Gallery procedure shown above:
Mr Dean Trotter
MBBS FRACS (Plas) Specialist Plastic Surgeon
ARC Plastic Surgery
Very large breasts can be burdensome and cause a number of medical problems, including back and shoulder pain, an inability to exercise, poor posture and intertrigo (a fungal rash under the breasts). Patients with large breasts may seek breast reduction. In general the aim is to reduce back, neck and/or bra strap pain, improve your ability to exercise or for hygiene reasons, rather than improving appearance. Breast reduction surgery has one of the highest satisfaction rates of any surgical procedure and most patients will be very pleased that they underwent surgery.
There are several different techniques, but in general the breast tissue is reduced, along with the overlying skin. The breast tissue is then reshaped to provide a better breast shape and the skin tailored to the new breast shape. Depending on the size of the reduction, this may result in a scar around the areola, with or without a vertical scar down the front of your breast (vertical breast reduction) and possibly another in the fold below your breast (‘Wise’ pattern breast reduction – the scar looks like an anchor). Some techniques also involve liposuction; however, it is unusual that liposuction alone will be an adequate technique of breast reduction.
Therefore, all breast reduction techniques will have some form of scar that you will need to accept before deciding to have surgery.
Other complications (as with any operation on the breast) include bleeding, infection, asymmetry, slow wound healing, anaesthetic complications and deep vein thrombosis or pulmonary embolus. Specific complications relate to the nipple. Usually with breast reduction the nipple and areola are lifted from a lower position on the breast to a more ideal position. This means that blood and nerve supply to the nipple and areola may become compromised. Very rarely, this results in failure of the nipple and areola to survive the operation. More commonly there is some reduction or even loss of feeling in the nipple following breast reduction. Up to one-third of women will experience this.
The other issue related to the nipple is that the ability to breastfeed may be affected. Not all women are able to breastfeed, so it is hard to determine exactly if a breast reduction will interfere with breastfeeding. Some women are unable to breastfeed following breast reduction, others can but have to supplemental feed, and others have normal breastfeeding ability.
Breast reduction surgery is offered in public hospitals to patients who meet strict criteria. The criteria exist to try to minimise the risk of patients developing complications of surgery. It is known that if a patient’s body mass index (BMI) is higher than 30, their risk of complications increases significantly. The BMI is determined by a formula: height (cm) x height / weight (kg) = BMI. In general, if a patient’s BMI is greater than 30 they will not considered for a breast reduction procedure, unless it is to match the other breast following breast cancer surgery.
Smoking interferes with wound healing and for this reason smokers are not usually candidates for breast reduction surgery. If you are a smoker you will not be considered for this procedure in a public hospital.
Betty was a 22-year-old woman who was referred to a plastic surgeon for consideration of breast reduction by her GP because she had constant neck and back pain. Betty had cup size F breasts, despite being of average height and weight. She had deep notches on her shoulders from her bra strap and found it difficult to buy bras and clothes. She was very self-conscious of her large breasts and found it difficult to exercise, even if wearing two or even three bras. Her breasts had always been large, as had her mother’s and older sister’s. Her mother had had a breast reduction at age 45 and said that it had ‘changed her life’. Betty’s mother had prompted Betty to see a plastic surgeon for an opinion.
The surgeon described her as a good candidate for surgery, noting that she was not overweight and mentioning that this meant Betty was at low risk of complications. The surgeon was also pleased that Betty had quit smoking and said that they didn’t normally operate on smokers due to the significant risk of complications.
Betty wanted to be about a C cup after the operation. The surgeon explained that they couldn’t guarantee a specific cup size but they would reduce the breast to a size that was about a C and in proportion to the rest of Betty’s body. The surgery took about two and a half hours and she stayed in hospital overnight. It was not a particularly painful operation and Betty felt quite comfortable with tablet painkillers. By the time she saw the surgeon again about two weeks later, she had noticed a huge difference. Her neck and back pain had disappeared. By six weeks she was starting to do exercises she had not done for many years, and she has not looked back. The anchor scar on the breast faded gradually and although she can still see it if she looks for it, she would be happy to have the operation again or recommend it to her friends.
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PSF would like to thank Dr. Dean Trotter who specialises in ‘breast surgery’ for his input into this blog post.