Breast reduction surgery, or reduction mammaplasty, reduces the volume of enlarged breasts.
How is the surgery performed?
Techniques for breast reduction vary, but typically the procedure involves an anchor-shaped incision that circles the areola, extends downward and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)
Stitches are usually located around the areola in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. Occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.
Will the surgery result in permanent scarring?
Mammaplasty leaves noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.)
How long is the recovery time?
You may be up and around in a day or two, but don't plan on returning to work for a week or more, depending on how you feel. Avoid lifting anything above your head for three to four weeks.
Will I need anesthesia?
Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.
Am I a good candidate for breast reduction?
Typically, breast reduction is performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.
In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to understand the procedure fully and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breastfeed.
In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. Photographs will be taken for reference during surgery and afterward. The surgeon also will examine your breasts and measure them while you're sitting or standing. Variables will be discussed that may affect the procedure, such as your age, the size and shape of your breasts, and the condition of your skin. You also should discuss where the nipple and areola will be positioned.
Be sure to tell your surgeon if you smoke and if you're taking any medications, vitamins or other drugs.
Your surgeon may require you to have a mammogram (breast X-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation.
Breast reduction doesn't usually require a blood transfusion. However, if a large amount of breast tissue will be removed, your physician may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used.
After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.
You may feel some pain for the first couple of days, especially when you move around or cough, and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain.
The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.
If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.
Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more and occasionally, it may be permanent.
Your surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. You'll have much less stamina for several weeks and should limit your exercises to stretching, bending and swimming until your energy level returns. You'll also need a good athletic bra for support.
You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.
A small amount of fluid draining from your surgical wound or some crusting is normal.
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