Breast Reduction

Mr Nassab will take a history from you to determine your concerns and learn about any medical problems or medications you may be taking. It is important to know if there is any family history of breast cancer. If you have had mammograms then it would be useful to know when these were taken and the outcome of these. Mr Nassab will examine the breasts and discuss what you hope to achieve from the surgery. It is often difficult to discuss changes in terms of cup sizes since bra manufacturers all have different sizing. This will, however, help understand how much of a reduction you would like to achieve. We will then discuss what technique of breast reduction would be suitable for your needs. Mr Nassab will then highlight the potential risks of the procedure.

Breast reduction has two main components, which are the skin incision pattern and the pedicle. When a breast reduction is performed the nipple is moved to a new position. The blood supply and tissues supporting the nipple are often called the pedicle. The main pedicles types used are the superior, superomedial, and inferior pedicles. The skin incision pattern will determine the type of scars you will have from the breast reduction operation. You will always have a scar around the nipple areolar complex. In some cases, a vertical scar may be used where you may only have vertical scar running from the areolar to the breast crease or inframammary fold. Sometimes a small horizontal scar may be used if there is some excess skin resulting in the short scar pattern. Traditionally, the inverted T pattern is used where you will have a scar around the areolar, a vertical scar and horizontal scar running along the inframammary fold.

There are always potential risks and complications associated with surgery. Complications are rare but can occur. The main complications of breast reduction surgery include:

Bleeding

Bleeding can occur after your procedure and oozing from the wounds is common. Some bleeding can accumulate under the skin resulting in a haematoma or blood collection. Small haematoma will usually resolve with time and may not need any further treatment. Larger haematomas, however, may need a return to theatre to remove them and find the source of bleeding.

Infection

Infection can occur and most often can be managed with antibiotics. Sterile procedures and antibiotics given during the operation try to reduce the risk of infection.

Wound breakdown and healing problems

The most common site of wound breakdown or healing delay is the so called T junction. This is the area where the vertical and horizontal scars meet and the point of maximum tension when the breast is stitched closed. If this occurs it may take longer to heal. There are pre-existing risk factors for poor wound healing such as smoking and diabetes.

Scarring

There will be permanent scars on the breast depending on the type of skin incision pattern. Scars can sometimes become hypertrophic or keloid which means they may be raised, red and lumpy. This can occur around the areolar or along all the scars. Patients will usually have a tendency to develop this type of scarring or there may be a family history of abnormal scarring.

Asymmetry

There is always some degree of asymmetry between breasts and nipple areolar complexes. Occasionally, after breast reduction there may be residual asymmetry or patients may become more aware of pre-existing asymmetries.

Change in Nipple Sensation

Due to the nature of surgery and movement of the nipple there is risk of changes to nipple sensation. This is usually reduced nipple sensation after surgery that is often temporary but may be permanent.

Nipple Loss

Very rarely there is risk of nipple loss that can occur when the blood supply to the nipple is disrupted. There is a higher risk of this when the breast is very big and the distance the nipple is moved is longer. In extreme cases, the nipple may be removed pre-emptively and used as a nipple graft.

Fat Necrosis

Fat necrosis occurs when the fat in the breast loses its blood supply. This may result in firm hard areas where the fat has not survived. Small areas often resolve with time.

It is generally said that you will not be able to breast feed after breast reduction. This is because some of the glandular tissue is removed and nipple areolar complex has been moved. There are some cases where patients have been able to breast feed but in general most will not be able to breast feed.

The shape of the breasts will change with time. With time and gravity the breasts will drop resulting in ptosis or drooping. In some cases, there may be ‘bottoming out’ which is the term used to describe fullness at the lower part of the breast. This most frequently occurs when an inferior pedicle is used where the bulk of the tissue is preserved at the lower part of the breast. Should you gain weight or loss weight the shape and size of the breast will vary accordingly. Changes will also occur during and after pregnancy. It is generally recommended that you wait about 6-12 months after pregnancy or breast feeding before undergoing a breast reduction procedure.