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Breast Reduction Surgery

What is the breast reduction surgery?

Breast reduction is the surgical procedure aims to remove excess fat, glandular tissue and skin to reduce size of breasts. During your consultation with Dr. Nieto you should express your feelings and your expectations about the procedure. Please let your physician know what you want to improve and what your desired outcome is.

There are physical and psycho-emotional reasons for women to go through breast reduction surgery.

Some of them are:

  • Neck, shoulders and back pain. Breast pain during the menstrual cycle.
  • Poor posture due to heavy breasts.
  • Skin irritation at the inframammary line (dermatitis).
  • Difficulty in breathing. Painful shoulder grooves from bra straps.
  • Restrictions on dress. Social isolation.


The candidate for breast reduction surgery

A good candidate for breast reduction surgery usually would be a healthy woman with real expectations about the surgery. Most patients are who go through breast reduction surgery refer being extremely satisfied with their results.

This surgery is usually performed in women with moderate to large breasts. Breast reduction surgery in obese women may require additional control to prevent obesity-related complications.

Some physicians consider that breast reduction may decrease risk of developing breast cancer. This is because risks of developing breast cancer increases as individuals get older. As a result, the adult female breast is more likely to develop breast cancer. By reducing the breast tissue, the probabilities of developing breast cancer are also reduced.

Breastfeeding and breast reduction surgery

Unlike other breast procedures, if the methods to preserve the lactiferous ducts are performed, the possibility for breastfeeding after breast reduction surgery exists. Nipple sensitivity would also be preserved. However, if excessive breast tissue is removed during breast reduction, the ability to breastfeed might be altered.

Preoperative breast evaluation During consultation, a complete history and physical exam will be performed. The type of breast reduction surgical method may vary depending on different factors, including:

  • Weight.
  • Breast size: mild, moderate or severe breast hypertrophy, gigantomastia.
  • Grade of ptosis.
  • Nipple position.
  • Distance between breasts.
  • Breast volume.
  • Shape of the thorax.
  • Skin quality (stretch marks -striae-, scars, etc.).
  • Benign breast disease.
  • Skin laxity and skin excess.
  • Tension on the skin with patient in erect position.
  • Difference in size between breasts.
  • Estimation of the new nipple-areola complex position.
  • Determination of the breast volume to be reduced according to height, weight and body shape of the patient.


In this consultation, your physician may recommend to have a mammogram before the procedure to screen for any signs of disease prior to the breast reduction surgery.



Hospitalization

Will I require hospitalization?

The length of your hospital stay depends on your health condition after surgery.

The breast reduction procedure

Types of incisions

Periareolar incision:

Performed in mild hypertrophic breasts.

Vertical incision

Used in moderate hypertrophic breasts with moderate ptosis. This incision provides better breast projection and also avoids the scar in the crease beneath breast. The redundant skin is pinched in the medial line to determine the excess to be removed.


Inverted T incision:

This is one of the most commonly performed breast reduction procedures. The inverted T incision is indicated when a minor-to-moderate reduction is required.

Preoperative markings are essential for obtaining optimum results.

The procedure begins by determining the incision lines. With the patient standing or sitting upright, the position of the new nipple-areola complex is marked. The size of the nipple-areola complex would be reduced. Once the proper nipple-areola complex location has been determined, incisions are made around the nipple-areola complex and the skin is deepithelialized. Then, the selected breast tissue is resected. Once the nipple is elevated, sutures are used to approximate the skin. The breast pillars are approximated to conify the breast, skin excess is resected, drains are inserted and the closure at the inframammary crease is done.

Once both breasts have been reduced, careful attention is paid to the symmetry of the breasts and position of the nipple. Depending on the volume of resected breast tissue and position of the nipple, the surgeon may – or may not- choose to perform an areola transposition.



Postoperative care

What can I expect after breast reduction surgery?

  • 1. As with any other breast surgery, you may experience some pain and discomfort which may be minimized through pain medication. Inform immediately to your physician, if painful or uncomfortable symptoms persist.

  • 2. Your doctor or hospital nurse will instruct you about proper caring for the bandages. You should call your doctor immediately if you experience severe pain, heat, excessive swelling, secretion, or erythema in the treated site.

  • 3. Your doctor or hospital nurse will instruct you about specific massage techniques following your surgery to help keep your breasts soft and natural looking.

  • 4. Topical medications must be applied according to the medical prescription.

  • 5. Accepting the scarring associated with breast reduction surgery is a real concern for many patients. However, regardless of the scarring, most patients choose reduction surgery to restore the size and shape of the breasts.

  • 6. Although, plastic surgery works to develop new techniques to restore the shape and size of breasts, the patient should clearly understand that outcomes only depend on her individual circumstances. Therefore,it is difficult that adult women may restore the juvenile appearance of breasts. Most patients refer being satisfied with the results from breast reduction surgery.

  • 7. Drainage tubes are removed within the following 24-48 hours. after surgery.

  • 8. The patient must rest at home for the first hours following surgery, in order to avoid risk of developing complications such as hematoma.

  • 9. Because breast reduction involves manipulation of the breast tissues, you may experience some loss of sensitivity in your breasts and the nipple area after surgery. Many patients recover their level of sensitivity 3-4 weeks following surgery, but some may take even one year. For some patients the breast sensitivity may be definitively reduced.

  • 10. It is important to use a good supportive bra during the 3 months following reduction surgery.

  • 11. Quite frequently many patients experience a brief period of depression and anxiety. These feelings may be caused by different reasons, such as the combination of pain medications, the post-surgical the frustration of waiting for results to appear. In fact, this is quite normal. Your feelings of sadness and depression will subside as you heal.

What care should be taken after breast reduction surgery?

Part of the success of surgery depends on the postoperative care. It is very important to follow the surgeon´s recommendations to achieve the desired outcome. Dr. Nieto closely observes her patient´s convalescence and healing. Please do not hesitate to contact her if you have questions or concerns. Written instructions will be given for your postoperative care to you and your family.

  • 1. A surgical dressing or soft bra must be worn for the following 2 weeks both day and night. Please do not remove it.

  • 2. Drainage tubes will be removed usually within 24-48 hours.

  • 3. Sutures are removed within the first two weeks following the surgery.

  • 4. You must rest at home for the first 48 hours following surgery.

  • 5. You will be given a prescription with antibiotics and pain medication to minimize any discomfort.

  • 6. Inform immediately to your physician if you develop an unexpected reaction to the prescribed medication.

  • 7. Prior to surgery, you must make arrangements for a responsible adult friend or family member to take you home and take care of you during your convalescence.

  • 8. You have to sleep on your back and keep your head elevated. You may elevate your body on two pillows.

  • 9. Avoid taking any medication that has not been prescribed by your doctor, especially aspirin (acetyl salicylic acid) or aspirin-like products (Ibuprofen, Advil, Motrin or Aleve). These medicines have anticoagulant adverse effects and may increase the risk of bleeding or scarring complications.

  • 10. You should expect some bruising and swelling as a natural effect of surgery.

  • 11. Avoid any activity for 2 weeks after surgery.

  • 12. Do not remove your bandages or surgical bra.

  • 13. You should also be careful about lifting your arms over your head for two weeks after surgery.

  • 14. You will not be able to drive a vehicle for the following weeks.

  • 15. Lifting heavy things, animals or children may affect the area of surgery. You must avoid any activity that increases risk of hitting.

  • 16. Do not allow sutures or dressing to get wet until they have been removed.

  • 17. You must avoid shaving the axillary area for 2 weeks after surgery.

  • 18. Do not lie face down for the first 4 weeks or during the time indicated by your physician.

  • 19. Protect yourself from sun exposure for the following 2 months.

  • 20. You should resume your normal daily activities after 2 weeks.

  • 21. Exercise can be resumed 3 months after surgery.

  • 22. Patient must return to the office for general check up as indicated by the physician.

  • 23. You should keep examining your breasts as usually. Ask your doctor to teach you how to do a breast self-exam after breast reduction.

  • 24. It is important to understand that complete healing and final results after breast augmentation surgery may take from several months to one year.

  • 25. You should see your gynecologist for breast exam as usually.

  • 26. Please inform Dr. Nieto if you present heavy bleeding from the wound, severe pain or chest pressure, high fever (more than 38 degrees),significant redness or severe discomfort.




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