Breast reduction surgery is usually performed under general anesthesia in an inpatient or outpatient clinical setting. Many women spend one to three nights in the hospital after surgery, although some may be driven home a few hours after the procedure if no complications occur.
Before the procedure, the surgeon may mark incision lines on the breast while the patient is sitting up to ensure that the breasts are proportioned correctly. During the surgery, the plastic surgeon will make incisions around the areola (the dark pigmented area around the nipple), down the mid-line of breast and in the fold beneath the breast. In small reductions, incisions may not be necessary in the fold beneath the breast. All incisions will leave scars once healed.
There are two main types of breast reduction surgeries. In the first procedure, the surgeon removes excess breast tissue and skin but preserves the tissue where the nipple and areola are attached. This technique helps maintain optimal blood circulation to the nipple and areola and may allow women to breast-feed after surgery (although some milk ducts are removed with this technique). In the second technique, the breast ducts and nerves are cut and the nipple and areola are completely removed while the tissue is removed, and they are grafted to a higher position. Women will usually not be able to breast-feed if a free-nipple technique is performed. Small drainage tubes are also placed in the breast or under the arm to help remove blood or other fluids which may accumulate during the healing process. The tubes are usually removed within a few days after surgery, depending on the amount and rate of fluid drainage. Incisions will be closed with stitches, and gauze bandages may be placed over the breasts to facilitate healing. Breast reduction surgery usually takes approximately three hours but may take longer if a large amount of breast tissue is removed.
Most women will experience fatigue and breast pain for a few days after breast reduction surgery. Heavy lifting, pushing, or pulling should be avoided for four to six weeks after surgery; these activities may delay wound healing and cause more prominent scars. Moderate breast pain and sores around the nipple are usually controlled by prescription antibiotics, though some women experience random shooting pains in their breasts for the first several months after surgery. Drainage tubes and stitches will be removed within a few days after surgery (unless the surgeons uses dissolvable stitches). Severe complications are not common after breast reduction, but as with any surgical procedure, some women may experience problems.
Side effects of breast reduction surgery may include:
- Bleeding or infection
- Delay in healing
- Abnormal scarring
In rare cases, the breast or nipple skin does not heal properly and an additional surgery to graft the skin is necessary. Approximately 10% of women experience some loss of sensation in the nipple. The first menstrual cycle after surgery may cause the breasts to swell and become temporarily painful. As the breasts heal, swelling will subside and the breasts will become smaller. The breasts will also descend slightly as gravity acts on the new breast envelope. Most patients are pleased with this effect since it makes the breasts look more natural.
Breast reduction surgery leaves permanent scars. The scars will usually appear red and lumpy at first but will become less obvious over time. Women who smoke often have wider scars, since smoking interferes with the healing process. Women should continue to perform breast self-examinations each month and have annual mammograms if they are 40 years of age or older or at high risk of breast cancer, as determined by a physician.
Breast-feeding is possible in some cases after breast reduction surgery if the nipple and areola (dark pigmented area around the nipple) remain intact during surgery. Research has also shown that the less breast tissue removed, the higher the chances women may establish lactation. Many women who have had breast reduction surgery are not able to produce enough milk for their children. If the woman is able to produce some milk, she may use a nurse supplementer if she wishes to breast-feed. A nurse supplementer is a device worn around the neck like a necklace. It consists of a container that holds the supplemental milk, and thin tubes that may be taped to the womanâ€™s breasts. When the woman breast-feeds, the baby will receive the small amount of milk that the woman is able to produce along with the milk from the nurse supplementer. Many women feel that this helps them establish a bond with their children as they would if they breast-fed.
- The American Society of Plastic Surgeons (ASPS) provides information on breast reduction surgery at http://www.plasticsurgery.org/
Updated: May 2010