BREAST REDUCTION
INTRODUCTION
The cosmetic reduction of breast
size is a major operation requiring general anaesthesia and hospital admission
for one night. As the procedure requires a long anaesthetic patients taking
the oral contraceptive pill are advised to stop such medication for at least
one menstrual cycle. This is to reduce the risk of thrombosis (blood clot) in
the leg veins. Remember to take other contraceptive precautions at this time.
Patients are also strongly advised to stop smoking, at least whilst in hospital,
not only to reduce the chest problems that smokers experience with anaesthesia
but also because nicotine reduces blood flow to the skin which slows healing
and can result in the wound bursting.
The operation produces considerable
scarring. There will be scars (a) round the nipple (b) in a straight line from
underneath the nipple down to the breast fold and (c) all along the breast fold.
Initially these scars will be fine, bright red lines but although they should
fade to a pale white over six months or so they can stretch widely or become
thickened and irritated. Nipple sensation will almost certainly be lost immediately
after the operation but this can return to normal or rarely even better than
that before the operation. Breast feeding after the operation is possible in
some cases but is not guaranteed.
With time the breasts will undergo
the normal changes of age. That is they will sag and lose shape. It is not possible
to prevent this. Severe change in weight will affect the breasts as much as
the rest of the body but this change can prove to be difficult, or even impossible,
to correct by diet.
Your breasts will be photographed
before the operation as part of the clinical record. These photographs remain
confidential and are kept securely.
The hospital holds a pre-assessment
clinic (PAC) which is run by the nursing staff. You will be invited to attend
one of these clinics a week or two before the operation. They are intended as
a medical screen to identify problems and carry out any necessary tests before
the day of your surgery. Sometimes it will be arranged for you to see the anaesthetist
at this clinic.
OPERATION
The exact amount of tissue removed
varies from case to case but can be more than 1 kg for each breast in an operation
that may last for three hours. Loss of blood during surgery can need a blood
transfusion. After the operation the wounds will be painful (although this will
be reduced by painkillers, initially by injection and then by tablet) and you
will feel very tired and weak for several days. The wounds are not normally
covered by dressings so you will be aware of some minor bleeding along the incision
lines. Thin plastic tubes (drains) will empty internal bleeding into a plastic
bottle. These drains stay in place until the day after surgery. After removal
of the drains (which can be uncomfortable) you may wear a well fitting supportive
bra. The buried stitches will dissolve. Adhesive paper strips are used to reinforce
the wounds. The breasts will be quite swollen and bruised for a few weeks. Initially
the breasts will be a very odd shape (rather square) but this will improve with
time as the swelling settles and the breasts become more rounded and normal
in shape.
DISCHARGE
When discharged from hospital the
breasts may remain uncomfortable if not adequately supported in a bra of the
correct size. Some patients find it helpful to wear a bra at night. However
it is not always necessary to wear a bra and many find it more comfortable without.
Strenuous exercise, running or heavy lifting should be avoided for three months.
Gentle swimming, provided that the wounds are well healed, is probably acceptable.
Before leaving hospital you will
be given an outpatient appointment but if you have any problems, worries or
concerns after discharge from hospital please feel free to telephone for advice.
I can generally be contacted on 07850 484 672 but if I cannot be reached immediately
a message can be left on my office answerphone (0208 463 0019) and I will get
back to you as soon as possible.
Your GP will be given full details
of your surgery and progress.
COMPLICATIONS
No operation on the human body is
without risk. A few of the more common problems are listed below. This list
is intended to inform rather than frighten and it does not cover every thing
that can go wrong.
1. Anaesthesia. The small risk of an anaesthetic applies as in any operation.
Smoking and the oral contraceptive pill increase this risk.
2. DVT. There is a risk of deep vein thrombosis occurring during any operation.
Precautions are taken during the surgery to reduce this risk. You will also
be fitted with tight stockings to wear before, during and after surgery. After
discharge from hospital it is worthwhile wearing the stockings, day and night,
until you are fully mobile.
3. Wound Breakdown/infection. The wounds can heal rather slowly and may occasionally
weep or ooze blood. Larger areas of breakdown can occur particularly at the
middle of the breast fold where the scar lines join. This generally heals on
its own but sometimes required a small skin graft. In very rare cases breakdown
and infection require an emergency operation. The risk of wound breakdown is
much greater in those who are overweight and or smoke. Poor quality scarring
follows wound infection.
4. Stitches. The absorbable stitches sometimes work themselves out onto the
skin surface where they cause irritation. They are easily removed.
5. Sensation. Nipple sensitivity can be absent after the operation and in some
cases this will be permanent.
6. Fat Necrosis. Areas of fat and breast tissue deep within the breast can form
tender lumps. These generally settle after a few months or so although the hardness
may remain permanently. Occasionally larger volumes of tissue breakdown and
produce liquid fat which can discharge from the wound or even become infected.
This may result in breast distortion, unevenness and loss of breast volume.
7. Breast Feeding. Should you become pregnant breast feeding is usually not
possible.
8. Shape. The breasts in time will sag and lose their youthful shape. This is
a natural ageing process, which can be a little unpredictable after operation.
9. Scars. The scars will stretch and may thicken. They may become darker than
the surrounding skin.
10. Nipple Loss. Very rarely the nipple skin dies either partially or completely
resulting in nipple distortion or loss and unsightly scarring. If this happens
corrective surgery may be required but can never recreate a completely normal
looking nipple. In black skin there is a risk of losing colour in the nipple
and surrounding areola.
11. Revision. Occasionally there is surplus skin, which can cause a lump at
each end of the scarring in the fold under the breast known and these are known
as ‘dog ears’. If necessary they can be trimmed, under local anaesthesia.