Breast Reduction Lift

Breast reductions are very commonly requested surgical procedures. Any woman seeking this surgical care perceives herself as having large breasts. As every large breasted woman does not desire a surgical reduction, there are often other factors in play. These are very personal but often include one or more of the following factors:

1. Marked breast asymmetry
2. True gigantism
3. Unacceptable aesthetics (excess drooping, disproportion, etc.)
4. Neck, shoulder, and back symptoms perceived to be related to breast weight (sometimes not the only contributing factor)
5. Skin problems in the breast fold
6. Difficulty fitting in clothing
7. Social / Psychological

It is important to realize that all women have some degree of asymmetry with respect to:

1. Breast volume
2. Breast shape
3. Chest wall placement of each breast
4. Nipple-areolar size and shape
5. Nipple-areolar placement on the breast mound

Some degree of breast asymmetry will persist after your surgery no matter how carefully the surgery is done as precise measurements and excision of the redundant tissue is possible.

Patients seeking solely a breast lift (mastopexy) procedure are very satisfied by the absolute volume of their breast tissue (often reshaped adequately by a good quality bra). In their case, the natural unsupported breast shape is displeasing. Breast reshaping techniques base on surgical principles described below can be used to create a more aesthetically pleasing breast shape. In some cases, women who seek breast reshaping also desire more breast volume and undergo a breast lift and augmentation (either simultaneously or as a staged procedure).

LOCATION

Breast reductions performed in a local hospital setting for insurance covered procedures and in private surgical facilities for uninsured procedures. Breast lift procedures (with or without augmentation) are performed in private surgical facilities, as they are uncommonly insured procedures. In either case, you should be accompanied home from your surgery and have someone with you on the night after your surgery.

CONTRAINDICATIONS (some may be relative)

1. Multiple surgical procedures on the breasts
2. Undiagnosed breast lump(s) or known breast cancer
3. Obesity
4. Likely or planned future pregnancy
5. Medical conditions prohibiting elective surgery
6. Unrealistic expectations

PREPARATION

Prior to any plastic surgical procedure patients should avoid alcoholic beverages for one week prior to breast surgery. Anti-inflammatory drugs (Aspirin®, Motrin®, Ibuprophen, Advil®, etc.) should stopped two weeks prior to surgery due to their effects on the body’s blood clotting system. Failure to do so may lead to increased bleeding during the operation, blood clots (hematomas) and post-operative bruising. If you require painkillers on a regular basis for arthritic pain or headaches, the use of Tylenol ES® will not affect blood clotting. The use of herbal supplements or traditional medicines should be discussed with your surgeon pre-operatively to see if they will affect your surgery.

All medical conditions and medications must be disclosed to your surgeon pre-operatively. Medical conditions such as high blood pressure must be well controlled before all breast surgery as bleeding and hematomas are a risk.

Smoking requires special mention as chemicals in smoke can cause vasoconstriction of blood vessels resulting in reduced blood supply to the redraped body tissue. Smoking should be stopped 2-3 months before the operation in order to eliminate the added risk of tissue loss due to smoking. Some surgeons will refuse to perform elective cosmetic operations on smokers due to this risk.

THE PROCEDURE

There has been much debate over the ideal method of reducing unwanted breast tissue and providing a predictable and sustainable shape with the least conspicuous scars. Even today, many debates persist over wither reductions using the most commonly performed Wise-pattern (anchor) incisions are to be eventually replaced in favour by vertical reduction patterns. Other still have designs on eliminating the vertical scar portion on the breast, leaving only the scar in the breast fold. These debates exist because there is no perfect solution.

Once a skin pattern has been chosen and marked on the breast(s), a method of shifting the nipple-areolar complex is required. There are two basic choices:

1. To move the nipple and areola as a free tissue graft
2. To leave the nipple and areola attached to a dermoglandular pedicle of tissue (through which circulation is maintained).

There are several methods of accomplishing the latter, which include:

• Dermal pedicles
• Breast pedicles
• Combinations of the two methods listed above.

A variety of factors related to you the patient (i.e. age, degree of ptosis, size of breasts, etc.) determine which method will be implemented. As there are proponents of each technique, I think it is fair to say that they all produce comparable results. Although many skin patterns have been described, most surgeons prefer to use one pattern in the majority of cases. The most commonly used Wise or “keyhole” pattern of skin incision allows surgeons to adequately remove the redundant skin in both the vertical and horizontal dimensions (which may be less reliably done through the use of short scar techniques). This leaves a resulting anchor type scar with the lower scar often hidden in the fold below the breast.

Once the nipple and areola have been isolated, the excess skin and breast tissue is excised. Bleeding is controlled. The breast is then re-assembled by suturing the medial and lateral components to each other and to the chest wall. The nipple and areolar complex are then inset and the skin incisions are closed. Difficulties in breast-feeding have been reported with some approaches where all glandular breast attachments have been separated from the nipple.

A mastopexy or breast lift is carried out in much the same fashion but the nipple and areola are always left attached to the breast substance, and only excess skin is removed. The skin incisions may vary (periareolar) and no glandular breast is removed. It is simply reshaped and anchored (using pillar techniques and in some case facial slings) to the chest wall muscles.

THE RECOVERY

The typical convalescence following breast reduction surgery is 3-4 weeks. A supportive bra (without an under wire) is often used in the early post-operative period. If your surgeons recommends you wear your bra without an under wire, you can simply make a small cut in the fabric and slide out the wire. This can be replaced and re-stitched at a later date. Pain is controlled with prescription medications for the first days to week. Most patients require only over-the-counter medications or are comfortable without pain medication within a week of the procedure. Stool softeners may be helpful if prolonged use of prescription narcotic medication is required. Bruising and swelling of can become more noticeable after 3-4 days. Remember that this is a normal part of recovery and disappears within 2-3 weeks of the procedure.

Remember, it is a good idea to take some time off work. We usually recommend a week with the option to take additional time if required. To make things easier on yourself clean house and do chores that are more physical prior to your surgery as you won’t feel like doing them for at least a week. Having some prepared meals and lowering items on shelves may be helpful so you don’t have to do too much overhead reaching in the first couple of weeks. Arranging assistance for childcare in the first few days will be a big help.

Work activities should be avoided for 2-4 weeks and longer in cases of manual labor. Allow 4-7 days before engaging in any activities that require much arm use. Activities that cause a natural rise in blood pressure should be avoided for 2 weeks (yes this includes sex). Sports may be resumed after 3-4 months. Everyone recovers differently so listen to your body.

Following breast surgery you will experience pain and bruising around most of the breast area. Bruising of the breast skin will resolve in 2-4 weeks. At the incision sites you may notice clear or blood-tinged weeping that commonly resolves in 2-4 days. The wounds themselves will remain raised and red for 6-9 months before they start to smooth and fade in colour. It will take up to a year before the final appearance of the scars can be fully appreciated. Altered skin sensation of the breast is common post-surgery and usually resolves in 6-12 months. Occasionally, the altered sensation is permanent. Also remember that if you have had a breast-lift (mastopexy) or breast reduction, your areola will be reduced to an aesthetic norm. Lastly, final breast shape takes many months to establish.

UNAVOIDABLE CONSEQUENCES

If a breast reduction is performed, there are many unavoidable consequences of this surgery. These aspects are so common and expected that they should not be confused with unexpected complications. These include:

1. Scars (which may vary in nature from good to adverse)
2. Sensory changes / loss over the breast (including the nipple and areola) which may be minimal to marked in nature
3. Possible restricted ability to nurse a child (breastfeed)
4. A period of recovery
5. Bruising at the incision sites and weeping at the incision sites for a few days

If a mastopexy (breast lift) procedure is done instead of a formal reduction, the same consequences are incurred with the possible exception of the patient’s inability to breastfeed.

POTENTIAL COMPLICATIONS

It is impossible to list all the potential risks of surgery therefore what follows is an incomplete list. The common complications have been included.

These complications of surgery may be life threatening or even result in death. However, in the well patient these risks are slight. In most instances a single operation leads to a satisfactory result. On occasion, complications of surgery or aesthetic considerations may require a secondary surgical procedure. For a more detailed discussion on expected results, recovery, and specific complications, please see your individual surgeon.

WHAT TO EXPECT

In spite of individual differences in pain perception, post-operative pain is often underestimated, especially following submuscular implantation. Recently, new techniques have arisen to help deal with this problem. Another note is that implants may sit very high (on the chest wall) in the early post-operative period and are expected to settle some (over the next 4-8 weeks). Women comment on the initial firmness of the breast that appears to soften with time but obviously never reach the consistency of normal breast tissue. Bruising in the axillary (arm pit) or abdominal region may be significant with either the trans-axillary or TUBA procedures.

Breast scars will take approximately 12-18 months before they can be assessed in their final form. During that time protection of the scars from the sun is essential. During that time protection of the scars from the sun is essential. Although proper sun protection is essential on all exposed skin, high SPF sunscreens (SPF 45 0r 60) are essential over the surgical scars, for 12-18 months, to prevent permanent darkening of the scars. Often these scars are very good to excellent. Residual breast numbness may occur but is exceedingly rare. If you started out with some breast sag (ptosis) the addition of the volume replaced or added by the implant appears to mostly if not completely reverse this appearance. In addition to the breast lift, the additional volume often fills the skin and “pseudo-blanches” the appearances of stretch marks, making them less noticeable. Remember that it is possible to get new stretch marks secondary to the augmentation process if you request very large augments for your body size. These usually lighten with time but never disappear. In general, patient satisfaction with this procedure is extremely high.

COST

Breast reduction surgery is commonly covered under the Canadian Medical Plan. In cases of breast lift (with or without augmentation) the final cost for such procedures will be at the discretion of the plastic surgeon performing the procedure. The average cost of this procedure, published by the Canadian Society of Aesthetic (Cosmetic) Plastic Surgery (CASPS) is $6000 (with a range of $6000-$12,000). Costs will vary based on the requirement for augmentation and the implant type used.

DISCLAIMER

This website does not cover all of the medical knowledge related to breast augmentation nor does it deal with all possible risks and complications of surgery on the breasts. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical procedure.