Breast reduction surgery

Breast reduction surgery (reduction mammoplasty) is the removal of extra fat, glandular tissue, and skin from the breast to make your breasts more proportional to your body and help with the symptoms associated with large breasts. Large breasts may affect physical health and cause difficulty while exercising and playing sports. Additionally some women may not like the large size of their breast and may get this surgery done for cosmetic reasons.

Some men also suffer from enlarged breasts. This condition is called gynaecomastia and generally starts around puberty due to an imbalance in hormone levels. Other reasons for gynaecomastia include the use of marijuana or anabolic steroids and excessive weight gain. In some men, breasts may shrink after some time, but most times, the enlargement in the breasts does not subside. So a breast reduction surgery is done as a cosmetic procedure in such men to treat gynacomastia.

A doctor may recommend a breast reduction surgery to women if their cup size is D or larger and causes the following symptoms:

• Pain in the neck, upper and lower back, and shoulders 
• Pain in the breasts
• Headache
• Deep marks on the shoulders due to bra straps
• Abrasions 
• Stretch marks
• Difficulty in sleeping due to uncomfortable sleeping positions
• Difficulty breathing while lying on your back
• Irritation of the skin under the breasts due to itching, redness, and rashes
• Degenerative arthritis of the upper back and neck
• Numbness in the hands due to the stretching of nerves in the shoulder area

Breast reduction surgery may also be done to achieve symmetry between breasts, if one breast is enlarged or if breast reconstruction surgery has been performed on one breast.

Breast reduction surgery may be performed in men with enlarged breasts or a condition called gynecomastia if they are not confident or are too self-conscious to perform activities in which they have to be bare-chested.

The following are the contraindications to breast reduction surgery:

• Significant health problems such as uncontrolled diabetes and blood pressure
• Smoking
• Any lumps or suspicious mass in the breast

The following things need to be done before a breast reduction surgery:

• Some tests will be performed before the surgery to check the breast health, including a mammogram in women.
• A physical exam should be performed in men to check for the presence of cancer.
• The doctor will require your medical history and enquire if you are taking any medicines.
• Photos of your breasts will be taken for your health records.
• Inform the surgeon if you are pregnant, want to get pregnant as you may have to delay your surgery in such a case.
• Do not have blood-thinning medicines like aspirin, ibuprofen, vitamin E, ginseng, and other supplements for at least two weeks before and two days after the surgery. You may take your regular medication unless the doctor asks you to stop.
• Avoid smoking or being near someone who smokes for a month before the surgery and two weeks following surgery as smoking may affect the healing of your wound and can cause infections.
• You will be asked to sign a consent form before your surgery allowing the surgeon to perform the procedure.
• Avoid eating anything from the night before your surgery. You may be allowed to drink clear fluids up to three hours before the surgery. 
• On the morning of surgery, clean your chest and underarms well with an antiseptic soap and do not apply any powder, lotion, or deodorant.

Breast reduction may be performed by liposuction (surgery that removes fat from the body by using a suction technique) along with the surgical methods mentioned below.

This surgery is performed in the following manner in women:

• An anesthesiologist will administer general anaesthesia (you will be asleep during the procedure) to you. 
• Once the anesthesia takes its effect, the surgeon will make one of the following incisions (cuts):
  • A circular incision around the areola (a small ring of pigmented skin around the nipple)
  • A racquet or keyhole-shaped incision with a rounded cut near the areola and a vertical cut to the crease of the breast
  • An anchor or inverted T-shaped incision
• Once the cut is made, the surgeon will reposition your nipple while it is still attached to its nerve and blood supply. 
• If necessary, the surgeon may reduce the areola by trimming it at the edges. He/she will reuce the breast tissue, lift it and reshape it.
• If your breasts are large and pendulous, the surgeon may remove the nipple and areola and transplant them to a higher place on the breast. 
• The surgeon will then bring together the tissues with the help of layered sutures for support. Sutures and self-adhesives or surgical tapes are used to close the wound.
• Finally, a healthcare practitioner will apply a bandage or dressing over the incision.

The same procedure for breast reduction is used to treat gynecomastia in men.

If fatty tissue (without the extra skin) is the cause of your large breast size, liposuction alone can provide desirable results.

Breast reduction surgery generally takes about two hours. After the procedure, the surgeon will insert a tube under your skin on the operated site to help drain any fluid or blood that may have accumulated there. This tube will be removed at the time of discharge from the hospital.

You will be allowed to go home on the same day of surgery.

Once you go home, the following care may be needed:

• You may be given narcotic pain medication to help control the discomfort after the procedure. Avoid driving after taking these medicines. 
• You may need to have a stool softener to help with constipation. 
• Women should wear a surgical bra all the time for about six weeks after the surgery. The bra will provide support to your breast while it heals. After two weeks, you may wear a sports bra. This bra should have a closure in the front and have cups for support. 
• Do not wear any bras with an underwire for about three months. You may use gauze (a thin piece of cloth) as padding for your incision.
• Men may need to wear a compression bandage constantly around the chest for a few days to  reduce the swelling and assist in healing.
• You may shower two days after your drainage tube has been removed. 
• Keep your wound clean and avoid soaking in pools and bathtubs. 
• Your doctor may ask you to avoid exposing your incision scars to sunlight for a while and to use strong sunscreen, if it is unavoidable, .
• The procedure leaves permanent marks that can be covered easily under a bra or regular clothing; however, they may fade with time.
• Try to stay active and walk around in the house. This will reduce swelling, prevent constipation, and lower the risk for blood clots. However, avoid any vigorous activities for four to six months after the procedure. 
• Avoid upper body exercises for six weeks after the procedure, though your may perform easy lower body exercises after two weeks . 
• You may be advised to perform arm and shoulder exercises about four times each day.
• Avoid driving for about two weeks or until you have complete upper body movement, including being able to swerve in an emergency. 
• Do not lift any heavy objects for about four to six weeks after the surgery. 
• You may resume your work in four to six weeks after the surgery unless your surgeon says otherwise.

Breast reduction helps to reduce pain and discomfort caused in the back, neck, breasts and shoulders caused by large breasts. The ability to exercise and perform tasks also improves after breast reduction surgery.

In men, this surgery increases their confidence.

When to see the doctor?

You should go to your doctor if you see any of the following symptoms:

• Swelling, bruising and redness that lasts for a few days
• Increased pain that is not relieved with medication
• Fever 
• Bleeding at the incision site
• Greenish or yellowish discharge from the site of surgery or foul odour 
• Loss of feeling or movement
• Any side effects of medicines like nausea, vomiting, or headache

Some of the possible risks of breast reduction surgery are:

• Infection
• Bleeding
• Scarring
• Permanent or temporary changes in sensation in the nipple and breast
• Formation of blood clots inside the body
• Poor wound healing
• Risks due to anaesthesia
• Fluid build-up at the operation site
• Damage to tissues, nerves, muscles, and lungs 
• Possible inability to breastfeed
• Asymmetry of breasts 
• Changes in pigmentation, discolouration of the skin with swelling and bruising
• Excessive firmness in the breasts
• Persistent pain
• Fat necrosis (death of deep fatty tissue in the skin)

Your follow-up visit will generally be in one to two weeks after the breast reduction surgery. During this visit, your doctor will remove sutures if non-absorbable stitches have been placed.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.