Additional Frequently Asked Questions (FAQ) About Breast Reduction FAQ and Info
There are several techniques currently used in breast reduction surgery. These include:
The manual technique where surgeons remove tissue after having opened the breast along the tissue lines. Surface tissue is removed, as well as lifted.
The tumescent technique that is, in all actuality, liposuction in a lesser form.
Yes, breast reduction surgery should be considered permanent, although the remaining fat cells will swell and enlarge if you gain weight. Likewise, in the event of a pregnancy, the tissues swell or take on fluid and store milk. Natural or synthetic hormones may also cause breast tissue to swell and be tender to the touch. If you take hormonal supplements, it is quite possible to gain small amounts of breast tissue back.
The exception is in virginal hyperplasia/hypertrophy, where the estrogen levels are high and the development of the breast may be ongoing.
First, your doctor will discuss your goals with you and explain what can realistically be achieved. A surgeon should take into account your hip size when determining your new breast size. Removing too much breast tissue will make your hips look large by comparison, giving you a pear shape. Obviously, you can request significant removal, although you may want to consider this balance when determining your end size. Many women with large breasts just want them smaller, but may later regret having the majority of their breast volume removed. I am just suggesting thorough consideration before making a commitment.
Your surgeon will then show you before-and-after breast reduction photos of his or her work. You may also wish to show him or her photos of what you like and do not like. He or she should discuss the risks at length and the details that are associated with breast reduction surgery. There is no "one size fits all" technique when it comes to this procedure. It is all individual, just like you! But do realize that your surgeon may not be aware of newer or lesser scarring techniques, so do your research beforehand and get several opinions before scheduling your surgery.
Prior to your breast reduction surgery, a complete medical history is taken to evaluate the general health of the patient. The breasts are then examined thoroughly to determine the most effective surgical approach. The surgeon will go over the anesthesia to be used, the procedure, what results might realistically be expected and possible risks and complications.
Mammograms or x-rays may be taken along with preoperative photographs. Preoperative instructions often include the elimination of certain drugs containing aspirin for several weeks before surgery to minimize the possibility of excess bleeding. Birth control and other estrogen containing hormones may also be discontinued temporarily (depending upon the individual). Antibiotics, pain relievers and other medications may be prescribed a few days prior to your surgery for your convenience so you'll be completely prepared with no excess worry.
You may also be instructed to have blood tests performed, which may include a complete blood count (CBC), a pregnancy test, clotting tests, and others. This all depends upon the surgeon's requirements, so these tests will vary.
For the liposuction technique, small incisions are made within the natural fold underneath the breast and perhaps on the outer side as well. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent), Lidocaine (pain reliever) and epinephrine (prohibits excessive bleeding and excess absorption of Lidocaine) are injected into the targeted area. This technique engorges the tissues with solution for a firmer working area and the softer fat cells are suctioned out. The epinephrine inhibits bleeding during the operation.
Another liposuction technique involves ultrasonic energy waves. These ultrasonic waves energize the fat molecules and literally melt the fat into a liquid that is removed by suction. Unfortunately, ultrasound liposuction can result in burns if the surgeon is not careful.
The manual removal technique is similar to a breast lift operation but with more internal tissue removed. With this technique there will be scars associated with the breast lift (more than likely anchor-shaped) since an extensive amount of tissue is likely to be removed and proper repositioning and recontouring of the breast is performed.
In any case, the targeted breast tissue and fat is removed, and sutures are sometimes used in the closure of incisions for the smaller, liposuction-assisted breast reduction and most definitely for the traditional breast reduction techniques. Then, a support garment or surgical bra is worn for proper, compact healing. A surgical or soft bra will be worn day and night for several weeks or months.
Incisions are usually made within the natural folds under the breasts, sometimes around the areolae, and in a line from the crease to the areolae. Some procedures require only a keyhole incision (LeJour lift). The surgery is not a minor one and breast reduction scars should be expected. Unnecessary scarring is generally avoided, although in nonliposuction techniques the scarring is more pronounced. Discuss with your doctor his or her incision placement of choice, and why, and remember to get several opinions.
After your breast reduction procedure, you may be placed in two bras as well as an elastic bandage. In some cases, you may remove the top bra only and rewrap the breasts with the elastic bandage the day after surgery. Some patients are told not remove the bandage or bra for at least three days. Patients may choose to wear the bandage for up to 10 days if they find it provides added comfort. Patients are usually instructed to wear their surgical bra for 21 days both day and night. However, it is advisable to wear a high quality support garment of any kind until the scar matures, which may take up to a year. Please ask your surgeon for specific instructions.
During recovery, you will be carefully monitored. You may be allowed to be driven home a few hours later or may be required to remain in the hospital. If you live more than an hour or so away from your surgeon, he or she may insist that you remain at a hotel in the vicinity in case you experience complications.
Some patients are instructed to ice their breasts continuously for the first 48 to 72 hours. If this is the case, put an ice bag (or bags of frozen peas) over a cloth or dishtowel on top of your breasts. Do not put ice packs directly on your skin. This will maintain coldness continuously without damaging the skin and reduce any discomfort and swelling significantly.
Breast reduction pain connected with the procedure is minimal to moderate and is controlled with oral pain medication. Prescribed antibiotics are taken postoperatively for several days to prevent infection. Instructions for the day and night after surgery include bed rest with limited activities. During your postoperative visits, your surgeon will determine when normal activities can be resumed, normally at three weeks. Strenuous activities and heavy lifting must be avoided for several weeks.
You should notice a gradual reduction in discomfort. Fever greater than 100.5 degrees should be reported to your surgeon. Marked increases in tenderness after 48 hours accompanied by redness may indicate an infection and should be reported immediately.
You may be limited to sponge bathing for the first three days after surgery as you should not get the bandages wet. You can remove the bra after eight days, but only to put on a fresh one. After 14 days a normal shower may be taken. Be sure to replace the bra immediately after showering or bathing. However, some surgeons require that you shower in a bra for several weeks.
Swelling may increase over the first three days. Your doctor may recommend Arnica montana or bromelain. There may also be some bruising, and the arnica and bromelain can help alleviate some of this as well.
You should wear your bra 24 hours a day for at least the first three weeks. After the initial 21-day period, the bra should be worn at least during the daytime for six months. Your surgeon will remove the tapes covering the suture lines in approximately 10 to 15 days.
Complications and slow healing are rare. However, there are certain inherent risks connected with reduction mammoplasty, which will be thoroughly discussed at your consultation. The risks and instances of slow healing are more significant in smokers.
It takes about a week and a half for most of the swelling to subside. Some patients are more prone to bruising than others. Some doctors suggest arnica and a topical ointment, others recommend bromelain or drinking pineapple juice starting three days before surgery. These products are thought to decrease both bruising and swelling in all procedures and in most cases have shown a significant decrease in both complaints. You should take your prescribed pain medication to alleviate any breast reduction pain or discomfort that you experience. If you feel that your pain is severe, do not hesitate to call your surgeon or the staff member on call.
Most patients return to work within two weeks, although some patients have returned after just five days. Breast reduction recovery is highly individual. The discomfort is more than likely the main reason people tend to take time off from work. You should not bend over, lift your arms over your head or exercise until well after three weeks post-op.
You should notice the difference in breast volume immediately. If the procedure was due to back pain associated with very large breasts, pain relief is usually immediate. After the swelling subsides, you will begin to notice a difference in the compact appearance of your breasts.
There are more risks with this operation due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, it tends to turn orange-ish clear and drain from the incision. However, it can spread and worsen. If the tissue becomes necrotic, immediate treatment is necessary! You must have the tissue removed before the necrosis spreads, a major infection develops, or gangrene sets in.
Patients have been known to suffer burns from the ultrasonic technique. The fat is melted within the body by energizing the fat molecules with high frequency radio waves and is then suctioned out. There may be asymmetry or hyperpigmentation (permanent dark spots) from the bruising. Major blood loss is a factor in some cases, as is hematoma and infection. Unfortunately in most breast reductions, breastfeeding will not be an option for any future children. There is also the risk of loss of blood supply to the treatment area and permanent numbness due to nerve damage.
Another risk of breast reduction surgery is pulmonary thromboemboli, or blood clots in the lungs. The risk is highest with liposuction-assisted reductions, or when liposuction is performed in combination with breast reduction. A blood clot can break free and travel to the lungs, throwing the patient into breathing distress and subsequently into cardiac arrest or coma, leading to the loss of oxygen rich blood to the brain. Pulmonary thromboemboli can happen within three weeks of the surgery, but patients will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. Pulmonary thromboemboli can occur suddenly and without warning.
Arnica is a perennial herb that has been used in Europe for centuries to treat swelling, soreness and bruising. When properly prepared, Arnica may significantly decrease the healing time. There are many formulations from different companies. Sublingual (under the tongue) types are the most often recommended for plastic surgery.
Arnica should never be taken in raw form. This plant, like many medicinal plants, can cause intestinal bleeding, abdominal cramping and sickness if ingested. Homeopathy is the medicinal use of tinctures and suspensions using herbs and other plants, and only respectable homeopathic remedies and tinctures should be consumed.
Derived from the pineapple plant, bromelain is an anti-inflammatory formula containing an enzyme that dissolves proteins. It is most often used after sports injuries to relieve edema and after surgical procedures to help with swelling.
Other products or supplements that you may have heard of or that have been recommended are Arnica montana, vitamins A, K or C. Please discuss these with your surgeon if you are interested or have questions.