Breast reduction is also known as reduction mammaplasty, and is designed to reduce the weight and size of the breasts. A number of women with very large breasts suffer from back and neck ache, rashes underneath the breasts, and difficulty with finding a suitable wardrobe. The operation reduces the overall size of the breast by removal of breast tissue and skin while simultaneously tightening and reshaping it. It also usually involves repositioning of the nipple site to the correct level.
Who is a candidate? You may be a candidate for breast reduction if you fulfil some of the following criteria:
Dissatisfaction or self-consciousness about the largeness of the Breasts associated with one or more of the following:
- Pain in the back, neck or shoulders
- Indentations on your shoulders by pressure from bra straps
- Asymmetry of the breasts (one larger than the other)
- Rashes or skin irritation/fungal infection underneath your breasts
- Size and weight of your breasts interfering with physical activity
- If you suffer from Virginal Hypertrophy of Breasts [see below].
Many women request the surgery as they are sick and tired of the heavy weight as well as the unwelcome attention that large breasts attract. The operation may be performed at any age but generally it is better to wait until breast growth has stopped. The majority of the women come after completion of childbearing. Although childbirth and breast feeding can affect the size and shape of the breasts, some women prefer to have the operation done even before starting a family as they are distressed by the size.
Virginal hypertrophy: there is a condition well known in medical circles but not so well known to the public. This refers to an uncommon condition where young girls develop very large breasts which grow to huge sizes completely out of proportion to their body. There is no medical treatment except surgery. This is correctable by reduction surgery. In such cases, surgery is needed at a fairly young age to spare the girl the physical burden and psychological problems.
The consultation: Consultation involves getting a full medical history and developmental history of the breasts, particularly to know if they are still growing or have stabilized. Any breast biopsies or family history of breast cancer is also significant. You should inform your surgeon if you have a tendency to decrease or increase the size of your breasts with body weight fluctuations. It may be necessary in this case to reach your ideal weight prior to surgery. An examination of the breasts is done noting the size, presence of any lumps, position of the nipple, and quality of the skin. You will be asked about your desired breast size and any other aspects you would like to improve.
Breast reduction does not increase the risk of developing breast cancer [it may theoretically decrease the risk as there is less breast tissue after surgery]. If you there is a history of breast cancer in your family, then we may recommend a mammogram before surgery, and another some months after surgery.
Surgery: The ‘classical’ operation involves an incision which runs around the areola, and then from the lower edge of the areola to the crease underneath the breast. From here, it runs under the natural curve of the breast, lying within the crease (but see below for newer short scar designs). Breast tissue and skin are removed and the nipple areola complex is brought up to its new position usually attached to the breast tissue underneath. It thus can maintain its sensation and the ability to breast feed may also be preserved, however, this cannot be guaranteed.
The ‘newer’ operations all aim to reduce the scars and improve the shape and projection. See below under refinements for details…
Post-Surgery: There is surprisingly little pain in this operation. You will be fitted with a support bra to be worn 24/7 for 2 weeks and for another three weeks during waking hours. Drains, if any, are removed in 24-48 hours, most women are discharged home the following day. Showering is possible if water proof dressings are in place. You could get back to work by 2 weeks and exercising may be allowed after a month.
Results: In the first instance, one would note that the operation does involve a considerable number of surgical scars, however, it is surprising to note how little concern this is of most large breasted women who are very satisfied with the reduction in breast size. In fact, the level of patient satisfaction resulting from breast reduction is amongst the highest of any plastic surgery procedure. Unless one loses or gains significant amount of weight or becomes pregnant the breast size should remain fairly constant. Gravity and the effects of age will alter the shape of every woman’s breasts with time, and a breast "lifting" procedure may be required after some years to restore the more youthful contours. Since the scars will essentially lie in the same place, no additional scarring will take place.
Complications: At the time of your consultation, potential complications will be discussed, including fluid collections, blood collection under the skin, delayed healing, infection and very rarely partial or total loss of the nipple due to poor blood supply. Smokers are particularly prone to this complication and must quit smoking 3 weeks prior to surgery. Following reduction, minor imperfections of size or height of the nipple may be evident when comparing the two breasts; however, these are easily adjusted at a later date.
Refinements: The traditional method is outlined above but is being done less and less by Dr. Mohan Rangaswamy. The global trend now is to use short scar or Vertical Scar Mammaplasty whenever possible. Dr. Mohan has been performing vertical short scar mammaplasty for over 12 years. The advantages are: shorter scar, better shape and projection, no drains and quicker recovery. The down side is that the skin looks wrinkled and folded initially but in over 95% cases this excess skin is absorbed by the body in 1-3 months. 5% of patients need a minor skin revision under local anesthesia after 6 months but 95% avoid long scars.
A further refinement in selected cases is to use only the cut around the areola in a technique called Bennelli round block or Peri-areolar scar method. This is sometimes combined with a small implant. Yet another method especially in minimal reductions is to use auto-implant: breast tissue from the lower segment of the breast is shifted to the upper pole giving more fullness where needed. Finally, fat grafting especially to the upper pole can add further aesthetic enhancement to such breasts which are not only reduced but recreated into beautiful breasts again.
Note: Appropriate Before and After pictures can be viewed during consultation.