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.
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.
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, age 30 and above, a baseline mammogram must be obtained prior to operation.
Prophylactic antibiotics are prescribed to reduce the risk of surgical wound infection. A prescription for pain medication is also written so that you have your medication 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. Patients cannot operate motor vehicles after surgery and recently sedated patients will not be placed 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
Photographs will be taken of your abdomen and any other areas upon which Dr. Capella will be operating. Specific instructions regarding the date and time of your procedure will be given to you. You are not to eat or drink anything after midnight the night before surgery. Exceptions may be made for certain individuals. You will need to arrange for an adult to drive you to the surgical facility on the day of the operation and for the first visit after the surgery. You should wear loose fitting clothing that will wash easily in the event they are soiled. Do not wear jewelry, contact lenses or bring valuables to the operating room. Remove all body jewelry from pierced body parts; this can interfere with the procedure and may represent a safety threat to you because of the use of electro cautery during the procedure. Do not shave or wax your abdomen prior to surgery; this may increase your risk of infection. Any shaving that is necessary will be done the day of surgery by our staff.
The balance of your surgical fee is due at this pre-operative visit.
Finally, Dr. Capella will write prescriptions for preventative antibiotics to decrease your risk of infection and a narcotic analgesic for post-operative pain relief.
Day Of Breast Reduction Surgery
Reduction mammoplasty is performed under general anesthesia. Typically, the operation takes about two 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. 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.
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 the recovery room in order to recover from the anesthetic.
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 take three doses of antibiotics after surgery.
You may shower two days following surgery at which time all dressings may be removed. Mild soap and water may come in contact with your breasts. Scrubbing of the breasts should be avoided. You will be advised to wear a comfortable bra (no underwire) around the clock for the first week and daily thereafter. Your first follow-up visit will be one week following surgery. No stitches need to be removed as they are all dissolvable.
Walking is encouraged as soon after surgery as possible. However, heavy lifting and vigorous activities involving the upper body should be avoided for six weeks. Activities involving heavy perspiration should be avoided for two weeks. 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.”
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. 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.