Spire Thames Valley Hospital 01753 665434
Spire Dunedin 0118 9553420
Berkshire Independent Hospital 01753 665434

Breast reduction

Probably the most beneficial procedure that we do for our patients, relieving the discomfort and encumbrance of large breasts. Women whose breasts are too large can suffer from a multitude of symptoms ranging from breast pain, back and neck pain, shoulder strap pain to soreness of the skin underneath the breasts. These problems are in addition to the weight and volume of their breasts which is often embarrassing and may cause difficulty in fitting clothes.

These problems can all be relieved with a breast reduction which is a very reliable and safe procedure creating a smaller lighter breast, in proportion to your body and of a size that you wish.


How do we do a Breast Reduction
The aim of surgery is to remove excess breast tissue from the central and lower parts of the breast. The nipple usually requires repositioning and to achieve these objectives I use a surgical technique known as a superior medial pedicle technique. The pedicle is a means of preserving blood supply to the nipple whilst it is elevated to its correct position and allows the new breast to be shaped around it.

The superior medial pedicle is the most reliable way of preserving blood supply to the nipple and is also the technique which has the best chance of preserving feeling to the nipple. It also gives greater flexibility in determining size and shape of the new breast. The incisions and scaring are shown in the diagram below.



Sutures are all buried underneath the skin and absorbed by your body. The final closure of the wounds is with suture tapes and dressings which remain in place for 7 days.

Surgery is performed under general anaesthetic and usually requires an overnight stay in hospital.

A drain may be used to remove excess fluid following surgery. If a drain is used it will be removed before you leave hospital.
Avoiding the horizontal scar
The anchor shaped scar is the usual scar. The horizontal element of the scar in the inframammary fold can be avoided in some patients with relatively small reductions. Avoiding the horizontal scar requires skin to be bunched up in the lower part of the breast. This increases the risk of the breast dropping in the early years following surgery and may require a second operation to remove excess skin.

If it is feasible to avoid the horizontal scar with a vertical scar technique this will be discussed with you prior to surgery.
What size will I be following surgery
Your input as to what size you would like to be is vital. The aim is to create a well proportioned breast with the nipple just above your inframammary fold. We aim to create a breast which has a nice natural shape and which is appropriate to your body shape. There are limits as to how small you can go and maintain a good shape to your breasts In patients who have a very broad base to their breasts when a larger breast is necessary if you wish to maintain good projection.

Before surgery we will discuss your expectations as to the size that you would like to be. We cannot guarantee a specific size but usually achieve what a patient wants., There may be a difference of one cup size or occasionally more between your ideal and what we can achieve.

Unfortunately we cannot weigh the amount of breast tissue left but do weigh the tissue removed to maintain symmetry. If you are larger on one side, which is quite common more tissue can be removed from the larger side to compensate.
Aftercare
After you leave hospital the dressings should remain undisturbed for the first week.

Painkillers will be prescribed for you to take home.

You should not drive for 48 hrs following a general anaesthetic but should be up and about with plenty of walking and light activity.

We will see after the first week to check your wounds and remove the dressings. After the dressings have been removed you can resume normal skin care showering or bathing and apply moisturising cream to the wounds.

We will ask you to wear a firm support bra at all times for the first month following surgery and then by day for the next 2 months. It is advisable to always wear a good sports bra during vigorous exercise.

We would encourage you to return to your normal lifestyle as soon as you can following surgery within the limits of any discomfort that you may have. We do however advise against running for the first 2 months following surgery to reduce the strain on the breast and protect tissues from stretching. Exercise on a treadmill or bike is encouraged as is swimming and upper body exercise.

Recovery should be a progressive return to normal activity with increasing comfort and well being. Yours breast will be swollen initially but will soften as time passes.

If you notice a sudden increase in pain or swelling, particularly if you feel unwell it is important that you contact the hospital where surgery was performed so that we can review you to see if you have developed any complications
Complications
A breast reduction is an operation performed under general anaesthesia so it is important that you read the section on complications of anaesthesia and surgery in general.

Specific complications related to a breast reduction are as follows;

Loss of feeling in the nipple.

The nerves that supply feeling to the nipple follow a varied course in different individuals. The nerves are also too small to see and protect. The superior medial pedicle is the best way to preserve nipple sensation in the greatest number of patients but even using this technique 40% of patients will lose feeling in the nipple.

Loss of blood supply to the nipple which may end up with tissue loss.

The superior pedicle is again the most reliable procedure for preserving blood supply to the nipple which is vital to it’s survival. Loss of blood supply with blistering and possible tissue loss is rare using this method.

Smoking

Smoking constricts blood vessels reducing blood supply to the tissues impairing wound healing and increasing the risk of tissue damage. The way that the operation is performed, particularly the creation of a pedicle is in itself a restriction of normal blood supply. If blood flow is further reduced by smoking the risk of complications is increased so it is vital that you avoid smoking before and after surgery.

Ideally you should stop smoking for a month before surgery and until a month after. Vaping is not as damaging but nicotine is the chemical that causes the blood vessels to constrict and therefore vaping should be avoided for 24hrs before surgery and until the wounds are well healed.

Asymmetry

We weigh the tissue removed but cannot weigh what is left behind. Any pre-existing difference in size between your breasts will persist unless we remove more tissue from the larger side to compensate. The need for this will be discussed with you before surgery if necessary.

Even if the volume of your breasts are equal there may be differences in shape which are unpredictable.

Not achieving the size that you want

The size that you would like to be will be discussed with you before surgery as will any limitations that we may expect in the eventual size of your breasts. Immediately before surgery I will plan the operation with you by marking the new position of your nipple on your breast and marking the proposed incision lines. The position of your nipple is very important in determining the shape and size of your new breast.

At surgery we weigh the amount of tissue removed but can only estimate what tissue remains to create the new breast. Asymmetry can be corrected at this stage.

We are usually able to achieve the size that you wish but there may be a difference of one cup size and occasionally more in the final result. It is very useful to know from you whether to err on the larger or smaller size when planning and conducting the operation. Further surgery can be done to remove more tissue if you are too large but the breast can’t be made larger without the use of implants or fat transfer.

Fat necrosis

Breast tissue is being moved about during the operation which can interfere with the blood supply to the tissues particularly in smokers. This can lead to partial damage to the fatty tissues of the breast leaving hard lumps which can be uncomfortable and may require further surgery to remove them.

This complication is fortunately very rare.

Loss of shape particularly in the upper pole of the breast

Over time your breast will soften and settle into a lower position. Individuals very enormously in how much settling will occur and if the settling is severe you will lose fullness in the upper part of the breasts.

Subsequent changes in size.

Your new breast is made of your own breast tissue which can increase or decrease in size as time passes just as your natural breast would have done. Future changes in size are unpredictable and it is not wise to try to guess the future by leaving someone smaller or larger in the expectation of later change.

There is also a variable amount of fat in the breast and changes in body weight will affect breast size just as it would if you had not had a breast reduction. If your weight does fluctuate or you are planning to lose weight it is better to lose the weight first and be at a long term stable weight before going ahead with surgery.

An exception to this guidance is where someones breasts are so large that they cannot exercise to help them lose weight. Careful planning and sizing can then help to achieve a satisfactory outcome.

Unsatisfactory result

Unfortunately we cannot guarantee specific results in relation to the size, shape or symmetry of your breasts. We can however assure you that we will do everything in our control to achieve the best result for you as can be testified by many happy previous patients.

Scars

Inevitably you will be left with scars as shown in the diagram. These are usually narrow and slightly paler than your surrounding skin after the scars have matured.

In the early stages following surgery the scars will look good although they may show some irregularity due to underlying suture material and where skin has to be bunched up to compensate for different wound edge lengths. This bunching will flatten in the first few months.

All scars go through a period of change after surgery with increasing redness and possible thickness as extra scar tissue is laid down in the wounds over the first few months. This usually peaks at around 3 months following surgery with the redness and lumpiness settling over the next year.

If this hyper activity of the wounds is excessive it can be improved with taping and pressure therapy.

The final appearance of a scar cannot be predicted nor necessarily controlled and occasionally a patient may end up with a poor scar.

All the wounds are closed with absorbable sutures. Occasionally a piece of suture material particularly a knot may work it’s way to the surface and need removing. This does not have any long term implications for the wound.

In the area surrounding the nipple the upper layers of the skin are removed preserving the blood supply in deeper tissue. This buries some of the glandular structures in the skin which occasionally form small cysts called inclusion cysts which will discharge onto the surface of the skin resolving the problem.

Mammograms after a Breast Reduction

It is of course vital that you continue to participate in the Breast Screening program if you are of an eligible age. Any scarring following surgery is distinguishable from the signs of early breast cancer. It is probably wise to wait until 3 months after surgery to be screened as the pressure used in screening can be uncomfortable.