Breast Reduction

Large or hanging breasts might cause an aesthetic disproportion to the body appearance and a physical obstruction when performing physical activities. Usually the discomforts are back pain, physical burden, shaving bra-bands but also sweating, heating and eczemas in the breast folds.

Principles: Reduction of the breast gland and its skin envelop and reshape the gland and redrape the skin. The extent of the planned reduction and the sites for the nipples is drawn on the breast preoperatively.

Technique: After the reduction of skin and parts of the glands, the remnants are shaped and further shaping comes with the redraping of the skin.
The scar runs around the nipples, downward in the middle to the inframammary fold and here to the sides like an inverted T or anchor. Depending on the correction needed, variations concerning the scars with shorter scars or scars around the nipples only are possible. The longer the transposition of the nipple is, the longer scars are needed. If needed, drains are inserted and these are mostly removed the day after the operation. A compression bandage is applied over the thorax. This should be kept for 10 days.
The possibility to feed by breast might be decreased. The sensibility of the nipples might be lost.

Anaesthetic: Please refer to "Breastoperations".

Operating time: 3-4 hours.

What happens afterwards?

• In spite of the big operation the postoperative course is rather painless. At rest no pain is present but changes of position can cause some discomfort which hardly is prevented with painkillers.
• 3-4 days of fatigue is common.
• The stitches are removed after 8-10 and after 14 days.
• You should sleep on the back for 3-4 weeks.
• The arms should not be elevated over the horizontal plane.
• Cardriving is forbidden for 10 days.
• A sporting bra should be used all 24 hours during 3-4 weeks after removal of the bandage. Thereafter in the daytime for a couple of months (to prevent for pulling of the scars).
• Physical activities should be abandoned for one month.
• Transient anaesthesia of the nipples for 1-2 months is common. Numbness can stay permanently.
• Using skintape across the scars for 2-3 months should relieve tension on the scars.
• Sun exposure directly to the scars should be avoided for 6 months as to prevent for permanent hyperpigmentation and redness of the scars.

Complications Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is made.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E . These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections, which in case it happens will be treated with antibiotics.

Healing problems: The blood supply to tissues is essential for proper healing. In reductionplasties or larger breastplasties the nipple is transposed on long pedicles from where the blood supply comes. In extreme transpositions the risk is greater for disturbances that can lead to partial or full loss of the nipple (necrosis). After secondary healing in those cases there will be scarifications that has to be corrected at a later time. Big breasts are often fatty and fatty tissue has sparse blood supply. Fatnecrosis can occur that leads to healing disturbances in the deep, which prolongs healing over time. Bloodvessels in skin under tension are strangulated and the blood supply will be decreased. The biggest tension lies in the submammary fold where healing problems are quite common. The best prophylaxis is a bra and the use of taping. Scars can be corrected.

Scarring: All scars are red for a couple of months and they fade away during the fist year. Direct sun or solarium against the scars should be avoided to prevent them for permanently become red or pigmented.

Loss of sensibility of the nipple: As the nipples are transposed, the sensory nerves to them can be cut. A transient anaesthesia is common. A permanent loss can occur.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation.