Female
Breast Reduction
What
is a breast reduction?
Breast
reduction surgery, or reduction mammaplasty,
is a cosmetic
surgery procedure by which fat,
skin, and other breast tissue are
removed in order to decrease the overall
size of the breasts. Breast reduction
is intended for women that suffer
from inconvenience, medical problems,
or embarrassment due to breasts that
are either out of proportion to the
body or are different sizes.
Who
is a candidate for breast reduction?
One
of the most important factors in determining
if breast reduction is right for a
woman is her dissatisfaction with
the breasts. While simple self-consciousness
may be the most prevalent reason for
seeking breast reduction, proportionally
large breasts can also restrict a
woman’s activities, make clothes
fit awkwardly, or cause medical problems.
Medical problems that breast reduction
can help relieve include:
- Irritation of the skin under the
breasts
- Indentations in the shoulders
from bra straps
- Pain in the back or neck
- Difficulty breathing
- Skeletal deformities
There
are some criteria that should be met
before a patient undergoes breast
reduction surgery. A woman’s
breasts should be fully developed
before she considers having surgery.
Because breast reduction surgery can
inhibit milk production, women who
are anticipating future pregnancies
may not be good candidates. Finally,
a woman should be open to learning
about the procedure and its results
and should be capable of honestly
evaluating how appropriate it is for
her. A qualified breast reduction
surgeon can help assess the appropriateness
of the surgery.
How
is breast reduction surgery performed?
The
surgical process begins with a consultation
between the woman and the breast reduction
surgeon. The surgeon will inspect
the patient’s breasts and may
have a mammogram taken. The patient
will also receive advice on how to
alter daily practices such as eating,
drinking, smoking, and taking medication.
The surgeon may have blood drawn from
the patient in the rare case that
it is needed during surgery.
Breast
reduction surgery may be performed
on an inpatient or outpatient basis.
It is almost always performed using
general anesthesia.
The
most common technique for breast reduction
surgery begins with a three-part incision.
The first cut is made around the outer
edge of the areola (the dark skin
surrounding the nipple). The next
is made in a straight line from the
bottom edge of the areola downward
to the base of the breast, ending
at the crease under the breast. The
surgeon makes the third incision horizontally
along the crease. Through the opening
that is formed, the surgeon carefully
removes excess fat, glandular tissue,
and skin from the breast. Liposuction
may be used to remove fat from the
armpit region. The surgeon moves the
areola into its new position, higher
up on the breast. The skin from both
sides of the areola is pulled down
and underneath it, and the excess
is trimmed. The incisions are then
sewn up.
There
are several variations of the standard
technique:
- In some cases – when reduction
is performed on extremely large
breasts – the areola must
be removed entirely and regrafted
to a new position. Blood vessels
and nerves to the nipples that are
ordinarily left attached are severed,
resulting in a loss of sensation.
- The procedure can sometimes be
completed without the vertical incision
between the areola and the crease
of the breast, leaving much less
conspicuous scars. This is often
the case in breasts that do not
require a particularly dramatic
reduction.
- If only the removal of fat is
necessary, the physician may use
only liposuction in a still less
invasive form of breast reduction.
This eliminates the need for most
of the incisions and results in
minimal scarring.
What
is recovery like?
Immediately
after breast reduction surgery, the
chest is wrapped in gauze bandages.
These are removed in a few days and
replaced by a surgical bra. Depending
on the surgeon’s preference,
drainage tubes may have been inserted
into one or both breasts to draw out
fluid or blood that can accumulate
during surgery. These tubes are usually
removed after one or two days. The
stitches in the incisions are removed
at intervals over the following three
weeks. Pain is acute for a few days,
and moderate discomfort in the chest
can persist for a week or so. Considerable
swelling and bruising can arise and
remain for a few weeks. The breast
skin can become dry, though moisturizer
alleviates this.
Many
surgeons recommend that the patient
avoid sexual intercourse for at least
the first week, as this induces swelling
in the breasts. Strenuous activities
and contact with the breasts should
be avoided for about the first month.
Looking
further along, it is important to
note that a woman’s first menstruation
following surgery may cause the breasts
to swell and hurt. Occasional shooting
pains in the months following breast
reduction are not uncommon, though
sometimes they can be symptomatic
of something serious, so they should
be reported to the doctor. The patient
can also experience a loss of feeling
in her breasts. This is usually due
to residual swelling, and feeling
should return as the swelling subsides.
After six months, only scars should
remain, and eventually these should
be difficult to notice.
More
severe complications of breast reduction
surgery can include:
- Bleeding
- Infection (treatable with antibiotics)
- Reaction to anesthesia
- Small sores around nipples (treated
with an antibiotic cream)
- Slight imbalances in breast size
or positions of nipples
- Poor healing (common to smokers)
- Inability to breast feed (if the
milk ducts were removed)
- Permanent loss of feeling in the
nipples or breasts
Loss of blood flow to the nipple
and areola (rare)
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