How is breast reduction performed?
For the liposuction technique, small incisions are made within the natural fold underneath the breast or perhaps on the outer side as well. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent ), Lidocaine (pain reliever) and epinephrine (prohibits excessive bleeding and excess absorption of Lidocaine) are injected into the targeted area. This technique's purpose is to engorge the tissues with the solution for a firmer working area and the fat cells (which are softer) are suctioned out. The epinephrine prohibits bleeding during the operation and less blood is lost during the procedure.
There is a liposuction technique which involves ultrasonic energy waves. These ultrasonic waves excite the tissues' water molecules (fat molecules being the target) and literally melt the fat into a liquid for ease of removal by suction. Unfortunately, each patient's molecules may react differently or in the case of unskilled surgeons, may improperly handle the equipment resulting in severe burns.
There is the manual removal technique which is often incorporated into with a breast lift operation. With this technique there will be scars associated with the breast lift more than likely anchor shaped as extensive tissue will more than likely be removed and proper re-positioning and re-contouring of the breast will be performed.
In any case, the targeted breast tissue and fat is removed, sutures are sometimes used in the closure of incisions for the smaller, liposuction-assisted breast reduction and most definitely for the traditional breast reduction techniques. Then, a support garment or surgical bra is worn for proper, compact healing. A surgical or soft bra will be worn for several weeks both day and night.
How many techniques are there for breast reduction?
There is a manual technique where surgeons remove tissue after having opened the breast along the tissue lines where surface tissue will be removed as well and lifted.
There is the tumescent technique that is in all actuality, liposuction in a lesser form.
The liposuction technique can also be used with ultrasonic energy but has an increased chance of injury due to burns. Apparently the high frequency waves can over-excite the water molecules (or any fluid) causing them to boil beneath the skin as well as damaging superficial tissues as well. Unfortunately there is also the possibility that blind removal will accidentally disturb or remove milk ducts/glands in such a way that a patient's breast feeding chances are severely decreased.
Is breast reduction permanent?
Is it quite painful? Is there much bruising?
What are the risks of breast reduction?
There are more risks with this operation due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision. If the tissue becomes necrotic, that's a whole other ballgame! You must have the tissue removed before a major infection develops, possibly causing gangrene. If anything happens regarding tissue necrosis or compromised vascularity please research Hyperbaric Oxygen Therapy (HBOT) it could save your breasts AND your life. I have a separate section on this.
Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases. As is hematoma and infection. Unfortunately in most breast reductions, breast feeding will become a memory for any future children. Thankfully there may be newer techniques which may prohibit this type of loss. There is also the risk of loss of blood supply to the treatment area and permanent numbness due to nerve damage.
Another risk of breast reduction is pulmonary Thromboemboli, although not as high of a risk as it is with liposuction-assisted reductions or when liposuction is performed in combination with breast reduction. A thromboebolus is a blood clot and this blood clot can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma -- leading to the loss of oxygen rich blood to the brain. Pulmonary Thromboemboli can happen within three (3) weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. However, pulmonary Thromboemboli can occur suddenly, without warning. Most patients with P.E. collapse and begin rapid deterioration after attempting to climb a flight of stairs.
What does a typical breast reduction consultation entail?
Firstly, your doctor will discuss your goals with you and he will explain what can realistically be achieved. A surgeon should take into account what your hip size is. Your breasts may be a hindrance to you but removing too much will make your hips look large and give you a pear shape. Obviously you can request significant removal, just consider balance when determining your end size. Many women with large breasts just "want them out!" but may later regret having the majority of the breast volume removed. I am just suggesting thorough consideration before committing.
He or she will then show you photos of his work, you may also wish to show him photos that you have brought to the consultation of what you like and do not like. He or she should discuss the risks at length and the details that are associated with a breast reduction. There is no one size fits all technique when it comes to this procedure. It is all individual, just like you!
Protocol for a pre-operative appointment if you should choose to undergo a breast reduction:
Prior to surgery, a complete medical history is taken in order to evaluate the general health of the patient. The breasts themselves are then examined thoroughly to determine the most effective surgical approach. The surgeon will go over the anesthesia to be used, the procedure, what results might realistically be expected and possible risks and complications.
Mammograms or x-rays may be taken as well as pre-operative photographs. Preoperative instructions often include the elimination of certain drugs containing aspirin for several weeks before surgery in order to minimize the possibility of excess bleeding. Birth control and other estrogen containing hormones may also be discontinued temporarily (depending upon the individual). Antibiotics, pain relievers and other medications prescribed a few days prior to your surgery for your convenience as we want you to be completely prepared for your surgery with no excess worry.
What should I expect post-operatively?
The patient may be placed in two bras as well as an Ace bandage. In some cases you may remove the top bra only and rewrap the breasts with the Ace bandage the day after surgery. Some patients are told not remove the Ace bandage or bra for 3 days. Patients may choose to wear the Ace bandage for up to 10 days if they find it to provide added comfort. Patients are usually instructed to wear their surgical bra for 21 days both day and night. Please ask your own surgeon for specific instructions.
During recovery, the patient is carefully monitored and is allowed to be driven home a few hours later. Although, a surgeon should insist that you remain near the vicinity in case you experience complications.
Some patients are instructed to ice continuously for the first 48 to 72 hours. If this is the case, you will put an ice bag (or bags bags of frozen peas) over the breasts to maintain the coldness continuously. This will reduce any discomfort and swelling significantly. The pain connected with the procedure is minimal to moderate and is controlled with oral pain medication. The antibiotics that were prescribed will be taken for several days post-operatively to prevent infection. Instructions for the day and night after surgery include bed rest with limited activities. Your surgeon will determine when normal activities can be presumed at your post operative visits -- normally at 3 weeks. Strenuous activities and heavy lifting must be avoided for several weeks.
You should notice a gradual reduction in discomfort. Sometimes swelling will increase over the first three days. Fever greater than 100.5 should be reported to your surgeon. Marked increases in tenderness after 48 hours along with redness may indicate an infection. This should be reported immediately.
You may only sponge bath for the first 3 days after surgery as you must not get the bandage wet. You can remove the bra after 8 days but only to put on a fresh one. Replace the bra quickly after washing. After 14 days a normal shower may be take. Be sure to replace the bra immediately after showering or bathing.
There will be swelling and your doctor may prescribe a pharmaceutical grade Arnica montana for the relief of this. There may be some bruising but the Arnica montana will help alleviate some of this.
You should be wearing your bra 24 hours a day for the first 3 weeks. After the 21 day period, the bra should be worn at least during the day time for 6 months. The tapes that are over the suture lines should not be removed as your surgeon will remove them in approximately 10-15 days.
Complications and slow healing are rare, however there are certain inherent risks connected with reduction mammoplasty which will be thoroughly discussed at your consultation. The risks and instances of slow healing are more significant in smokers.
When will I be able to return to work?
When will I be able to see the results?
Where are the incisions made?