Breast Reduction
If you have large breasts, it's likely you experience pain, whether it's in your back, neck, shoulder, or your breasts. If this sounds familiar, you are a candidate for breast reduction surgery.
Choices
For the vast majority of women, making your breasts smaller improves most (if not all) of your breast-related symptoms.
Because the majority of breast tissue is fat, the goal of treatment is to remove volume, while preserving breast gland (milk producing) tissue. Removing breast tissue improves your symptoms, but may not lift your breasts. Both excess breast tissue and breast skin can be removed, resulting in breast elevation, but with the cost of longer incisions that removing breast tissue only.
Liposuction and Ultrasonic Resection
Breast tissue only removal is accomplished by either liposuction or by ultrasonic resection. Only 1 or 2 small incisions are required for either technique.
Ultrasonic resection is similar to ultrasonic assisted liposuction. Ultrasonic energy has two effects on breast fat: 1. Some fat is liquefied, and 2. Other fat was "loosened." The treated fat is then vacuumed away, reducing your breast size. While excess breast skin is not removed, "tightening" of the skin occurs, but the extent of skin tightening is not always predictable.
While there is no evidence that ultrasonic energy can cause breast cancer, it may take 30 years (or longer) to definitively establish if there is any increased risk. It is possible that retained breast fat may leave shadows on a mammogram that could be confused with early breast cancer.
Liposuction breast reduction has more limited use. You must meet certain mammographic and size criteria. Higher levels of suction, and more aggressive instruments are needed that when ultrasonic treatment is used.
"Open" Breast Reduction
Open breast reduction has the benefit of long-term follow-up, but requires scars around your nipple, extending from your nipple to the fold beneath your breast, and in the fold beneath your breast. Breast volume from you nipple to beneath your breast fold (approx. 10-cm wide) is preserved. Remaining breast tissue and excess breast skin are removed. Scars may range from as thin as a pencil line to as thick as the pencil. If your breasts are especially large, you have a greater risk of experiencing complications from surgery.
Surgery
Surgery is performed as an out-patient. Your breasts are often marked before surgery. To remove any blood or fluid collecting after surgery, drainage tubes may be placed during surgery. Drains are typically removed before you are discharged from the hospital.
Your old brassiere is used as part of your dressing. The difference between what you were and your new breast size is made up with gauze.
Before discharge from the hospital, you must meet certain simple criteria: your pain must be controlled by oral pain medication, you can eat and drink without nausea, and you can go to the bathroom without becoming dizzy. If you experience difficulty at home, you are to call my office.
Care at Home
At home, you should rest, allowing your body to recover from surgery. Activity will be dictated by comfort. You may shower the day after surgery. Maintain breast support, either with your current bra (with padding), or with a new bra. Some drainage is normal. Excessive drainage should be reported to the office.
Return to Work
Most patients can return to work within 7-10 days. If you have a physically demanding job, you may need more time to recover. On average, it takes 3-6 months for you breasts to assume a more "normal" look and feel. Complete healing takes up to 1 year.
Further Surgery
For excessively large breast, some form of "touch up" surgery may be needed. The most common problem is persistent fullness under your arms. If needed, this can often be performed in the office under local anesthesia.
Risks of Surgery
The risks of surgery are the same as any other surgery. They include bleeding, infection, scarring, altered sensation, asymmetry, and possible need for additional surgery.
Cancer Monitoring & Treatment
Reduction surgery does not change your cancer risk. Recommendations for breast cancer surveillance are unchanged: monthly self-examination, periodic mammograms, and examination by your doctor. Your new baseline mammogram can be done 1 year after surgery.
Should you develop breast cancer, it is likely you may require a mastectomy, rather than a lumpectomy.
Pregnancy & Nursing
Your breasts will respond to the hormone changes of pregnancy the same as if you never had surgery. This means that you may experience breast droop or loss of additional breast volume. If you are considering becoming pregnant, be sure to consider the effects of pregnancy on your body.
Since the milk production and collection system is not completely removed, you can consider nursing (should you become pregnant after surgery). With nursing, spotty areas of breast engorgement are common.
Weight Change
If you gain or lose significant amounts of weight, your breast size and shape may change.