BREAST REDUCTION
What is Breast Reduction?
This operation is performed to remove excess skin, breast tissue and fat tissue from the breasts. It is usually performed for breasts that are excessively heavy and large in size. This often leads to recurrent episodes of upper back pain, shoulder pain which radiates into the neck with grooves marked in the skin by the bra straps and recurrent episodes of a burning rash either between or below the breasts. Also the patient usually complains that they have great difficulty in fitting clothes and are unable to participate in sport.
In cases where the physical symptoms (see above) are severe, some medical aids will grant benefits to help cover the costs of this operation. In other cases this operation may be undertaken on careful evaluation even if the patient does not have severe symptoms as listed above.
General Questions
Prior to the operation, the projected new nipple position is calculated and marked. Around this, according to a pre-determined formula the markings of the proposed incision lines are made in pen.
This operation is usually performed under general anesthetic but in selected cases is very well tolerated under local anesthetic with intravenous sedation. During the operation, the excessive breast tissue, fat tissue and skin is removed according to the pre- planned pattern which is tailored for each individual patient. The remaining breast tissue with the nipple still attached is moved up to a higher position and the skin envelope closed around it.
Dissolving internal sutures are used
exclusively. Soft plastic drainage tubes are then placed into the wound to
allow drainage into the dressing of any bleeding that may occur post
operatively. These drains are removed 24 – 48 hours after the operation. At the
end of the operation, the upper chest and shoulders are enclosed in a firm well
fitting and supportive bandage.
The average duration of operating time in theatre for this procedure it +2 hours. Most patients stay in hospital for 24 – 48 hours after the procedure. It takes about 10 – 14days for the wounds to heal and most patients are able to return to work > – 3 weeks after the operation. Clearly this depends on the nature of their work.
It is very important that no strenuous physical activity of the arms and
shoulder girdle be attempted for 2-3 weeks after the procedure. Kindly note
that this includes driving a Car, carrying heavy weights and exercising. It is
also important to realise that it takes anything from 12-18 months for the
final results in terms of shape, scar appearance etc. to become finalised.
Excessive bleeding and infection are the most likely complications from any surgery. Although minor bleeds and superficial wound infections do occur on occasion in breast reduction, this is uncommon. Every attempt is made to maintain good healthy tissue with a good blood supply.
On rare occasions, especially where there has been previous surgery in the breast, the blood supply to the nipple and breast tissue may be compromised. This may lead to death of the nipple and some breast tissue. The risk of this happening should be discussed on an individual basis.
It is more important to realise the following 3 points:
Scars –
your doctor will explain to you exactly where and how long the scars will be.
We cannot always control the final outcome of scars and these depend on
individual factors. It is important to realise that some scars May become
thickened, red and itchy and this will be discussed with you.
About 25 –
30% of patients who undergo breast reduction develop some change in the
sensation of the nipple areola complex. This is seen less commonly with modern
operating techniques but is more likely with very large breast reductions (1 –
2kg per side). This alteration in sensation may take the form of complete
numbness of the nipple or partial numbness thereof.
Breast feeding – about 30% of women who undergo breast reduction are unable to breast feed afterwards. Please note that some women cannot breast feed even without surgery
Before
surgery – please do not take any products that contain Aspirin or large doses
of Vitamin E for 3 weeks ore-operatively. If you take any form of over the
counter medication please notify your doctor well before the operation.
Ideally,
smokers should stop smoking completely at least 2 weeks before the operation.
If this is not possible, we would request smokers to cut down to 3-4 cigarettes
a day and abstain from smoking completely for 24 hours before surgery.
Please
report any signs of a cold, infection, boils or pustules appearing within 3
weeks of surgery.
The night
before and the morning of surgery We recommend a shower OF bath with antiseptic
shampoo (e.g. Betadine with conditioner or alternative if allergic to lodine).
Please wash your hair with Betadine or alternative the day before surgery.
Armpits should be shaved closely on the day before surgery.
Post
operative advice – it is extremely important that you limit the use of your
arms for 2 – 3 weeks. Do not lift your arms above shoulder level. Keep your elbows
to your sides. Do not lift anything heavy or drive a car until 2- 3 weeks after
surgery.
In the
first 24 hours, we recommend bed rest although the patient may go to the
bathroom with assistance. If you are comfortable on your side this is
permissible however do not attempt to sleep on YOUR stomach for 4 weeks after
surgery.
You may
expect moderate pain and discomfort for the first few days post operatively
this will be similar to muscle pain after strenuous physical activity.
The breasts
will be bandaged until the drains are removed at 24 – 48 hours. The bandages
will then be replaced until 5 – 6 days post surgery. Do not wear a brassiere
until you have been given permission to wear one.
Mild to
moderate bruising and swelling of the breasts is to be expected for up to 10
days after the operation. Any signs of bleeding or rash should be reported. lf
the post operative pain is more severe on one side than the other or one breast
appears larger than the other, please report this to your doctor as soon as
possible.
Patients
must not expect the breasts to look normal a week or so after the operation.
The final shape will only be reached 8 months to a year after surgery. The
final appearance of the scars may take 1% – 2 years to develop. Initially the
breasts May seem very high. prominent and flat under the nipples. This is
temporary.
Scars may
be pink or even raised in areas for 18 – 24 months after surgery. Treatment of
the scars may be necessary with special tape, creams Or injections to achieve
the best scars.
Some
patients develop alteration of the sensation in the nipple on a temporary basis
and this usually recovers in 6-8 months.
Please
avoid getting overheated and do not sit in the sun for 2 weeks after surgery.
Please wear
loose fitting clothes that are easy to slip on and off with minimal use of your
arms. Do not wear tight sweaters.
Finally, please avoid large crowds and any persons who have colds or flu for at least 6 weeks after surgery. After 3 weeks you can resume most normal activities except for tennis, golf, swimming or strenuous exercise which can be resumed usually after 2 months.
It is very
important to wear a close-fitting supportive bra for 3 months post- surgery.
We also
strongly recommend wearing adhesive paper tape over the scars for 3 months
post-surgery. YOU will be shown how to do this.
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