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Published by BUPA's Health Information Team
February 2004
Breast reduction is an operation where the excess fat and skin
are removed from the breasts. The breasts are then reshaped to
form smaller breasts, and the nipples are repositioned. Breast
reduction can also be used to even up the size of the breasts
where one is much larger than the other.
The size of a woman's breasts is partly determined by her genes
- the inherited factors that also affect height and frame. It
is also influenced by her weight and by hormones.
Some women develop particularly large breasts from early adolescence.
Others develop them later in life, during the menopause or following
the use of HRT. For some women, large breasts are a source of
physical and psychological discomfort.
Choosing to have a breast reduction
Women can feel very self-conscious and can become depressed about
the size of their breasts. Large breasts can lead to numerous
problems, including:
- back, neck and shoulder pain and grooves in the shoulders
from bra straps
- excessive sweating, rashes and infections under the breasts
- difficulty participating in sport
- unwanted attention and comments
- difficulty in finding comfortable and attractive clothes to
fit
Large breasts may appear droopy, with downward-pointing nipples.
Breast reduction (reduction mammoplasty) may relieve many of
the symptoms mentioned above. However, there is always some scarring
on the breasts as a result of surgery. This will vary from person
to person, and according to the type of incision (surgical cut)
that is used. The surgeon will discuss the position of the incisions
with the woman before the operation.
Getting advice
When you are considering a breast reduction, the best first step
is to contact your GP. They will have an overview of your general
health, and may know about any past illnesses or conditions that
increase the risks of complications during surgery.
A breast reduction is usually a cosmetic procedure and not essential
to your health. You will only qualify for a breast reduction on
the NHS if you meet specific, often strict, criteria set out by
your local health authority. Many women are unlikely to qualify.
To decide if you meet these criteria, you'll usually be referred
to a surgeon and a psychologist or psychiatrist. They will report
on whether there are good enough psychological, social or physical
reasons to justify surgery on the NHS.
Breast surgery is also performed privately, but it is worth asking
your GP to recommend a suitably qualified surgeon.
Issues to consider
Before you opt for breast reduction, you should consider the
result you hope to achieve. Some women initially want a radical
reduction in size, but this can affect the final shape and appearance
of the breasts, so a more moderate reduction may be a better option.
Many women find that the benefits of breast reduction far outweigh
the side-effects. However, because a breast reduction is done,
at least in part, for cosmetic reasons, it is especially important
to carefully consider the risks.
Because breast size alters with body weight, you will be more
suitable for surgery if your weight is stable. Your breasts won't
grow again after surgery, but they may still fluctuate in size
if you gain or lose weight.
If you are a younger woman, the surgeon will advise you to wait
until your breasts have stopped growing before performing the
operation.
As with breasts that have not been surgically reduced, some drooping
will still occur as you get older.
Consultation with the surgeon
Before the breast reduction operation you should always have
a consultation with the surgeon who will operate on you. This
is your chance to ask questions about the operation. It is a good
idea to bring a list of your questions to the consultation.
The surgeon will also give you advice on how best to prepare
for the operation. If you are overweight, you may be advised to
lose weight beforehand. Smokers will be advised to give up because
smoking increases the risks of surgery, including delayed healing.
With your permission, the surgeon will also photograph your breasts
for a confidential "before and after" reference image.
Many people find it helpful to take notes during the consultation,
bring a friend for support, or tape-record the consultation. This
is completely normal (and often encouraged by the surgeon).
The breast reduction operation
If you decide that you want to have the operation you will be
asked to sign a consent form. This is to show that you are aware
of what the procedure involves, including the possible risks,
and give your permission for it to go ahead.
Breast reductions are carried out under a general anaesthetic.
You will need to stay in the hospital overnight after the operation
and sometimes for longer.
Your surgeon or the hospital will give you advice about recovery,
including what home arrangements to make and who to contact if
complications occur. You will need to wear a special, supportive
bra for a few weeks after the operation.
Side-effects
These are the unwanted, but usually temporary effects of a successful
procedure.
- You may feel sick as a result of the general anaesthetic or
painkillers.
- There will be some pain and discomfort for a few days, and
your breasts may feel tender and lumpy for weeks and even months
after the procedure.
- You will always experience some scarring although this usually
fades with time.
- You are also likely to lose sensation in the nipple, and this
numbness may extend over part of the breast as well.
- It is unlikely that you will be able to breastfeed after a
breast reduction, as your nipples are separated from the milk
ducts in the operation.
Complications
Complications are unexpected problems that can arise during or
after the procedure. Most people are not affected. However, in
rare cases they can be severe and even fatal.
The major complications of any operation are:
- unexpected reaction to the anaesthetic
- excessive bleeding during or after surgery
- wound infection
- developing a blood clot, usually in a vein in the leg (deep
vein thrombosis)
Specific complications of breast reduction include:
- occasionally, scars may stay thick, red and irritable for
a long time
- rarely, abnormalities of the blood supply may result in loss
of part, or even all, of a nipple
- breasts will always change shape slightly after the procedure,
but occasionally the breasts may be more uneven than normal,
or the nipples may not be level
Follow-up
You will always have a post-operative consultation with your
surgeon to review the results and to check on your progress. Once
you've returned home, you'll need two to six weeks of rest depending
on your age and health. A week or two after surgery, your stitches
will either dissolve, or you'll need to return to the hospital
to have them removed.
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