbing at the beginning, but it will be better after a certain time.
These scars are pink-red at the beginning, and if the patient has no pathological wound healing, they will be paled and whitened after a couple of months.
Healing period after the surgery
In the fourth hour after the surgery it will be allowed to eat. After the eating you may stand up. The accommodation period in the hospital is 1-2 days. During the first couple of days you will have drains for collecting the blood and fluids on the operation area. These drains will be removed in 3-5 days according to the fluid amount. It is recommended to make limited arm movements during the first days. First week you will have bandages around tour breasts, at the end of the week these bandages will be removed and only the thin bandages will be used to cover the stitches.
You can take a bath after the removal of drains and bandages.
It is normal to have swellings on the operation area. Sleeping in a half-sitting position will be good to heal the swelling and lessen the possible pains. After the discharging, an appropriate sized athletic bra without metal must be used.
You will have blushing, swelling and irritation on the stitch lines when the wounds are healing. After one or two months the stitch scars will be paled more quickly. After six months or one year the scars will be almost invisible. The possible bruises are temporary and they will be healed in a short period according to your skin type.
For sure you will have some pains, but they can be controlled easily with painkillers. Four days after the operation you can go back to your normal daily life and start to work. The heavy activities like sports must be avoided for 2 months.
After the operation tour back pain will be healed because you don’t have to carry your heavy breasts. You can walk more easily and upright. You will have no rash or bad smelling problems. As the overly large breasts are pulling down your arms, the nerves which are going to your arms and hands will be tightened in the shoulder under the collar bone. This causes to pains in your hands, arms and wrists; and power loss on hands.
You can also get rid of these problems with the breast reduction surgery. When your breasts become smaller, you can have more freedom of action and make sports.
If you have asymmetry problem (if one breast is larger or more sagged, if the nipples have important size difference) these aesthetic defects will also be removed. The patients will be happy as they can wear the dresses that they couldn’t wear before.
As some of the breast tissue will be removed during the operation, the breast cancer risk will also be decreased; besides that, as the remaining breast tissue is lessened in volume the diagnostic of a future breast cancer will be more easy. You will have a more healthy sexual life.
The Risks of Breast Reduction Surgery
Each and every surgical procedure is bearing a certain amount of risks. The breast reduction surgery has also its own risks and complications. It is good to know these risks.
Bleeding: Even that the drains will be placed to avoid the blood accumulation on the operation area, some blood accumulations called hematoma can be occur. This complication shows itself with bruise, swelling and pain on the breast. Generally it may occur on the patients who took aspirin or similar blood diluting medicaments during the last 10 days before the operation.
Infection: This complication is very rear. The source of the infection is generally the bacterium in the milk channels. Normally these bacterium are not causing infections, but they can be spread into the tissue with the incisions of the channels during the breast reduction surgery and cause to the infection.
Commonly if the patient is weak or has an additional disease she also has the infection risk. If the patient has diabetes or anemia or if she is old, the infection risk will be increased.
The most common reason is diabetes. If the breast reduction surgery candidates have diabetes, they have to know that their stitches may poorly heal or some infections may occur. An other reason of these kinds of complications is smoking the cigarettes. Because of that we are recommending to stop smoking for two weeks before and after the surgery.
Poor wound healing on stitches or openings: it will be seen only if the patient has a wound healing problem or weakness. The most common reason is diabetes. It is possible t have some opening on the edges of some stitches or delayed wound healing. Some areas of the breast skin or breast areola can not be healed normally and the healing period can be longer. Even there might be some losses on the skin and nipple tissue.
In this case often dressing or some additional surgeries for removing the unhealed tissue can be necessary. The smokers are bearing more risks about skin loss and wound healing complications. The Insensitivity on the Nipples: According to the used technique, size of the breast and sagging degree, the sense losses may not be occur, may be partial or full.
Asymmetry: Lots of women have natural breast asymmetries. The differences between the breast and breast nipple forms, sizes or symmetrical differences may be noticed after the operation. But your breasts will me more symmetrical then the past after surgery.
Scars on skin: All surgical incisions are leaving scars. The quality of these scars can not be estimated. Abnormal scars can be developed on the skin or deeper tissue. In some cases the scars must be corrected with additional surgical operations or treatments.