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Breast Reduction

Breast Reduction is one of the most life changing procedures in plastic surgery. It is a procedure by which breast tissue is removed in an aesthetically pleasing way. The heaviness is removed, the nipple elevated to a higher position and the nipple areolar complex reduced so that you have the appearance of a small nipple.

A breast reduction is traditionally considered to be a cosmetic procedure. I think in a great majority of patients it is in fact a functional procedure.

Indications for a Breast Reduction,

-Large uncomfortable breasts.

-Large painful breast causing neck and back pain.

– Skin rashes below the breasts.

-Shoulder grooving from bra straps digging in to shoulders

-Inability to exercise

-Aesthetically pleasing way to removed masses in the breasts.

The procedure takes about two hours. I would recommend that you stay in hospital for one night. You will have two drains. The drains remain for a week. I have to see you once a week until all the wounds are healed. That may take anything from four to twelve weeks. The greater your body weight the longer the wounds will take to heal.

The surgical procedure starts with incisions or cuts. Those will be the scars that you will ultimately see on your breasts. I perform the majority of large breast reductions via the inverted T incision. This type of cut in my hands give the most beautiful breast shape. A better shape at the expense of scarring.

I try to keep the vertical component of the scar as short as possible. Initially this leads to puckering of the scar which after a period of about six months settles in to a short flat scar.

Below follows an illustration of the scar you may expect. After the surgery I commence a specific scar protocol to limit and aid scarring.

You will be placed in a comfortable bra in theatre. The procedure I not very painful.

 

The wounds should be kept clean and dry for two weeks after the procedure. Ideally you should have a dressing change weekly after the surgery in the dressing clinic until satisfactory wound healing have been achieved.

 

You will go home on pain medication and antibiotics which should be used as instructed. Drains remain until it drains less than 60 ml in two consecutive days.

We recommend that you do not drive during the first 7-14 days after the operation. Movement and exercise should be limited during the first six weeks after surgery. As a rule of thumb you should not be doing anything that causes pain and discomfort.

Cosmetic surgery is an important and exciting decision.

It is important to understand that although the change following surgery is immediate the overall aesthetic improvement can only be appreciated at six months to a year following the surgery.

Every surgical procedure involves a certain amount of risks. It is important that you understand these risks and the possible complications associated with them.  An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefits. Although the majority of patients do not experience these complications it is still important that you are aware of them.

-Bleeding

-Seroma or fluid collections

-Unequal size and shape of both the breasts and nipples

-Fat necrosis or hard lumps. Fat necrosis is the way the breast tissue scars on the inside. The lumps may improve over time but never ever disappear completely. Fat necrosis is easily discernible on a mammogram or ultrasound. It is not wise to operate for fat necrosis you most often worsen the situation.

-Poor scaring, including hyperopic and keloid scarring

-Nipple loss: The reduced breast size may not be able to support the survival of the nipple & areolar (brown area) which may lead to complete nipple loss.  This is more common in large breasted patients. I would recommend that you do not reduce your breast too much.

-Change in Nipple and Skin Sensation: You may experience a decrease/increase in the sensation of the nipples and the skin of your breast. Partial or permanent loss of nipple and skin sensation can occur in one or both breasts and nipples.

-Delayed Healing: Wound break down or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take a long time to heal. Areas of skin or nipple tissue may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Individuals who have decreased blood supply to breast tissue from past surgery, smoking or sugar diabetes may be at increased risk for delayed wound healing and poor surgical outcome.

Smokers have a greater risk of skin loss and wound healing complications.

-Bleeding requiring a blood transfusion. Although a rare complications it may occur in patient with very cystic breast tissue where multiple cyst removal results in continuous oozing or bleeding from the surgical sites.

-Pneumothorax. You may suffer a puncture of the lung during the pain blocking procedure for which you may require a chest drain.

-Deep vein thrombosis. A DVT is a condition where a clot forms in your legs which may progress to the lungs or the brain. This condition may be fatal. It is thus important to inform your surgical team of a personal or family history of clot formation.

-Anaesthetic related complications

There are many conditions that may influence the long-term result of breast surgery. It is unknown how your breast tissue may respond or how wound healing will occur after surgery. Secondary surgery may be necessary to perform additional tightening or repositioning of the breasts. Should complications occur, additional surgery or other treatments may be necessary.

In Conclusion

The list above provide possible complications associated with breast surgery. The aim is not to scare you, but to inform you. I feel it is my ethical duty to make sure a patient understands and appreciate the surgery.

All things considered I have been lucky enough not to have had an unhappy patient. I am sure you will experience your surgery as a life changing happy experience transforming your body into the temple you will grow and love.

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