Breast Reduction

Pre-operatively, you will be seen by the pre-assessment team who will advise you if any changes to your medications are required before surgery. We have provided advice on strategies for your lifestyle to optimise your surgery recovery and outcome in our Information Hub. “Practice” sleeping on your back – If you’re a side/stomach sleeper, train yourself pre-surgery to avoid accidental strain post-op. Use a pregnancy pillow for support.

After surgery, there are lots of ways to invest in your recovery to optimise your surgery outcome. We have written an article with our advice in the Information Hub which covers the strategies that we would recommend to you.

Normally for patients undergoing cosmetic breast surgery we would recommend a mammogram for if you are aged over 40 or for those who have other risk factors, such as a family history of breast cancer. It is rare to find anything wrong in the breast tissue removed at the time of a routine breast reduction. For this reason, it is not usual to send the tissue to a laboratory for examination under the microscope. However, if there is a strong family history of breast cancer or a previous history of breast disease, then we are likely to advise that the tissue be examined further.

While some women retain the ability to breastfeed after breast reduction surgery, this is uncommon. You should assume breastfeeding will not be possible, regardless of how much time passes before having children. The ability to produce breast milk depends on the remaining breast being connected to the nipple by the breast ducts and these ducts are usually cut during surgery. If you wish to breastfeed, it would be sensible to delay breast reduction surgery until after you have completed your family

You should wait six months to a year after pregnancy/breast-feeding before considering a breast reduction, as during this time your breasts will be getting smaller (involuting) and there is a danger if you have a breast reduction too soon after a pregnancy, your breasts will end up too small. There is also a risk that surgery will provoke the breasts to start lactating again.

Unfortunately, we cannot guarantee specific postoperative cup sizes, but most patients are very happy with their results. During your consultation, cup sizes will be discussed but these are often inaccurate as they vary between bra manufacturers, and also many patients have never been formally measured.

In the early post-operative period, the breasts will be swollen and it may take six months for your final size to be revealed. This will be influenced by any weight loss or gain during this period.

Your final breast size depends on your body’s fat distribution, which can change if you gain weight after surgery. Breasts also contain glandular tissue that may respond to hormones – some patients (especially younger women) experience continued growth due to oestrogen and progesterone, and pregnancy can influence this also. In these cases, a second reduction may eventually be needed.

Additionally, if your breasts were very heavy before surgery, the supporting ligaments may have stretched permanently. Over time, this can lead to natural drooping (ptosis), even after reduction. While results are long-lasting for most patients, these factors can influence your outcome.

Breast reduction surgery is a safe and commonly performed procedure, but like all surgeries, it carries some risks. Mr McLean leads efforts to reduce complications and improve the safety of breast reduction surgery by ‘stacking marginal gains’. This has resulted in excellent outcomes following surgery for his patients.

The overall complication rate for routine breast reduction is less than 10% and most of these are minor problems. While serious complications are rare, it is important to be fully informed before making your decision. Below are some possible risks and how they are managed.

• Scar – this will depend on the type of breast reduction surgery that you have and will be discussed with you at your consultation
• Haematoma (bleeding)– a collection of blood may cause swelling and pain. Small haematomas resolve on their own, but large ones may need a second operation to remove the blood clot and stop bleeding.
• Seroma (fluid accumulation)– a small amount of fluid may collect in the breast post-surgery. Most resolve naturally, but symptomatic cases may require needle aspiration.
• Infection– some minor wound infections may require antibiotic treatment.
• Wound healing problems – occasionally, there may be areas that take a bit longer to heal due to either infection or impaired blood supply. If there is a lot of tension around the vertical scar then there may be a minor problem where the vertical scar meets the infra-mammary scar (the ‘T junction’).
• Abnormal scarring – in very young and/or darker skinned patients the scars can thicken, become raised and itchy after surgery (scar hypertrophy) and in severe cases become keloid scars. This is very rare and can be treated.
• Loss of nipple sensation– temporary numbness in the first few months is common, with permanent numbness seen rarely (more common in very large breasted patients.
• Nipple blood supply issues – when repositioning the nipple to the more youthful position, the nipple is kept alive on a pedicle of breast tissue (with its own blood supply). Very rarely the blood supply can be interrupted, which can lead to a range of outcomes from skin scabbing and discolouration to partial nipple necrosis or complete loss.
• Breast asymmetry– there may be minor asymmetry in size, volume or shape between the two breasts and in particular in the shape of the nipple areolar complex. It is important to realise that any asymmetry in the nipple areolar complex prior to surgery will remain. Adjustment may occasionally be necessary.
• Fat necrosis – if the breast is very fatty, then when it is incised some areas of fat may lose their blood supply and die. This will become evident in the postoperative period with an area of hardness in the breast. This can occasionally lead to contour irregularities in the breast shape. In most cases it resolves, without treatment, over a 3-6 month period.

It is important that the breasts are held in place firmly for the first few weeks after the surgery and a well-fitted surgical bra helps. At Enova Surgery, we have included a resource to assist you in selecting your postoperative bra. Please bring one of the bras to theatre with you so that it can be put on at the end of the operation whilst you are still asleep.

These bras need to be worn for six weeks following the surgery, both during the night for sleeping and during the day. You should then be fitted for your new regular underwear.

The Department of Health give advice on protecting patients who are considering cosmetic surgery.

Specific advice regarding breast reduction can be obtained from The British Association of Aesthetic Plastic Surgeons:

• Read more about Breast Reduction
• Visit the The British Association of Aesthetic Plastic Surgeons website