Breast reduction surgery is an operation to solve a number of health problems coming with large breasts (back pain, pain in the wrists, excessive sweating, rash and infection under the breasts, ) and to make the appearance of the breasts more aesthetic for women.
Breast reduction surgery is one of the most frequent applications of aesthetic surgery and is an operation that increases the quality of life of the patient who needs to be done for whatever purpose.
Being breasts too large may depend on hormonal causes, being overweight, or being unable to lose weight after pregnancy or inherited characteristics.
Being the breasts over-sized may lead hump (lordosis), back and neck aches, numbness and loss power in hands (compression of hand-arm nerves at shoulder), rash and bad smell under breasts, marks on shoulders caused by the bra straps, psychosocial problems, which may be seen especially in teenage girls, and being unable to perform activities such as sports due to large breasts and thus obesity.
To whom is breast reduction made?
This surgery has no certain age. Breast reduction surgery is done after completion of breast development, however there are some exceptions, in some cases a surgery may be needed before completion of development for the normal psycho-social development not to be affected in teenage girls having breast over-growth in adolescence. In older women, the risk of complications is compared with the need for surgery, and then a decision can be given for the procedure. Before the surgery, it should be questioned whether the growth in the breasts arising from a hormonal problem or not, whether the growth in the breasts continue or not, whether there is any painful or painless mass, or any infection or surgical intervention in the breasts or not.
Selection of surgical procedure to be used:
The techniques of breast reduction surgeries affect short and long-term results of the surgery. Every technique used has its own advantages and disadvantages. These can be discussed in detail and decided with the patient or left to the surgeon’s own choice. The following criteria help me decide the technique;
• The placement of the nipple and nipple circumference in the new position should not affect the blood build up support of these structures.
• I prefer protective techniques to the nipple sense
• Nursing feature must be preserved depending on the age of the patient
• Aesthetic should be decided according to the shape of the breast and the amount to be removed
• Several methods have been defined to accomplish all these principles. Naturally, all surgical techniques have their own advantages and disadvantages.I prefer to use the superiomedial pedicle technique on and the central pedicle technique frequently in my patients. It is possible to shape the breast tissue and the skin separately, and to close the skin like a cover without tension, and to minimize the scar with these techniques. If the breast is not very sagging, it is finished with vertical scar. If the nipple is quite ptosis and sagged down, the “T” scar should be applied, the “T” scar is placed so it cannot be seen when patient is wearing swimwear. With these methods, which I prefer for breast reduction, sense of nipple is not damaged, milk channels are not affected, and a long-lasting steep and contoured breast can be made. With these techniques, the surgery is more successful and the effects of the surgery last longer.
EVen though the breast reduction surgeries are varying, there are certain common procedures such as reducing excessive skin, breast and fat tissue, downsizing nipples if they are too large and moving them to desired position from low position, and making the breast identical as much as possible if there is asymmetry between two breasts.
Breast Reduction After Pregnancy:
Pregnancy leads to serious changes in the female body. Breasts enlarge especially during pregnancy and sagging accompany it after breastfeeding. After breastfeeding, breast surgery can be planned.
Relationship between Breast Reduction Surgery and Breastfeeding
For normal breastfeeding, it is necessary to have the presence of functional breast tissue and nipple sensation. There is no question of damaging breastfeeding with a surgical procedure that does not damage these features. The stimulation of the nipple by the baby’s sucking causes a contraction in milk glands with a hormonal cycle in which prolactin and oxytocin hormones play a part and milk and thus leads lactation. In order for this suction reflex to work, the sensitivity of the nipple head is essential. In controlled studies performed in recent years, although decrease in nipple sensitivity was frequent in the first postoperative month, it improved in the following months. In the women with large breasts, nipple’s sensitivity to vibration and pain has also decreased.
In breast reduction operation, if the nipple is separated from the underlying tissue and applied as a free patch, the breastfeeding is not possible to occur. Since nipple left connected to a certain amount of breast tissue in all breast reduction methods applied through new techniques, breastfeeding feature of the breast is going on however, its amount can decrease. The factor determining the amount of milk supply is the amount of breast tissue left after surgery, and not losing the integrity of the nipple and its channels. Because most of the tissue removed in breast reduction operations are fat tissues. For this reason, it has been shown that the breastfeeding is possible in breast reduction surgeries with nipple pedicle.
Relationship between Breast Reduction Surgery and Breast Cancer
There is no scientifically proven relationship between breast reduction surgery and breast cancer. It can be also said that it reduces breast cancer risk by allowing the examination of removed tissues histopathologically (at the cell level).
BEFORE AND AFTER SURGERY
If you are planning to have no breast reduction surgery, you should apply for a plastic surgeon and be informed. Since reduction is made with different methods to the people having different physical characteristics, it is important that you have a complete physical examination and talk with your doctor about some subjects. Whether you have any heart, vein or blood disease or not; whether you are diabetic or not, whether you smoke or not, those are all important. It is important that you plan a post-operative pregnancy. You should share your expectations about your breasts with your doctor, which is not pleasing at this point – such as size, asymmetry, being too large.
Blood tests are performed for anesthesia before the surgery and you are examined by an anesthesiologist. The anesthesiologist assesses that you are suitable for the surgery medically. Breast ultrasound for patients under 40 years old and mammography for patients over 40 years is appropriate. You should not take aspirin or other blood thinners within 10 days before surgery. In the case of smoking, it is necessary to quit smoking within two weeks preceding and following the surgery. If you are diabetic, your doctor will decide if surgery will be done in this case. You should not drink alcohol within 48 hours before surgery. Alcohol lowers your body resistance and interacts with anesthetic drugs. The most important is that you cut the food intake six hours before surgery.
Just before the surgery, the planning and the drawing done while the patient is standing is affects the result of the surgery. When the patient is standing, the place where the nipple will be moved, the shape that will be given to the breast is drawn on the breast with a pen. Since the shape perception will disrupt when the patient is laid down on surgery table and the breasts will spread both sides, it is quite important for drawing to be made while the patient is standing.
The surgery is performed in a fully-functioned hospital and under general anesthesia. The surgery takes 3-4 hours depending on the size of the breasts and the operation method to be applied. All extracted tissue is sent to the pathologic examination, and if there is an unrecognized cyst or malignant formation, it is caught in an earlier stage.
It is very difficult to say how many years the contour given by the breast reduction surgery will last. It is important to remember that this surgery and all kinds of aesthetic surgeries do not stop the aging process. Aesthetic surgeries cannot stop aging, it only allows you to look younger and aesthetically pleasing. In breast reduction surgery, there will be scars surely. In general, a Inverted-T shaped scar at the edges of areola and coming down from the areola to the breast crease or a “vertical scar” in the shape of a paddle coming from the areola to the breast crease is formed. Although this scar is apparent at first, it gives good results over time. These scars are initially pink-red in color; If the pathological wound healing i is not in question n the patient, they gradually fade and whitens in months.
RECOVERY PROCESS AFTER SURGERY
After surgery, you can get up after a meal. The duration of stay in the hospital is 1-2 days. In the first few days, vacuum drains are used to collect blood and serum leaks. According to the amount received, this drain is removed after 3-5 days. Limiting arm movements is beneficial. There is a band wrapped around the chest for the first week, it is removed in the first week, and only thin bands covering the sewing lines are used. After drains and tapes are removed, the patient can take a bath. Edema is often normal. Laying in half-seated position will ease to edema and pain more quickly. After the drains and bands are removed, it will be appropriate to use a non-wired sports bra fitting to your new breast measurements.
There will be some redness and itching on stitch lines while the wound is healing, after a month or two, the marks of these stitches start to disappear. Scars will be more and more faded within six months and a year. In the surgery area, the bruises last for a week or two.
Some pain can be suffered after the surgery, but it can be controlled with painkillers. Patient can turn her normal life in one week or shorter mostly. It is recommended to avoid heavy activities such as sports for 2 months.
Benefits of breast reduction surgery
After surgery, your back-ache passes, you can walk comfortably and steeply. You can get rid of the rash and odor problem under the breasts. With breast reduction you can get rid of your problems like arm and wrist pain and numbness. When your breasts reach to a normal scale, your ability to move increases and you become able to play sports. Women are also often happy to wear clothes they cannot wear formerly. By surgery, the risk of breast cancer is reduced because a part of the breast is taken, and since the remaining breast tissue is reduced in volume, it will be easier to diagnose a future breast cancer. Because you have a breast that you like, your confidence in yourself increases and you have a healthy sex life.
Risks of Breast Reduction Surgery:
Although all surgeries have risks, the risks which may occur in Breast Reduction surgeries must be known by patients.
Infection: This complication is rarely seen. The source of the infection is usually bacteria found in the milk ducts. Normally, bacteria that do not cause a certain infection here can be dispersed into the tissue by cutting off milk ducts during breast reduction and can lead to infection. Those who will have breast reduction surgery should know that there may be healing problems in diabetic suture lines or that infections may develop. Another cause of such complications is smoking. For this reason, we recommend that you do not smoke within two weeks before and after the operation.
Bleeding: This complication manifests itself with bruise, swelling and pain on the breast. It usually occurs in patients taking aspirin or similar blood thinners within 10 days prior to surgery.
Numbness at nipple area: Depending on the technique used, the size and sag of the nipple, the loss of sense may not occur or may occur partially or completely.
Healing Problem on Stitches: It is only seen if there is a wound healing problem or low body resistance of the person. The most common cause for this is diabetes. Separation of wound edges or delay of wound healing is possible. Some areas of the breast skin or nipple may not heal normally or may take a long time to heal. There can even be a loss in the skin and nipple. In this case, frequent medical dressing or advanced surgical intervention to remove or unhealed tissue may be necessary. Smokers are under greater risk of skin loss and wound complications.
Asymmetry: Asymmetry occurs naturally in many women’s breasts. Differences in shape, size or symmetry of the breast and nipple can also be seen post-operatively. However, your breast will be more symmetrical than their former shape after the surgery.
Scars on skin: The quality of these scars is unpredictable. Abnormal scars may develop on the skin or deeper tissue. In some cases, neurologists need surgical correction or other treatments.