Breast reduction, or reduction mammoplasty, is indicated for women with health problems and/or extreme self-consciousness associated with very large, heavy breasts.
The goal is to give the woman a more attractive contour with smaller, better-shaped breasts in proportion with the rest of her body. She will then benefit from decreased health problems associated with large breasts and an improved self-image.
The most common medical problem associated with very large breasts include back, neck, and shoulder pain caused by the excessive weight. Appropriate candidates may also have skin irritation, shoulder grooving, poor posture, and interference with normal daily activities such as exercise. Excessive breast size may also lead to a decreased sense of attractiveness and self-confidence.
Breast Reduction is often covered by insurance. Please check your policy as some plans specifically exclude coverage for this surgery, no matter how medically necessary. Insurers require a certain volume of tissue be removed to qualify. This quantity is usually related to the patient’s height and weight (body surface area), but is high enough to exclude patients who are seeking predominantly cosmetic benefits. After an examination, Dr. Wigod will be able to better estimate if you are likely to qualify for insurance coverage. The office will then submit a letter and await approval before proceeding.
Breast reduction is done under general anesthesia on an outpatient or inpatient basis. The operation lasts 3-4 hours. Fat, glandular tissue, and skin is removed from the breasts to makes them smaller, lighter, and firmer. The size of the areola, the darker skin surrounding the nipple, is also usually reduced.
Incisions are made around the nipple-areola complex and extend vertically below the nipple and in the fold under the breast. Using the superior-medical pedicle or inferior pedicle technique, the nipple-areola complex is then moved upward to the desired location and the breast tissue rearranged for closure. Care is taken to maintain the nerve and blood supply to the nipple. Dr. Wigod uses pedicle techniques in most patients. Liposuction may be added in select patients to remove excess fat from the armpit. Liposuction only for breast reduction is not recommended by Dr. Wigod as he feels the technique either removes insufficient tissue to give relief or removes enough an leaves a poor cosmetic result due to ptosis and poor shape.
In some instances, such as extremely large breasts or in patients who cannot tolerate a longer operation, the nipple may be removed as a skin graft and then sutured into the appropriate new location. This nipple grafting method is safer in that damage to the nipple during movement is minimized, and the operation may be performed in less time. The breast may actually have better shape, but erotic sensation to the nipple is lost.
Drains are placed and exited under the armpits. The wounds are closed in an upside down “T” shape with a combination of absorbable and removable sutures. Afterward, the breasts are placed in a surgical bra or binder.
You will usually be discharged the same day, but may be scheduled for an overnight stay depending on your pain level, overall health, and other factors.
Your wounds will be dressed with gauze and a breast binder. Dressings should be changed daily or when significantly soiled. You do not require dressings once you have no more drainage from your wound, but you should have a clean soft cotton garment in contact with the wound which is washed or changed daily. During the first 3 weeks after the operation, you should wear a breast binder or loose sports bra. During the second 3 weeks, you may wear a regular soft bra without underwire. After 6 weeks, you may wear an underwire bra for short periods and progress to longer periods over the next month.
Your skin will be closed by a combination of visible and deep sutures. You may have some oozing which is not unusual. If you have a pedicle technique, you will be able to see your nipples and may wash your breasts in a shower 24-48 hours after the operation. If you have the nipple grafting technique, you will have what looks like a package tied over your nipples and should keep this dry for one week at which time the bolster (package) will be removed. In the meantime, you may sponge bathe. Your sutures will be removed at 2 weeks post-op.
You will have a rubber tube, called a drain, exiting from each breast. They are there to allow controlled drainage from the wound and to decrease pain. These tubes may be removed from one to several days after the operation. The drains should be emptied every 8 hours and the drainage tracked in milliliters (cc’s). Your recovery nurse will instruct you. You may shower with the drains in. If a drain is accidentally removed, it is not an emergency as it will not be reinserted. Notify Dr. Wigod during the next business day.
You will be provided a narcotic for pain. You may start taking ibuprofen 48 hours after the operation. Do not use ice or heat on your breasts unless specifically discussed with Dr. Wigod. Your pain should improve rapidly during the first few postoperative days and then resolve more slowly. Pain should limit your activity and you should avoid heavy lifting and sweating for about 3 weeks.
Your breasts will feel swollen for 2 to 4 weeks. Gradually they will “settle” into a more rounded shape. Your breasts will continue to change with time as the operation does not stop the natural aging process. Dr. Wigod makes every effort possible to create symmetry. Since approximately 90% of women are asymmetric pre-operatively and since tissue removal during the operation is very subjective, exact symmetry cannot be guaranteed and should not be expected.
Small scabs or limited wound opening with drainage is not unusual, particularly at the center of the inverted “T” where tension is greatest and blood supply is least. Although Dr. Wigod will make your scars as inconspicuous as possible, permanent scarring is inevitable. Smokers are more likely to experience poor healing and wider scars. The scars will be red and raised in the months following the surgery, but they should improve and become less obvious with time. Most clothing and bathing suits will cover the scars.
The breast is a functional organ, and every effort is made to maintain that function by using pedicle techniques. The ability to breast feed after the operation cannot be guaranteed. Most patients will have minimal long term change in their nipple sensation, and some may even have slight improvement. Many patients, however, do have temporary decreased nipple sensation. A few patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. The nipple and areola can usually be rebuilt, however, using reconstruction techniques.
Other problems may occur such as delayed healing, fat necrosis, blood clots, infection, and need for further surgery. Overall, the operation is very successful and patients are usually satisfied with their results.