Breast Reduction and Mastopexy - ‘breast rebalancing’

The female breast is made up of a gland, the nipple and surrounding skin - this may be an obvious statement, but many of the plastic surgery procedures of the breast simply rebalance these components for a cosmetically improved result. The breast can be reduced, reshaped and remodeled, and the skin redraped around it, placing the healthy nipple at the apex of the remodelled breast. Your surgeon may elevate the breast (mastopexy / uplift) in conjunction with a reduction, depending upon your aims. Your surgeon assesses the amount of breast and skin, and the position of the nipple on the breast mound. If the breast is loose in a large excess skin envelope, then there is scope to elevate the breast and tighten the skin around it - re-siting the nipple appropriately. If the breast is large and the skin closely applied, then your surgeon will reshape and remove breast tissue, protecting the nipple and re-siting it on the reshaped breast mound to make a comfortable, proportionate bust. The weight of large or pendulous breasts may cause a variety of medical problems such as back and neck pain, skin irritation and shoulder soreness from tight bra straps. Large breasts can also make a woman or a teenage girl feel extremely self-conscious. Breast reduction surgery aims to reduce the bust size, for an aesthetically improved shape and nipple position.

There are many different techniques of breast reduction and so the position of the resultant scars may vary. There is always a circular scar around the nipple and a second vertical scar running from the nipple to the fold beneath the breast. A transverse scar may also created which runs along the fold beneath the breast. The length of the overall scars reflects the amount of breast skin removed. Breast scars are visible initially, but with time become fine, pale and flat.

The Operation

The operation is performed under a general anaesthetic and takes two and a half hours. After the operation the breasts are supported with dressings and an unwired bra. Drains are usually placed and removed at 24-48 hours. Usually the patients stay in hospital for one or two nights. Antibiotics and routine pain relief may be prescribed for the immediate peri-operative period. Firm dressings are removed at one week, and replaced with a close fitting sports bra or crop top. Small areas of weeping through the suture line are dressed within the bra if necessary. Underwiring is avoided for 6 weeks. Sutures are usually dissolving and do not require removal.

After the surgery

It is important to wear an unwired bra for six weeks in order to support the breasts as much as possible whilst they acquire their stable final shape. During the first two weeks following the surgery, the breasts are swollen and feel ‘tight’, bruised and tender. Excessive lifting, carrying and household activities should be avoided. For most occupations two weeks is necessary off work and strenuous exercise should be avoided for six weeks. Driving should be avoided until seat belts can be worn comfortably. In most cases this is possible at three weeks.

Nipple and skin sensation returns variably after the surgery. Many women with large breasts have altered nipple sensation before surgery, and in some of these women, nipple sensation will improve post-operatively. Small irregularities in scar and breast skin fade out over time. The bust softens and falls into a natural drop with time. Breast reduction is usually an extremely satisfying procedure, improving the contour size and shape of the bust and restoring body proportion. Many women feel more confident and are relieved of the physical discomfort of large breasts.

Possible complications

Complications after breast reduction are not common. When they occur they are mostly a temporary nuisance rather than having a long term consequence. Examples of the more worrisome complications are given below, and include but are not limited to -

• A blood clot may accumulate in the breast after the surgery. This may need evacuation under a general anaesthetic. This has no long term effects on the outcome of surgery.
• Patients experience altered sensation of the nipple (decreased or occasionally increased sensitivity) especially in the short term. In the vast majority of patients this sensation returns to normal within four to six months of surgery.
• Wound healing can occasionally be problematic. This can lead to a small area of skin breakdown at the junction of the vertical and the horizontal scars. This problem is usually treated with regular dressings.
• Occasionally a small area of the nipple can be lost. This is rare and occurs mainly in smokers or in very large breast reductions.

London Chambers of Plastic and Cosmetic Surgery

Mr Raj H Ragoowansi MB MSc FRCS (Plast), Director, Consultant Plastic Surgeon
Mr Jonathan A Britto BSc MB MD FRCS (Plast), Director, Consultant Plastic Surgeon

Central Chambers : 48 Harley Street, London W1G 7JQ
Regional Chambers : 4 Cherry Blossom Lane, Chelmsford, Essex CM3 6JQ.
Practice Manager : Julie Hughes,
Tel : 0870 418804 or 01621 826816,
Fax : 01621 826815.