At our premier plastic surgery center in St. Louis, our Body Aesthetic Plastic Surgery & Skin Care Center team treats St. Louis breast reduction patients. In the paragraphs below, the breast reduction procedure is described.
Women with very large, heavy and drooping breasts may experience a variety of medical problems caused by their excessive breast weight. Symptoms typically include back, shoulder and neck pain, skin irritation and rashes beneath the breasts, stooped posture, permanent shoulder indentations caused by bra straps, and sometimes breathing difficulties. Physical activity may be restricted by the size and weight of the breasts. In addition to such physical problems, unusually large breasts can make women, or teenage girls, feel extremely self-conscious and embarrassed. Finding clothes that fit is another worry.
Breast reduction, technically known as reduction mammoplasty, removes fat, glandular tissue, and skin from the breasts to make them smaller, lighter, and firmer. When needed, the surgery also reduces the size of the areola (the darker skin surrounding the nipple). The goal is to create smaller, well-shaped breasts that are in better proportion to the rest of the body.
Breast reduction is usually performed to relieve physical, and often emotional, discomfort rather than simply to improve cosmetic appearance. Because of this, some health insurance policies will cover the surgery costs. The staff at BodyAesthetic Plastic Surgery will help determine if surgery might be covered by insurance.
In most cases, breast reduction is performed after the breasts are fully developed, but it can be done earlier if large breasts are causing serious physical discomfort and/or psychological difficulties for teenagers. The best candidates for reduction are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is usually not recommended for women who intend to breastfeed in the future because the surgery removes some of the glandular breast tissue, which can decrease milk production.
Breast reduction is not a simple operation, but it is safely performed by trained plastic surgeons. The procedure does leave noticeable and permanent scars, though they will be covered by a bra or bathing suit. (Poor healing and wider scars are more common in smokers and dark-skinned individuals.) The procedure can also produce breasts that are slightly asymmetrical or unevenly positioned nipples. However, most women with very large breasts are not symmetrical to begin with.
Some patients may experience a permanent loss of feeling in their nipples or breasts. In a very small percentage of women, the nipple and areola may lose their blood supply and the tissue will die. In such rare cases, the nipple and areola can be reconstructed with skin grafts taken from elsewhere on the body.
Breast Reduction: The Surgery
Breast reduction surgery is performed in the hospital on either an outpatient or inpatient basis, depending on whether you need to stay overnight in the hospital after surgery. The length of the procedure is determined by the technique used and amount of tissue removed but usually takes 2 to 4 hours.
Techniques for breast reduction vary and depend on the size of the breasts and the degree of reduction the patient wants. The procedure we use most often includes an incision that circles the areola and then extends downward vertically to the inframammary crease (the natural fold below the breast). This short-scar breast reduction leaves a scar shaped like a lollipop. If the breasts are very large, another incision that runs horizontally along the inframammary crease may be needed. This traditional reduction mammoplasty scar is shaped much like a boat anchor.
After the excess glandular tissue, fat, and skin are removed, the nipple and areola are moved into their new, higher position. The remaining skin and tissue are then draped around the areola until a pleasing breast shape and contour are achieved. Liposuction is sometimes used to remove excess fat from the area near the armpit.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. This will result in a loss of sensation in the nipple and areolar tissue, and breastfeeding will be impossible.
What To Expect After Breast Reduction
After surgery, the breasts are wrapped in an elastic bandage or a surgical bra placed over gauze dressings. This dressing is usually removed 4 to 5 days after surgery and replaced with a soft sports bra that provides support and is worn 24 hours a day for several weeks, until the swelling and bruising subside. Most stitches are absorbable and do not have to be removed.
You will feel some pain for the first few days, especially when you move around or cough, and some discomfort will remain for a week or more. Your surgeon will prescribe medication to lessen the pain.
Your first menstrual period following breast reduction may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months.
If the nipples and areolas can be repositioned with their nerves intact, you will have some loss of feeling in the nipples and breast skin caused by the swelling after surgery, but this usually fades over the next 6 weeks or so. In some patients, however, the sensory loss may last a year or more; rarely, the loss of sensation is permanent. Nipple sensation is lost completely if the nipples and areolas must be removed completely and re-grafted into a higher position.
Your surgeon will give you detailed instructions for resuming your normal activities, but you should be up and moving around your house within a day or two after surgery. Most women can return to work (if it’s not too strenuous) and social activities in 1 or 2 weeks, though the breasts may continue to ache occasionally for a couple of weeks. You should expect to have much less stamina for several weeks and limit exercise to stretching, bending, and swimming until your energy level returns. Also, avoid lifting or pushing anything heavy for 3 or 4 weeks.
You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell. Anything other than gentle contact with your breasts should be avoided for about 6 weeks.
A small amount of fluid draining from your incisions is normal, as is some crusting around the incisions. If you have any unusual symptoms, such as bleeding or severe pain, call your surgeon right away.
Although much of the swelling and bruising will disappear in the first few weeks, it may be 6 months to a year before the breasts settle into their final shape. Even then, their shape may fluctuate in response to hormonal shifts, weight changes, or pregnancy.
Your surgeon will try hard to make your scars as inconspicuous as possible, but breast reduction leaves extensive and permanent scars. They often remain lumpy and red for months, then gradually become less obvious and may eventually fade to thin white lines. Fortunately, the scars are not visible when a bra or low-cut top is worn. Almost all breast reduction patients are more than willing to accept the scars in exchange for having normal-sized breasts.
Of all plastic surgery procedures, breast reduction produces the quickest body-image changes. Almost immediately after surgery you will notice that the physical discomfort of large breasts is gone, your body will look better proportioned, and clothes will fit better. Even so, some patients are quite shocked at first by the smaller breast size. It may take a little time to adjust to your new body so be patient and remember why you wanted the surgery in the first place.
Length Of Surgery
2 to 4 hours
Usually outpatient for smaller breasts and short-scar procedures. One night in the hospital is typical for very large breasts that require a traditional breast reduction with its additional incisions.
Breast Reduction: Side Effects
Pain for a few days. Soreness, swelling and bruising for a few weeks. Some loss of nipple and breast skin sensation until the swelling subsides. Breast sensitive to stimulation for up to 6 weeks.
Breast Reduction: The Risks
Permanent scars that are not visible when wearing a bra but may be unattractive in the nude. Wide and/or red scars. Bleeding or infection. Decrease in sensitivity of nipples or breast skin, occasionally permanent. In rare cases, loss of nipple and areola if blood supply is not vigorous.
Breast Reduction: The Recovery
Back to work: usually within 1 to 2 weeks.
Physical contact with breasts: about 6 weeks.
Fading of scars: several months to a year or more.
Settling of the breasts to their final shape: 6 months to a year.
Duration of Results
Permanent unless you gain a lot of weight. Some breast sagging will occur as you age.