Breast reduction (Mammoplasty surgery) can be defined as the surgical reduction of breast volume to achieve a smaller aesthetically shaped breast mound. There is evidence to suggest that breast reduction may reduce the individual risk of breast cancer.
Younger patients normally come with psychological issues and personal embarrassment and are the key elements in their decision to seek surgery. Large breasts are difficult to assess for swellings and lumps, thus making cancer detection difficult.
Indications for Breast Reduction Surgery
Very large breasts causing shoulder pain and/or backache is a primary indication for breast reduction surgery. Severe embarrassment, physically or sexually and infections below the breast are also indications for surgery.
Less common indications involve inability to exercise due to breast discomfort, inability to find fitting clothes and grooving of shoulder by bra straps. The goal of reduction mammaplasty is to reposition, reduce, recontour and reshape the breasts. The breast gland is reduced and lifted. The nipple areola complex may have to be reduced in most cases. Reduction Mammoplasty can be carried out at any age after breast development.
Breast Feeding After Surgery
Only certain segments of the breast gland are removed during the surgery. The milk carrying ducts are not disrupted by the surgery. This means that the breast feeding potential in young patients is maintained to a large extent. Many young women with large breasts tend to be poor breast feeders. This would continue after the surgery too. Those who are able to breast feed after Reduction Mammoplasty, may not be able to nourish their children completely by breast feeding
Breast Reduction and Breast Cancer
A significant portion of the breast tissue is removed during the surgery. This causes a reduction in the chance for breast cancer after breast reduction. Regular screening and check ups should be continued after the surgery, as the cancer risk is not nullified. Mammography findings will be slightly altered after the surgery due to scarring and calcium deposits. Cancer detection rates are not significantly altered by Reduction Mammoplasty if regular screening using physical examination and mammography are done.
Breast Reduction Procedure
Pre operative planning for the surgery is meticulously done with the patient sitting up. The amount of skin and breast tissue to be removed and the placement of the nipple are pre marked. The procedure is performed under general anesthesia. The surgery takes about 3 – 4 hours to complete depending on the amount of breast reduction and the technique used.
The technique used will depend on the volume of the breast to be reduced and the amount of skin sagging to be corrected. Liposuction may be employed as an adjunct in some cases, when there are easily accessible significant fat stores. The vertical short scar technique is the preferred method in our centre.
Very large Reduction Mammaplastie may require inferior pedicle reduction which will leave an anchor shaped scar. We prefer to perform Reduction Mammaplastie as a hospital based surgery.
After Breast Reduction Surgery
There will be fluffy dressing on the breasts after the surgery. You can start walking about within a few hours of the surgery. Tube drains inserted during the surgery to remove fluid collection within the reduced breast tissue is usually removed in 48 – 36 hours.
The post operative period is usually pain free and a tight pulling feeling on the chest is to be expected.
You can get back to desk work/light work in about 10 – 14 days. Physical exertion is to be avoided for a month after the surgery. Heavy physical activity can be resumed after 6 weeks. Initial follow up visits will be scheduled every couple of days. After the first week, we need to see you only once a week.
You could wear an all cotton sports bra after the initial healing period. Under wired bras can be worn only after 6 – 8 weeks. Driving a car, gym activity or fondling of the breasts are not recommended for 6 – 8 weeks Complications
Major complications are unusual following breast reduction. Minor complications like fat necrosis, delayed wound healing, serous collections in the breast can happen in a small percentage of cases. These problems can be easily tackled. They do not affect the ultimate result.
Decreased sensation on the nipple areola or other parts of the breast and pigmentation changes can occur following Reduction Mammoplasty. This improves naturally over a period of time. Mild breast asymmetry can occur, which is usually not very striking. Nipple loss and skin loss are very rare complications.