Breast Reduction – Dr. Ina Isac

Breast reduction is a surgical procedure that removes excess fat, glandular tissue, and skin to achieve a breast size appropriate for the body. Very large breasts cause women both physical and health-related problems, as well as psychological issues. In addition to an unsightly appearance, patients experience pain and discomfort. The weight of excessively large breasts prevents a normal, active lifestyle, and the emotional issues involved are just as significant as the physical ones. If the breasts sag but the patient is happy with their size when wearing a bra, then she is a candidate for a breast lift (mastopexy). However, if the patient feels that her breasts are sagging and their weight is causing back and neck pain, the bra leaves strap marks on her shoulders, she has difficulty finding clothes that fit, and her breasts prevent her from performing various physical activities, including sports, then she is a candidate for breast reduction.Smoking must be stopped at least 2 weeks before surgery because nicotine prevents oxygen from reaching the cells, thereby delaying healing. Some surgeons recommend taking arnica tablets 10–14 days before surgery to reduce postoperative swelling and bruising. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), homeopathic remedies (such as spirulina and ginkgo biloba), and vitamin E should also be avoided, as all of these increase the risk of bleeding during and after surgery.
The patient must not eat or drink anything for 6 hours before surgery.
In addition to routine blood tests, the doctor will order a mammogram to assess the current condition and to serve as a baseline for the future.
Breast reduction surgery does not increase the risk of cancer; on the contrary, it reduces it by removing breast tissue!
You’ll need to arrange for a relative or friend to take you home after surgery and, if necessary, stay with you for the first 2 days. The surgery is most commonly performed in a hospital or clinic under general anesthesia. The surgeon will very carefully and meticulously make preoperative markings using permanent markers. The size and shape of the breast, the quality of the skin, and the position of the areola and nipple will be carefully analyzed. Photographs will be taken. Depending on the size of the breast, the incisions may be shorter or longer. In all cases, there will be an incision around the areola. In cases where the breast is moderately enlarged, only a vertical incision may be used in addition to the periareolar incision. There are also cases where the vertical incision can be used for larger reductions. When the breast is large to very large, the classic incisions are around the areola, vertical, and horizontal in the inframammary fold. In the latter case, there are variations depending on the amount of excess breast tissue and skin, as well as the surgeon’s technical skill; thus, the horizontal incision may be shorter than usual or may be present only laterally (“L”- or “J”-shaped incisions).The areolas will be reduced in size and made symmetrical, and the skin above the nipple will be brought underneath to reshape the breast. The procedure involves excising excess glandular tissue and skin while elevating the nipple and areola on various flaps that ensure their viability. If the breasts are extremely large (gigantomastia), then the pedicle that might form is too long and could not ensure the viability of the areola-nipple complex; in these extreme cases, it is recommended to harvest the areola together with the nipple and reattach them at the end of the procedure as free grafts, which results in the loss of the nipple’s ability to feel sensation and to breastfeed; furthermore, it will no longer become erect. None of these disadvantages are present in classic breast reduction techniques. Sometimes the surgeon considers it necessary to also perform liposuction on the lateral areas and toward the armpit where there is excess fatty tissue. The surgery is relatively long, as it is meticulous and depends on the preoperative breast size as well as the technique used; it generally lasts between 2 and 4 hours. It is possible that suction drains will be used during the surgery to remove blood. The patient generally needs to remain hospitalized for at least one day. Bed rest is recommended for the first 2–3 days after surgery. Light movement within the hospital room and short walks are recommended as early as the second day after surgery. The breasts will be swollen and may have bruising. Avoid bending over and lifting objects, as these can cause swelling and bleeding. Swelling will peak on the 2nd or 3rd day, after which it will begin to subside. Bruising disappears within 7–10 days. Keeping the upper half of the body elevated helps reduce swelling.
The patient will need to wear a compression bra continuously for the first 45 days, and then at least at night for another 2 weeks. The sutures are removed after 14 days (generally, absorbable sutures are used, which either do not require removal or only have their ends trimmed). Light activities can be resumed in a few days (2–3), although some discomfort is possible.
In general, it is best to avoid more intense physical activities for the first few weeks after surgery. After any surgery, it is important to resume daily activities as soon as possible (for example, going to the bathroom on your own or taking a few steps around the room). This level of activity is the minimum necessary to prevent blood clots in the lower limbs. Intense physical exercise (jogging, weightlifting) should be avoided for several months.
The incisions will remain tender to the touch and redder for a few months (2–3), after which they will become paler and softer; over time, they may fade and diminish considerably. The area most prone to keloid formation is the inner part of the horizontal scar. To protect these scars, special scar-healing creams, silicone sheets, and triamcinolone injections are used. Avoid exposing the scars to the sun for 9 months, at which point the scars can be considered mature and relatively permanent in appearance. They will never disappear, but fortunately, they can be easily concealed by clothing.
You will notice that after surgery, sensitivity in the nipple and areola is no longer the same—it is reduced. This is usually temporary, but it may take several months, sometimes even a year, for sensitivity to return. Over time, the breasts will also take on a more natural appearance.
Sexual activity should be avoided for 2 weeks, and any trauma to the breasts should be avoided for at least 6 weeks.The size and shape of the breasts (smaller and firmer) should remain relatively constant as long as you do not gain or lose a significant amount of weight and as long as you do not become pregnant. However, gravity and age will take their toll, which means that after several years you may need a breast lift, as the breasts tend to sag over time.
Breast reduction surgery often has a dramatic effect on patients. It takes some time to adjust to the new appearance. This procedure is one of the cosmetic surgeries that provides the highest level of satisfaction to patients.

infection
Bleeding
Abnormal scars—may require revision later
skin necrosis
changes in nipple sensitivity
breast irregularities or asymmetries—may be corrected later
the possibility (in the case of a free areola-and-nipple graft) of losing the ability to breastfeed
partial or total necrosis of the nipple or areola
necrosis of deep fatty tissue with infection or the formation of hard nodules.

Following surgery, breastfeeding may be limited; you should discuss a potential plan to have a child with your doctor.
The procedure can be performed at any age, but it is best performed when the breasts are fully developed.
Pregnancy, as well as significant weight changes, can affect the outcome of the surgery.
The long-term results of breast reduction are very good; patients feel much more comfortable and have significantly greater self-confidence; however, over time, the breasts may sag due to age, gravity, weight changes, and hormonal changes.