Large
breasts can cause problems in many aspects of a woman's
life. When they are larger than the usual standards
of attractiveness in our society, the breasts are considered
aesthetically displeasing. A full breasted woman may
appear heavier than she really is and she may have difficulty
obtaining stylish clothing. In some cases, it may even
be difficult to find a properly fitting bra. Often,
women with large breasts feel very self conscious. Teenagers
may not develop proper poise and posture as they try
to hide the fullness of their breasts, a subject they
are unlikely to discuss freely with their parents.
The
actual weight and bulk of the breasts may cause physical
problems and symptoms which compound the feeling of
unattractiveness. There can be a feeling of uncomfortable
fullness, neck or back pain, and shoulder grooving.
These symptoms may contribute to limited performance
in certain occupations and in sports. Finally, large
breasts can also be difficult to assess for lumps or
masses, thus making cancer detection much more difficult
for the patient or for her physician.
The
goal of reduction mammaplasty is to reduce, recontour
and reshape the breasts. The breasts are made smaller.
The nipple areola complex is repositioned upward, and
if indicated, reduced in size. Excess skin and breast
tissue is removed from the lower and outer portions
of the breast.
A
preoperative plan is made which allows both the surgeon
and the patient to share in the decision as to the proposed
size of the breast after surgery. The surgeon will attempt
to make the breasts as identical as possible, but some
asymmetry may remain. Furthermore, it is not possible
to predict exactly how large the breast will finally
be after surgery. Healing results in some progressive
change in breast size, since some swelling may be present
for several months following surgery.
Surgical
Incisions
are made in the lower breast resulting in three scars:
one around the nipple, which usually heals very nicely;
a vertical incision from the nipple to beneath the breast,
which remains visible; and finally, an incision in the
fold beneath the breast (not used in short scar method).
Breast tissue is sculpted using a combination of sharp
dissection and occasional liposuction. The nipple remains
attached to the deeper breast tissue. The remaining
breast is folded around the nipple and its attachments
and the incisions are closed. Care is taken to close
these incisions as carefully as possible. Nevertheless,
patients must realize that resultant scarring is as
much a factor of tissue response as it is surgical skill,
and occasionally wide scars can form despite a nice
overall breast shape. Fortunately, with time, these
scars do tend to blend into the normal skin, becoming
less noticeable.
Although
it takes some time for final healing and shaping of
the breasts to occur, the initial recovery is typically
well tolerated and easier than expected for most patients.
There is some soreness after the operation and pain
medicine is required, but patients usually are fully
ambulatory the day after surgery. Generally the patient
may return to work five to eight days after surgery,
although full activity or extremely vigorous exercise
should not be undertaken for four to six weeks.
Reduction
– With Augmentation
In
some cases, patients chose to have some of the saggy
breast tissue that has been removed replaced with breast
implants. This operation helps to provide better fullness
in the upper breast. While it may seem strange that
a patient who is having surgery to remove breast volume
would choose to consider an implant, the combination
can work well in patients whose primary concern is sagging
related to excess volume. When considering this operation,
patients should carefully read the information on breast
augmentation as well as this information. Patients who
have extremely large breasts or require reduction for
improvement of symptoms such as pain related to their
large breast are typically not good candidates for simultaneous
placement of implants.
Complications
Wide
scars and slow healing are the most common problems
seen postoperatively. Other possible complications are
asymmetry of the breasts, hematoma, infection, loss
of nipple sensation and scarring or necrosis of the
nipple. Although pain is usually moderate, prolonged
pain, soreness or numbness is possible. These risks
will be discussed in detail during your consultation.
It is important that the patient understand that minor
revisions may be necessary after surgery in a significant
number of cases.
There
are possible complications which must be clearly understood
and weighed prior to surgery. Wide scars and slow healing
are the most common problems seen postoperatively. Other
possible complications are asymmetry of the breasts,
hematoma, infection, loss of nipple sensation and scarring
or necrosis of the nipple. Although pain is usually
moderate, prolonged pain, soreness or numbness is possible.
These risks will be discussed in detail during your
consultation. It is important that the patient understand
that minor revisions may be necessary after surgery
in a significant number of cases.
