Breast Reduction (Reduction Mammoplasty)

Background

Women with large, pendulous breasts often have trouble with back and neck pain, skin irritation, shoulder grooving from their bra straps, and even numbness and tingling in their fingers from the weight of their breasts. Disproportionately large breasts can make a woman feel very self-conscious, and make finding clothing that fits very difficult.

The operation known as reduction mammoplasty is designed to reduce the size and weight of such breasts by removing skin, breast gland, and fat. By unloading the neck and upper back, there is almost always dramatic functional improvement in such patients. The goals of the surgery are not only to improve one's appearance, but also to improve function by liberating the individual to perform many activities they are unable to perform with the burden of their breasts.

This procedure is usually performed in women who have fully developed breasts, but occasionally it is necessary in younger teenage girls when the breasts cause serious physical discomfort. Breast reduction should be reserved for women who do not intend to breast-feed.

The Consultation

Dr. Creasman will meet with you personally and after gathering a thorough medical history, he will examine your breasts, making measurements to determine the amount of breast tissue he expects to remove to give you a size appropriate to the rest of your physical characteristics. Every patient has their ideal about what size they would like to be after their surgery, but a good rule of thumb is to leave enough breast tissue to look and feel proportioned, and not to "over-do" the removal. There seems to be a tendency to want to remove as much breast tissue as possible, particularly in those women with extremely large breasts. It is prudent to listen to Dr. Creasman and allow him to guide you, using the measurements that he makes, and then decide how aggressive a removal you wish to undergo.

If you have insurance that covers breast reduction, the doctor will need to take pictures to send to your carrier to obtain pre-authorization to perform your operation. Depending on the insurance carrier, it can take several weeks to several months to obtain this authorization, so you need to plan ahead.

Risks of Breast Reduction

Complications of breast surgery are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, bleeding, or a reaction to the anesthetic or sedative medications. You may have temporary or even permanent areas of altered sensation, including numbness. Rarely, the nipple and areola may lose their blood supply resulting in some tissue death. (The nipple and areola can be rebuilt, however, using skin grafts from elsewhere on the body.) There is usually some difference in the size of breasts normally, and this is almost never perfectly correctable. There are fairly lengthy skin incisions that require a period of up to a year or two for completion of the scarring process for optimal appearance. In some ethnic skin types, scarring can be more prominent, and may require further treatment. The doctor will discuss your particular scarring potential in more detail at the time of your consultation.

Before Your Procedure

It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery. In women over the age of 35, a baseline mammogram must be obtained prior to operation.

Prophylactic antibiotics are administered intravenously just prior to surgery to reduce the risk of surgical wound infection. A prescription for pain medication is written at your preoperative visit, so that you have your pain pills when you return home from the operation. You will be told what bra to bring to surgery. Dr. Creasman recommends the use of homeopathic pills to minimize swelling and bruising. This is available for purchase in our office.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure.

You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.

This is a PreOperative Checklist for you to follow prior to your Breast Reduction:

1. Please pick up liquid Ivory hand soap and cleanse the skin of your chest and underarms with it for the three days prior to your operation.
2. Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms.
3. You should avoid shaving your armpits for two days prior to surgery. You should not wear deodorant the day of your surgery.
4. Wear a non-pullover blouse to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton panties and clean white socks. Do not wear makeup.
5. Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
6. Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts, including navels, nipples, and tongues, need to be free of jewelry for your safety.
7. Take any prescribed medications as directed.
8. DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
9. Avoid smoking for six weeks prior to surgery.
10. Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
11. Stock up on Coca Cola Classic. It is useful to reduce any nausea you might feel after your anesthetic.
12. Bring your bra with you to surgery.

You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for your comfort and safety.

The Operation

Reduction mammoplasty is performed under a general anesthetic, which means you will sleep through the operation. You will be provided with anesthesia by a board-certified anesthesiologist. Typically, the operation takes about three hours, but may be longer in women with extremely large breasts.

Prior to the operation, Dr. Creasman will outline the planned incisions on your breasts with a marking pen with you sitting upright. These skin markings provide a guide for the surgery, which is done with you in the supine position, so that in the upright position the breasts are shaped appropriately and are as symmetrical as possible. The outline of the incisions results in scars with a “lollipop” shape, going around the areola (which is made smaller), and vertically down the center of the breast.It is not typically necessary to use an incision horizontally in the fold beneath the breast. Dr. Creasman uses the “short scar” technique for almost all his breast reductions. In extrememly large reductions, the scar beneath the breast may be necessary

During the procedure, the breast tissue to remain with the nipple and areola attached, is preserved, while the skin and breast that is excessive is removed. This is done in such a way as to preserve the best possible circulation to the nipple and areola and the smaller mound of breast beneath it. Flaps of breast are developed and sewn together to secure not just the skin, but the breast gland itself in a smaller configuration. Some skin is removed to wrap the breast tissue in a tighter envelope, and the entire breast including the nipple are moved to a higher level on the chest, thereby giving the breast its new contour.

All incisions are closed with dissolving type stitches and surgical wound tapes. Thick gauze and cotton dressings are placed for comfort and support. After the operation, you will need to spend at least an hour in our recovery room in order to recover from the anesthetic.

The Post-Operative Period

You will need to have someone stay with you for at least the first 24 hours. There is mild to moderate pain that is well controlled with the pain medication that Dr. Creasman prescribes.

You will be seen back in the office in one to two days. Your wounds are checked. You will then be able to shower. The surgical tapes may be changed, as necessary. It is normal to have clotted blood on the tapes. You will be asked to wear a comfortable bra around the clock for the first six weeks and daily thereafter. There are no stitches to be removed. The breasts sit quite a bit higher on the chest early on and do settle into a more natural shape over the first 2-3 weeks. In particular the skin of the vertical portion of the closure using the “short scar” procedure is gathered toward the chest wall and this takes some time to heal and for the gathering to smooth out. There may appear to be redundancy of skin in this area, but this also smoothes out over the first month. Do not worry about this temporary appearance. It resolves without intervention in the vast majority of patients. It is not uncommon for there to be small areas of crusting or openings in the incision line. These heal on their own and only need to be kept clean and covered with an antibiotic ointment..

Even though you will be up and around in one to two days, it is important for you to limit your activity for optimal recovery. You should avoid any heavy lifting, pushing, or pulling for four to six weeks. Though you may do some stretching exercises and walking by the end of the first week, you should not plan to engage in any vigorous exercising for six weeks. This can stress the incisions and lead to complications such as delayed wound healing or prominent scars. You should avoid sexual activity for two weeks, as hormonal stimulation may make your breasts swell and lead to increased pain. Vigorous breast massage should be avoided for six to eight weeks.

The first menstrual cycle may bring swelling and pain out of proportion to your normal cycle. You may experience random shooting type pains for the first several months following operation. There is usually numbness of the nipples and breast skin for the first six to eight weeks due to the swelling of the breast, but this should subside. In unusual cases, the loss of sensation is permanent. Scars should be treated with topical silicone gel sheeting or other methods starting two weeks after all wounds are completely healed. Dr. Creasman or his nurse will advise you in more detail according to your progress after surgery. The optimal appearance of the scars occurs only after one to two years.

The appearance of the breasts changes over time. The breasts will become slightly smaller as the swelling subsides. They will also descend to a certain extent as the effects of gravity act on the newly tightened skin envelope. Most patients find this to be beneficial, in that the breasts look more natural after they have had time to "settle in". It is prudent to always wear a supportive bra to maintain the new contour of your breasts.