Top New York plastic surgeon Dr. Darrick Antell
is board certified in plastic surgery, emphasizing
aesthetic / cosmetic surgery. One of the plastic
surgery procedures he performs is breast reduction,
also known as reduction mammaplasty.
Reduction mammaplasty is a procedure where
fat, glandular tissue, and skin from the breasts
are removed. The goal is to give a woman smaller
breasts in proportion with the rest of her body.
If you are considering a reduction mammaplasty,
this section will give you a basic understanding
of the procedure.
To view more information about breast reduction,
please click on one of the links below.
If
you're considering breast reduction...
Women with very large, pendulous breasts may experience
a variety of medical problems caused by the excessive
weight-from back and neck pain and skin irritation
to skeletal deformities and breathing problems.
Bra straps may leave indentations in their shoulders.
And unusually large breasts can make a woman —
or a teenage girl — feel extremely self-conscious.
Breast reduction, technically known as reduction
mammaplasty, is designed for such women. The procedure
removes fat, glandular tissue, and skin from the
breasts, making them smaller, lighter, and firmer.
It can also reduce the size of the areola, the darker
skin surrounding the nipple. The goal is to give
the woman smaller, better-shaped breasts in proportion
with the rest of her body.
If you're considering breast reduction, this will
give you a basic understanding of the procedure
— when it can help, how it's performed, and
what results you can expect. It can't answer all
of your questions, since a lot depends on your individual
circumstances. Please be sure to ask your doctor
if there is anything about the procedure you don't
understand.
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The
best candidates for breast reduction surgery
Breast reduction is usually performed for physical
relief rather than simply cosmetic improvement.
Most women who have the surgery are troubled by
very large, sagging breasts that restrict their
activities and cause them physical discomfort.
In most cases, breast reduction isn't performed
until a woman's breasts are fully developed; however,
it can be done earlier if large breasts are causing
serious physical discomfort. The best candidates
are those who are mature enough to fully understand
the procedure and have realistic expectations about
the results. Breast reduction is not recommended
for women who intend to breast-feed.
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All
breast surgery carries some uncertainty and risk
Breast reduction is not a simple operation, but
it's normally safe when performed by a qualified
plastic surgeon. Nevertheless, as with any surgery,
there is always a possibility of complications,
including bleeding, infection, or reaction to the
anesthesia. Some patients develop small sores around
their nipples after surgery; these can be treated
with antibiotic creams. You can reduce your risks
by closely following your physician's advice both
before and after surgery.
The procedure does leave noticeable, permanent
scars, although they'll be covered by your bra or
bathing suit. (Poor healing and wider scars are
more common in smokers.) The procedure can also
leave you with slightly mismatched breasts or unevenly
positioned nipples. Future breast-feeding may not
be possible, since the surgery removes many of the
milk ducts leading to the nipples.
Some patients may experience a permanent loss of
feeling in their nipples or breasts. Rarely, the
nipple and areola may lose their blood supply and
the tissue will die. (The nipple and areola can
usually be rebuilt, however, using skin grafts from
elsewhere on the body.)
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Planning
your breast reduction surgery
In your initial consultation, it's important to
discuss your expectations frankly with your surgeon,
and to listen to his or her opinion. Every patient
— and every physician, as well — has a
different view of what is a desirable size and shape
for breasts.
Heavy breasts can lead to physical
discomfort, a variety of medical
problems, shoulder indentations due
to tight bra straps, and extreme
self-consciousness.
The surgeon will examine and measure your breasts,
and will probably photograph them for reference
during surgery and afterwards. (The photographs
may also be used in the processing of your insurance
coverage.) He or she will discuss the variables
that may affect the procedure-such as your age,
the size and shape of your breasts, and the condition
of your skin. You should also discuss where the
nipple and areola will be positioned; they'll be
moved higher during the procedure, and should be
approximately even with the crease beneath your
breasts.
Your surgeon should describe the procedure in detail,
explaining its risks and limitations and making
sure you understand the scarring that will result.
The surgeon should also explain the anesthesia he
or she will use, the facility where the surgery
will be performed, and the costs. (Some insurance
companies will pay for breast reduction if it's
medically necessary; however, they may require that
a certain amount of breast tissue be removed. Check
your policy, and have your surgeon write a "predetermination
letter" if required.)
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Preparing
for your breast reduction surgery
Your surgeon may require you to have a mammogram
(breast x-ray) before surgery. You'll also get specific
instructions on how to prepare for surgery, including
guidelines on eating and drinking, smoking, and
taking or avoiding certain vitamins and medications.
Some surgeons suggest that their patients diet before
the operation.
Breast reduction doesn't usually require a blood
transfusion. However, if a large amount of breast
tissue will be removed, your physician may advise
you to have a unit of blood drawn ahead of time.
That way, if a transfusion should be needed, your
own blood can be used.
While you're making preparations, be sure to arrange
for someone to drive you home after your surgery
and to help you out for a few days if needed.
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Where
your breast reduction surgery will be performed
Breast reduction is generally done in an ambulatory
surgical facility, as an outpatient procedure. The
surgery itself usually takes two to three hours,
but may take longer in some cases. You can expect
to remain in the recovery room for several hours
after the surgery.
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Type
of anesthesia for breast reduction surgery
Breast reduction is nearly always performed under
general anesthesia. You'll be asleep through the
entire operation.
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The
breast reduction surgery
Techniques for breast reduction vary, but the most
common procedure involves an anchor-shaped incision
that circles the areola, extends downward, and follows
the natural curve of the crease beneath the breast.
The surgeon removes excess glandular tissue, fat,
and skin, and moves the nipple and areola into their
new position. He or she then brings the skin from
both sides of the breast down and around the areola,
shaping the new contour of the breast. Liposuction
may be used to remove excess fat from the armpit
area.
Incisions outline the area of skin,
breast tissue, and fat to be removed
and the new position for the nipple.
In most cases, the nipples remain attached to their
blood vessels and nerves. However, if the breasts
are very large or pendulous, the nipples and areolas
may have to be completely removed and grafted into
a higher position. (This will result in a loss of
sensation in the nipple and areolar tissue.)
Skin formerly located above the nipple
is brought down and together to reshape
the breast. Sutures close the incisions,
giving the breast it's new contour.
Stitches are usually located around the areola,
in a vertical line extending downward, and along
the lower crease of the breast. In some cases, techniques
can be used that eliminate the vertical part of
the scar. And occasionally, when only fat needs
to be removed, liposuction alone can be used to
reduce breast size, leaving minimal scars.
Scars around the areola, below it, and
in the crease under the breast are
permanent, but ban be easily concealed
by clothing.
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After
your breast reduction surgery
After surgery, you'll be wrapped in an elastic
bandage or a surgical bra over gauze dressings.
A small tube may be placed in each breast to drain
off blood and fluids for the first day or two.
You may feel some pain for the first couple of
days — especially when you move around or cough
— and some discomfort for a week or more. Your
surgeon will prescribe medication to lessen the
pain.
The bandages will be removed a day or two after
surgery, though you'll continue wearing the surgical
bra around the clock for several weeks, until the
swelling and bruising subside. Your stitches will
be removed in one to three weeks.
If your breast skin is very dry following surgery,
you can apply a moisturizer several times a day,
but be sure to keep the suture area dry.
Your first menstruation following surgery may cause
your breasts to swell and hurt. You may also experience
random, shooting pains for a few months. You can
expect some loss of feeling in your nipples and
breast skin, caused by the swelling after surgery.
This usually fades over the next six weeks or so.
In some patients, however, it may last a year or
more, and occasionally it may be permanent.
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Getting
back to normal after breast reduction surgery
Although you may be up and about in a day or two,
your breasts may still ache occasionally for a couple
of weeks. You should avoid lifting or pushing anything
heavy for three or four weeks.
Your surgeon will give you detailed instructions
for resuming your normal activities. Most women
can return to work (if it's not too strenuous) and
social activities in about two weeks. But you'll
have much less stamina for several weeks, and should
limit your exercises to stretching, bending, and
swimming until your energy level returns. You'll
also need a good athletic bra for support.
You may be instructed to avoid sex for a week or
more, since sexual arousal can cause your incisions
to swell, and to avoid anything but gentle contact
with your breasts for about six weeks.
A small amount of fluid draining from your surgical
wound, or some crusting, is normal. If you have
any unusual symptoms, such as bleeding or severe
pain, don't hesitate to call your doctor.
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Your
new look after breast reduction surgery
Although much of the swelling and bruising will
disappear in the first few weeks, it may be six
months to a year before your breasts settle into
their new shape. Even then, their shape may fluctuate
in response to your hormonal shifts, weight changes,
and pregnancy.
Your surgeon will make every effort to make your
scars as inconspicuous as possible. Still, it's
important to remember that breast reduction scars
are extensive and permanent. They often remain lumpy
and red for months, then gradually become less obvious,
sometimes eventually fading to thin white lines.
Fortunately, the scars can usually be placed so
that you can wear even low-cut tops.
Of all plastic surgery procedures, breast reduction
results in the quickest body-image changes. You'll
be rid of the physical discomfort of large breasts,
your body will look better proportioned, and clothes
will fit you better.
However, as much as you may have desired these
changes, you'll need time to adjust to your new
image-as will your family and friends. Be patient
with yourself, and with them. Keep in mind why you
had this surgery, and chances are that, like most
women, you'll be pleased with the results.
With smaller, better proportioned
breasts, you'll feel more comfortable
and your clothes will fit better.
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© Copyright American Society of Plastic Surgeons
If you would like to contact New York plastic surgeon
Darrick Antell, or if have any further questions
about breast reduction or any of our plastic surgery
procedures, please use our contact
form.
Phone: (212) 988-4040
