.--Breast Reduction

Consultation  Pre-Operative Visit  Day Of Surgery  Recovery Process  Risks


Background On Breast Reduction Surgery
Women with large, pendulous breasts often have trouble with back and neck pain, skin irritation, shoulder grooving from their bra straps, and even numbness and tingling in their fingers from the weight of their breasts. Disproportionately large breasts can make a woman feel very self-conscious and make finding clothing that fits very difficult.

The operation, known as reduction mammoplasty, is designed to reduce the size and weight of such breasts by removing skin, breast gland, and fat. By unloading the neck and upper back, there is almost always a dramatic functional improvement in such patients. The goals of the surgery are not only to improve one's appearance, but also to improve function by liberating the individual to perform many activities they are unable to perform with the burden of their breasts.

This procedure is usually performed in women who have fully developed breasts, but occasionally it is necessary in younger, teenage girls when the breasts cause serious physical discomfort. Breast reduction patients are usually very satisfied with the procedure and often wish they had it earlier.

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Breast Reduction Surgery Consultation
Dr. Capella will meet with you personally and after gathering a thorough medical history, he will examine your breasts, take measurements to determine the amount of breast tissue he expects to remove to give you a size appropriate to the rest of your physical characteristics. While one of the goals of the surgery is to improve the appearance of your breasts, enough breast tissue should be removed to relieve the symptoms often associated with large breasts: back pain; rashes under the breasts; and shoulder discomfort. Dr. Capella will work closely with you to achieve a good functional and aesthetic outcome.

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Breast Reduction Surgery Pre-Operative Visit
You will visit with Dr. Capella several weeks prior to surgery. It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. In women over the age of 30, a baseline mammogram must be obtained prior to operation.

Prophylactic antibiotics are prescribed prior to and for a few days after surgery to reduce the risk of surgical wound infection. A prescription for pain medication is also written, so that you have your pain pills when you return home from the operation.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure. You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.

You will need to arrange for an escort to drive you to and from the operating suite located in our office. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery for your comfort.

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Day Of Breast Reduction Surgery
Reduction mammoplasty is performed under general anesthesia. You will be provided with anesthesia by a board-certified anesthesiologist. Typically, the operation takes about three hours, but may be longer in women with extremely large breasts.

Prior to the operation, Dr. Capella will outline the planned incisions on your breasts with a marking pen with you sitting upright. These skin markings provide a guide for the surgery, which is done with you in the supine position, so that in the upright position the breasts are shaped appropriately and are as symmetrical as possible. The outline of the incisions results in scars with an anchor shape, going around the areola (which is made smaller), vertically down the center of the breast, and horizontally in the fold beneath the breast. In smaller reductions, the scar beneath the breast may be eliminated.

During the procedure, the breast tissue to remain with the nipple and areola is preserved and the excess skin and breast tissue is removed. This is done in such a way as to preserve the best possible circulation to the nipple and areola and the smaller mound of breast beneath it. Flaps of skin are developed and are used to wrap the breast tissue in a tighter envelope, thus moving the nipple to a higher level on the chest and giving the breast its new contour.

Small drainage tubes are placed to evacuate any oozing, which can occur in the first day or so. All incisions are closed with dissolving type stitches. A bra and soft dressings are placed for comfort and support. After the operation, you will need to spend at least an hour in our recovery room in order to recover from the anesthetic.

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Breast Reduction Surgery Recovery Process
You will need to have someone stay with you for at least the first 24 hours. There is moderate pain that is well controlled with the pain medication that Dr. Capella prescribes. You will also take an antibiotic for four days after surgery. The drain tubes empty into a small bulb, or reservoir, which needs to be emptied periodically.

You will be seen back in the office in one to two days. You will then be able to shower. You will be asked to wear a comfortable bra around the clock for the first two weeks and daily thereafter. There are no stitches to be removed. It is not uncommon to see small areas of crusting along the incision line. These stitches heal over time, and only need to be kept clean and covered with an antibiotic ointment.

Even though you will be up and around in one to two days, it is important for you to limit your activity for optimal recovery. You should avoid any heavy lifting, pushing, or pulling for four to six weeks. Though you may do some stretching exercises and walking by the end of the first week, you should not plan to engage in any vigorous exercising for six weeks. This can stress the incisions and lead to complications such as delayed wound healing or prominent scars. You should avoid sexual activity for a week, as hormonal stimulation may make your breasts swell and lead to increased pain. Vigorous breast massage should be avoided for six to eight weeks.

The first menstrual cycle may bring swelling and pain out of proportion to your normal cycle. You may experience random shooting type pains for the first several months following the operation. There is usually numbness of the nipples and breast skin for the first six to eight weeks due to the swelling of the breast, but this should subside. In unusual cases, the loss of sensation is permanent. The optimal appearance of the scars occurs only after one to two years. The immediate appearance of the breasts changes over time. The breasts will become slightly smaller as the swelling subsides. They will also descend to a certain extent as the effects of gravity act on the newly tightened skin envelope. Most patients find this to be beneficial, in that the breasts look more natural after they have had time to "settle in."

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Risks of Breast Reduction Surgery
Complications of breast surgery are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, bleeding, or a reaction to the anesthetic or sedative medications. You may have temporary or even permanent areas of altered sensation, including numbness. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (NOTE: The nipple and areola can be rebuilt, however, using skin grafts from elsewhere on the body.) There is usually some difference in the size of breasts normally, and this is almost never perfectly correctable. There are fairly lengthy skin incisions that require a period of up to a year or two for completion of the scarring process for optimal appearance. In some ethnic skin types, scarring can be more prominent, and may require further treatment. The doctor will discuss your particular scarring potential in more detail at the time of your consultation. For additional information about the risks of breast reduction surgery, click here.

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