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Breast reduction overview
What is a breast reduction?
A breast reduction, which is also known as a reduction mammoplasty, is a surgical procedure that aims to reduce the size of a woman’s breasts. It is often referred to as a “boob reduction”. It is important to have a good understanding of the surgery before you go in for your operation. This breast reduction overview will provide you with a short introduction.
What can a breast reduction achieve?
You may consider having a breast reduction if your breasts are causing you physical discomfort, or you are unhappy with the size and shape of your breasts. A breast reduction can help:
- Balance a difference in breast size
- Achieve a more desirable look
- Relieve a feeling of unwanted attention.
Many women may choose to have this procedure done if their breasts are causing them unpleasant physical symptoms such as:
- Neck, back and/or shoulder pain
- Skin irritation under the breast fold
- Problems with clothing
- Skin indentation from bra straps
- Difficulties and discomfort during exercise.
Your surgeon may also choose to combine your breast reduction with a breast uplift and/or a nipple and areola reduction. This is so that they can achieve an overall more aesthetically pleasing result.
Who are BAPRAS and BAAPS?
When looking for a plastic surgeon to perform your breast reduction, make sure you choose one that is a member of either BAAPS or BAPRAS. BAAPS (The British Association of Aesthetic Plastic Surgeons) and BAPRAS (The British Association of Plastic Reconstructive and Aesthetic Surgeons) are the two leading societies for plastic surgeons in the UK. Surgeons belonging to these societies receive regular training which keeps their skills up to date.
We strongly advise that you check if your surgeon is a member of either BAAPS or BAPRAS before you have your procedure.
Breast reduction candidates
Why have a breast reduction?
Women who are unhappy with the size of their breasts may benefit from having a breast reduction. Although some patients choose to have this procedure done for cosmetic reasons, many also want it done to reduce unpleasant physical symptoms. The ideal breast reduction candidates can therefore include women who experience the following:
- Physical symptoms such as neck, back or shoulder pain
- Problems with clothing
- Indented skin from tight bra straps
- Discomfort while exercising
- Skin irritation under the fold of the breast
Women choosing to have a breast reduction for cosmetic purposes may want to do this because of:
- Breasts that are unequal in size
- Unwanted attention
- A desire to change the look of the breasts
Ideal candidates should be physically and emotionally healthy. They should also not be pregnant or nursing. If you have recently had a baby, you should wait 3 to 6 months after you have given birth and stopped nursing before you have your surgery.
Optimising your general health can increase your suitability for a breast reduction. You can achieve this by: doing regular exercise, reducing your alcohol intake, eating a healthy diet and stoing smoking.
What can a breast reduction achieve?
A breast reduction procedure aims to:
- Reduce the size of the breasts
- Remove any excess skin
- Reduce the size of the nipple and/or areola, if necessary
- Adjust the position of the nipple and areola
In most cases, the breast reduction will also include a breast uplift (mastopexy). Combining these two can create a better aesthetic result. Whether or not your surgeon includes an uplift can depend on the size of the reduction, as it may not be necessary for a small reduction.
Your surgeon will be able to tell you the details of what a breast reduction can achieve during your consultation.
Breast reduction procedure
is a breast reduction performed?
A breast reduction procedure requires your surgeon to make a skin incision before they can remove the excess breast tissue. The choice of which type of skin incision your surgeon will make is separate to the choice of which tissue removal technique they will use. This therefore means that there is a large variety of combinations of these two steps that surgeons can use for the procedure.
How does a breast reduction affect breastfeeding?
As your breast tissue contains ducts and glands that produce milk, removing parts of this tissue will have an impact on your ability to breastfeed. This means that the amount of tissue your surgeon removes and the methods they use to remove it will determine the extent to which you are able to breastfeed after surgery.
The skin incision technique will not greatly affect your ability to breastfeed, but it will represent the final appearance of your scar.
When choosing which techniques to use for your breast reduction procedure, your surgeon will consider your:
- Breast size
- Breast shape
- Areola size and position
- Degree of breast sagging
- Skin quality and quantity.
Your breast reduction procedure will involve the following steps:
1. Consent form
Before you have your breast reduction, you will need to sign a consent form for the surgery. You will meet your surgeon and anaesthetist to sign the form after they discuss the procedure with you. Normally, you either sign this form on the day of surgery or during your pre-operative assessment.
Your anaesthetist will give you your anaesthetic. Depending on what you and your surgeon have agreed upon, you will either have a general anaesthetic or a local anaesthetic with IV (intravenous) sedation.
3. Skin incision
Your surgeon will begin by making an incision on the skin. The choice of which incision they will use depends on how much excess skin you have. The types of incisions that your surgeon can make include:
This incision is made around the full circumference of the areola. It can only remove a small amount of tissue and is therefore most appropriate for very small breasts.
Surgeons use this incision for small to medium sized breasts.
The most common incision used for breast reductions is the inverted-T incision as it is most appropriate for larger breasts.
4. Breast tissue removal
After your surgeon has made the skin incision, he will remove the breast tissue to decrease the size of your breasts. The different breast tissue removal techniques include:
Technique 1: Pedicles
The most common technique that surgeons use are the “pedicle techniques”. These involve leaving a section of breast tissue called a pedicle attached to the nipple and areola. The pedicle contains a blood supply, nerve supply and milk ducts. This therefore allows for better preservation of nipple sensation and a higher chance of being able to breastfeed after the procedure. It is important to keep in mind however, that each technique will affect your ability to breastfeed differently. The two most popular ones are the inferior pedicle and the superior pedicle.
The pedicle is positioned below the areola where there is a large nerve supply. In combination with an anchor skin incision, this method is the most popular surgeons. They often use it for larger reductions.
The pedicle is positioned above the areola. This technique is most often combined with a lollipop skin incision.
Technique 2: Free nipple graft
Another type of tissue removal technique is a “free nipple graft”. This involves the surgeon removing the nipple, removing the underlying breast tissue and then stitching the nipple back on. Surgeons do not commonly use this method as there is poor preservation of nipple sensation and the ability to breastfeed will greatly reduce.
5. Closing of incisions
After your surgeon removes the excess breast tissue, they will close the incision with stitches.
6. Return to the ward
You will go back to the ward to recover after your breast reduction. As this procedure is quite invasive, most patients will need to stay in hospital for one to two nights.
Your breast reduction procedure may also include a breast uplift. Surgeons often combine these two procedures to help achieve a better result. Choosing a highly skilled Medbelle BAAPS/BAPRAS surgeon will ensure you get the best results from surgery.
Breast reduction consultation
What should I expect during my breast reduction consultation?
Your initial breast reduction consultation will normally last between 15 minutes to an hour. Your consultation time is your opportunity to be as honest and candid with your surgeon as possible. During your consultation, your surgeon will discuss a number of topics, including:
- Why you wish to have a breast reduction
- The desires and expectations you have from surgery
- Any personal or family history of breast cancer
- Current and past medical conditions, including any allergies you have
- The results of any breast investigations you may have had done e.g. biopsies and mammograms
- Any prescription or over-the-counter medications you may be taking
- Any current alcohol, tobacco and recreational drug use
After your surgeon has taken your medical history, they will examine your breasts and may take confidential photos for your medical record. Finally, they will discuss your treatment options and whether or not your desires can be met.
When recommending treatment options, your surgeon will take into consideration the following:
- The current breast shape and size
- The shape and size you want your breasts to be
- The quality of your breast tissue and skin
- The quantity of your breast tissue and skin
Your surgeon will also talk through the risks and complications that are associated with a breast reduction. It is important that you are aware of these so that you are able to make a fully informed decision.
Questions to ask during your breast reduction consultation
It is vital that you are honest with your surgeon about what you would like to achieve from your breast reduction. You should not hesitate to ask your surgeon any questions that you may have. Some questions that may be useful to ask are:
- Are my expectations and desires realistic?
- Where will my scars be?
- Is there anything I can do to help get the best results?
- Can you show me before and after pictures of breast reductions you have done before?
Breast reduction risks & complications
What are the main breast reduction risks and complications?
As with any surgery, a breast reduction procedure does carry the risk of complications occurring. It is essential that you are aware of all these risks before you go ahead with the surgery. The breast reduction risks and complications include:
Your surgeon will need to make incisions on your breasts during your reduction. This means that scarring is inevitable. The extent of the scarring will depend on the type of incision your surgeon chooses to use, and your skin’s ability to heal. Some patients may experience severe forms of scarring called keloid or hypertrophic scars. Patients who are likely to develop this are normally already aware of this.
Bruising & bleeding
You will experience some bleeding and bruising after your operation. This tends to be minimal and should decrease with time. In some cases however, the bleeding may become more severe. If this does happen, your breasts will feel very swollen and tight. You will most likely need to return to the operating theatre to have this treated. If your surgeon treats the bleeding promptly, it should not have a negative affect on your final results.
Numbness & altered sensation
The breast reduction procedure may cause damage to the nerves in and around your breasts. This can lead you to feel altered sensations such as numbness or oversensitivity in particular areas of the breast, especially the nipples. For most patients this is temporary, but in some rare cases it can be permanent.
Infection is a risk that comes with any surgical procedure. If you do develop an infection, it will most likely be a mild wound infection that can easily be treated with antibiotics.
If you experience any of the following symptoms of infection, you must flag them up to your surgeon:
- Pain that is not relieved after taking painkillers
- Increasing swelling or redness that is starting to move away from the incision site
- A high temperature of 38°C or over
- Pus-like fluid seeping from the incision site
- Foul smelling discharge coming from the incision site or drains
There is also a risk that you could develop a blood clot after a breast reduction. If the clot develops in your legs, this is known as a DVT (deep vein thrombosis). It can also however, develop in your lungs and this is known as a PE (pulmonary embolism). If the PE is large enough, it can be fatal.
There is a higher risk of developing these blood clots for patients who spend a lot of time not mobilising after surgery. For this reason, it is is vital that you do not spend all day resting in bed. You must get up and take light, short walks around the house to help the blood in your legs to circulate properly.
After a breast reduction, the lower half of the breast tissue may naturally droop down into a “teardrop” shape while the nipples stay in their place. This may make the nipples appear overly high. The extent to which this happens depends on how much breast tissue there is, and how heavy it is. It is most commonly seen when an Anchor incision and inferior pedicle technique are used together. Your surgeon can correct this with revision surgery.
A seroma is a pocket of fluid that can develop after a surgical procedure. The pocket most commonly develops under or around the incision site. Small seromas may resolve on their own, whereas larger ones may require your surgeon to drain them. You may have drains put in after surgery to help drain fluid, reduce swelling and prevent a seroma developing.
Tissue necrosis & nipple loss
During your breast reduction, certain areas of the your breast may lose t blood supply. If this occurs, it may cause the skin, tissue or fat in that area to die. This is known as ‘necrosis’.
If your surgeon chooses to use a free nipple graft technique for your breast reduction, there is a higher change of you developing nipple necrosis. This may result in the complete loss of your nipple. This is because when your surgeon removes your nipple from the breast, it loses its entire blood supply, making it more likely for the nipple to die. The risk of this happening also increases if you are a smoker.
It is also important to be aware that you may not be happy with the aesthetic result of your breast reduction. Many surgeons will not consider this to be a complication and will therefore not offer revision surgery free of charge. This is another reason why you must choose your surgeon carefully.
Choosing an experienced BAAPS/BAPRAS surgeon can help reduce the risk of all of these breast reduction risks and complications occurring.
Breast reduction preparation
How can I prepare for a breast reduction?
It is important for you to prepare before you have your breast reduction. Preparing well for your breast reduction can also help you through your recovery period. Below are some breast reduction preparation tips that may be helpful for you:
You will not be able to drive straight after your surgery. It is therefore important for you to arrange for a family member or friend to help you get home safely after your operation. We also recommend that they stay with you for the first 24 hours after surgery, as you will still be recovering from the anaesthetic.
It may be really useful to get some household chores done before you go in for your operation. Taking the bins out, cleaning and doing a big grocery shop before your breast reduction will give you more of a chance to rest after your operation. It may be also be helpful to cook some meals and freeze them so that you do not have to worry about cooking either!
Try to place hard to reach cupboard items such as mugs, crockery and dry food on the kitchen counter. This will prevent you having to stretch to reach them, which can help your recovery as stretching can place strain on your incisions.
Children & pets
A breast reduction is quite an invasive procedure. It is therefore important that you rest well and do not exert yourself. You should therefore ask your family and friends to help look after young children and pets whilst you are recovering.
Sleeping on your back, in an inclined position for the first few days after your surgery can help reduce swelling and bruising. You can do this by having lots of extra pillows on your bed.
Clothing & post-operative garment
It may be more comfortable for you to wear clothes that fasten easily from the front in the initial post-operative days. This prevents you reaching up to pull clothes over your head, which places strain on your stitches. Straining your stitches can increase the time it takes your wounds to heal.
You will also have to wear a post-operative garment after your breast reduction. Your surgeon will give you specific instructions on which garment to wear, how tight to wear it, and how long you must keep it on for.
Maintaining a healthy diet will help you through your recovery. This includes eating food that is low in salt and sugar, having as many fresh fruits and vegetables as possible, and drinking lots of water and caffeine-free drinks.
Smoking & alcohol
Smoking, taking recreational drugs and drinking large amounts of alcohol can all have a negative effect on your recovery. It is essential that you stop smoking and using all nicotine products at least 6 weeks before and after your breast reduction. Smoking lengthens your recovery by delaying the time it takes for your wounds to heal. It also greatly increases the risk of infection.
It is very important to notify your surgeon of all the prescription and over-the-counter medications that you take. Certain prescription and homeopathic medications can increase the risk of complications occurring. Your surgeon will discuss your medications and recommend the best course of action to take.
As certain homeopathic medications can increase the risk of bleeding and bruising after surgery, we recommend you stop taking them at least 2 weeks before your operation. These medications can include:
- St John’s Wort
- Multivitamin preparations
- Medications containing: ginger, ginkgo, garlic and cod liver oil.
Breast reduction aftercare
What can I expect after a breast reduction?
Your surgeon will give you advice for your breast reduction aftercare and recovery. They will discuss the following topics:
After your breast reduction, you will most likely need to spend one or two nights in hospital. Before you leave however, a post-operative appointment will be arranged for you. This appointment will allow your surgeon to examine your breasts, remove any stitches that are not dissolvable and treat any complications.
Time off work
In general, if you have an office job, you will need to take approximately 1 to 2 weeks off work after your breast reduction. If you have a job that requires more physical activity, you will need to take at least 2 weeks off. You surgeon will give you specific instructions on when you can return to work.
Return to sports & exercise
After you have your breast reduction, you will need to rest well and not exert yourself. You will need to start slowly when you begin exercising again. The general advice is as follows:
Week 1 – 3
Avoid all sports and exercises for the first three weeks after your breast reduction. Even minor aerobic sports may increase swelling and bruising.
Week 3 – 6
Three weeks after your breast reduction, you should be able to resume light aerobic exercises such as cycling. You should however be careful not to exert yourself too hard.
After week 6
After 6 weeks have passed, you should be able to to resume all sports, exercises and heavy lifting again.
Each surgeon will have different advice about when it is appropriate for you to resume sports and exercise after your breast reduction. It is therefore very important to follow the advice that your surgeon has personally given you.
As you will not be able to drive immediately after your breast reduction, you must arrange for a friend or family member to take you home. It may take 5 days to 2 weeks before you are able to start driving again, depending on your surgeon’s advice.
Although scarring is inevitable after a breast reduction, there are a number of techniques that can help aid the healing of scars. These include:
- Scar massage – gently massaging your scar after it has healed may help the skin to heal.
- Silicone gel, cream or sheets – silicone based products have been clinically proven to help reduce the appearance of scars. It is important that you use these products only after your incision has healed.
- Avoid sun exposure & sunbeds – you can help protect your scars by protecting them from sunlight and sunbeds. This not only protects the healing skin, but it also avoids darkening the scars.
You will be able to see an immediate change to your breasts straight after your operation but it may take 6 to 12 months before you can appreciate the full cosmetic appearance. It is therefore important to be patient!
Your Medbelle BAAPS/BAPRAS surgeon will give you specific advice regarding your breast reduction aftercare. It is vital to follow the instructions your surgeon gives you as this is specific to your recovery.
Breast reduction FAQs
Make sure you research your breast reduction procedure well before you go in for your surgery. The following breast reduction FAQs may help answer some common questions:
Can I get a breast reduction through the NHS?
Although possible, it can be quite difficult to get a breast reduction done on the NHS. It is often only offered to patients who are experiencing distressing symptoms. If you think you might be a candidate, you should speak to your GP first.
How long after pregnancy can I have a breast reduction?
You should wait at least 3 to 6 months after a pregnancy before having a breast reduction. This is to allow enough time for your breasts to settle before you have your procedure.
How long after breastfeeding can I have surgery?
As with pregnancy, you should wait at least 3 to 6 months after you have stopped breastfeeding before you have your breast reduction procedure.
Will I still be able to breastfeed after a breast reduction?
As your surgeon is likely to remove some milk glands and ducts during a breast reduction, this can effect your ability to breastfeed post-operatively. Many women can still breastfeed after surgery, but this depends heavily on the tissue removal technique that your surgeon uses. Certain surgical techniques will have more of an effect on your ability to breastfeed than others. For this reason, it is very important to notify your surgeon if you are planning to breastfeed in the future.
What effect do drugs have on a breast reduction?
Smoking, drinking large amounts of alcohol and taking recreational drugs can all increase the risk of complications occurring during and after your breast reduction surgery. Smoking in particular can increase the risk of developing infections and can also delay wound healing. You must therefore stop smoking at least 6 weeks before and after your procedure.
Do I need a GP referral for cosmetic surgery?
Most plastic surgeons will see you for an initial consultation for your breast reduction without a GP referral. Your surgeon may however, contact your GP to get details of your medical history.
Can I minimise the risk of complications?
A breast reduction is a complicated procedure. You should therefore make sure you choose a highly-experienced BAAPS or BAPRAS surgeon to perform your operation.
You can also minimise the risk of complications by exercising regularly, reducing your alcohol intake, eating a healthy diet and most importantly, stopping smoking.
What effect will weight loss or weight gain have on a breast reduction?
The effect that weight loss or weight gain has on a breast reduction depends on the amount of fat left in the breasts and the degree of the weight change. Any major weight changes will most likely have an effect on the final results and appearance of the breasts. It is for this reason that we advise that you reach your optimal weight before having your breast reduction surgery.
If you still have any questions that do not appear under these breast reduction faqs, give us a call and we would be happy to help you.