INTRODUCTION

The way a woman feels about her breasts is very personal. It is not easy to have to deal with teasing, unwanted attention, ill-fitting clothes, uncomfortable bra straps or not liking the way her breasts look. Oversized breasts or breasts that differ in size or shape from one another, can cause backache, skin rashes beneath the breasts and can be uncomfortable and difficult to live with.

Most women who ask for breast reduction surgery are those who have fully developed breasts. Breast reduction surgery is warranted however, in some younger women who have overwhelming problems with the size of their breasts.

Breast reduction surgery involves removing excess skin, fat and breast tissue from the breasts and reshaping them to give a smaller, firmer and usually more youthful appearance. The nipples and areolae are usually moved to a higher position on the newly created breasts.

There are various techniques for breast reduction, with different incisions and methods for removing and reshaping the breast tissue and moving the nipples.

INCISIONS

The extent of the scars depends on the size and shape of the breasts. Most commonly, scars are placed around the nipple-areola and extend downwards to meet a scar in the inframammary crease. Sometimes it is possible to have a shorter scar. It is important to understand the extent of the scar that is proposed in each individual and for the woman to discuss this with her surgeon.

MASTOPEXY (BREAST UPLIFT)

Mastopexy is usually requested by women who have drooping of their breasts after weight loss, pregnancy or loss of skin elasticity with age.

A mastopexy operation involves removal of the excess skin and relocation of the nipple-areola onto a higher position on the newly created breast mound. The resulting scars will be around the nipple-areola and depending on the amount of skin that is excised, there may be an extension of the scar downwards between the nipple-areola and the inframammary crease and along that crease.

ESSENTIAL CONSIDERATIONS AFTER BREAST REDUCTION SURGERY OR MASTOPEXY

Breast feeding and pregnancy

It is uncommon (but sometimes possible) to be able to breast feed after breast reduction surgery. This depends on the number of milk ducts left intact after surgery and whether the nipple is still connected to them. Breasts may normally enlarge by as many as 3 bra cup sizes during pregnancy. This can still occur after breast reduction surgery.

Age and changes in body weight

Results from breast reduction surgery are best when patients are at their ideal body weight when the surgery is performed, as any subsequent weight changes will change the size and shape of their breasts. Skin loses elasticity, breast glandular tissue involutes (becomes thinner) and breasts may become droopy with age. Reduced breasts will also change with age and when there is an alteration to general body weight.

Mammography

Screening mammography for the detection of breast cancer is currently offered to women aged 50-64 years in the UK. Breast reduction surgery will leave scar tissue within the breasts and it is important that the woman informs the radiographer and doctor that she has had previous surgery to her breasts. Breast reduction surgery does not increase the risk for a woman developing breast cancer.

Sensation

Nipple sensation is altered in about 15% of women after breast reduction surgery. Sensation can be reduced, heightened or lost. These changes in sensation can be temporary or permanent.

Sexuality

The enhancement of physical appearance can have immeasurable psychological benefits to a woman in terms of confidence and self-esteem.

Scars

Scars from breast reduction surgery are permanent. Scars go through a phase where they become firm before softening. Some scars become red and wide but usually settle down with time to become less noticeable. In a very small number of women, scars can become hypertrophic or keloid. Hypertrophic scars are red and lumpy and take longer to settle down. Keloid scars are those that become raised, wide, and itchy and can grow beyond the original scar. Keloid scars are rare. Women who have dark skin may have scars that have a deeper or lighter pigmentation than their normal skin. Discussion of scar placement with the surgeon before the operation is helpful.

Asymmetry

Most women have some degree of asymmetry between their breasts in terms of size, shape and placement on the chest wall. Breast reduction surgery will attempt to address this but it is not always possible to achieve perfect symmetry.

Cleavage

Symmastia is an uncommon naturally occurring condition. It may not be corrected by breast reduction surgery alone.

COMPLICATIONS

While complications are uncommon after breast reduction surgery or mastopexy, it is necessary for women to be aware of them and the possible need for further treatment if they occur.

Infection

Infection can occur after any surgical operation. If it happens, treatment usually involves antibiotics and rarely, a further operation in order to clear the infection.

Bleeding or haematoma

As with any operation, there is a small risk of bleeding that can cause pain and swelling. If a haematoma forms, a further operation may be necessary to control the bleeding and remove the accumulated fluid. This usually happens within the first week after surgery.

Nipple loss

The nipple-areola is usually relocated to a higher position on the newly formed breast mound in breast reduction surgery. It is left attached to its original blood supply. Occasionally this blood supply may not be sufficient in the new position. A further operation may be required to replace it as a free nipple graft.

Fat necrosis

If the blood supply to the refashioned breast fat is insufficient, some of this fat may die and cause a delay in wound healing. A further operation to remove this tissue or repeated wound dressings may be required.

Women who are most pleased with the results of their cosmetic surgery are those who have had it done for themselves rather than for anyone else. It is important to find out as much as possible about all the possible options when undergoing any surgery and to have a thorough discussion with the surgeon about the complete process. Cosmetic surgery can have immeasurable benefits to a woman in terms of her self-esteem and confidence.