Breast reduction surgery (Reduction mammaplasty)

Excessively large breasts are much more than a cosmetic issue – physical complaints include neck and back pain, breast pain, poor posture, painful grooves where bra straps have cut into the shoulders and skin rashes and irritations. Restrictions in physical activities due to breast size are not uncommon and finding clothes to fit is often a problem. Large breasts often lead to self-confidence issues too. Mr Henley points out, “The psychological impact of breast reduction can be life-altering. Being teased relentlessly for years and years over the size of their breasts has been extremely distressing for some patients. Not only does all the teasing go away after surgery, but also it opens up a whole new world of clothing options for a woman who has been hiding under baggy jumpers and tops for years.”          

Breast reduction (or reduction mammaplasty in surgical jargon) is an operation that reduces breast size to the proportion of a woman’s body for improved appearance and quality of life. The operation can also be performed on one side only to make each breast a similar size, if one side is much larger than the other.

The surgery takes between two to four hours to complete and is almost always performed under a general anaesthetic. You will be asleep through the entire operation.

A one to two night stay is recommended for this procedure.

Depending on the severity of symptoms, some ladies with very large and heavy breasts can have this procedure performed on the NHS. Talk to your General Practitioner (GP) about your treatement options.

Risks and side effects of surgery

There is a high complication rate with this procedure. Approximately forty individuals out of every hundred will develop some form of problem. Fortunately, however, the vast majority of these are only minor.

There will be permanent scarring where the incisions were made, which may take up to two years to fade and soften. Occasionally, scars can thicken and become unsightly, requiring further treatment. Most, but not all people feel that the trade-off between having small breasts with scars versus large, uncomfortable breasts is well worth it.

Contrary to popular belief, women with large breasts can experience difficulty with breast feeding. Breast reduction surgery can make it even more difficult, as the operation involves removing some of the milk ducts that lead to the nipple area. It is estimated that only fifteen ladies out of every hundred will be able to breast feed following this operation. Therefore, if breast feeding is important to you, you should avoid surgery until your family is complete.

Delayed healing frequently occurs and ranges from minor problems needing daily dressing changes for a while, to major issues that require further surgery. People with diabetes, smokers and people who are overweight are at increased risk of this complication. Sometimes, areas of fat and breast tissue form hard lumps – this problem, known as fat necrosis, can take a year or more to settle down.

Reduced nipple sensation is common and the ability for the nipple to go erect may also be affected, although this problem often resolves. Another complication relating to breast reduction surgery is nipple necrosis, with loss of part or the entire nipple, although this complication only occurs in about one out of every hundred people.

Whilst every effort is made to ensure that breasts are symmetrical after surgery, absolute symmetry cannot be guaranteed.

Other risks include bleeding, wound infection, chest infection and blood clots in the leg (known as a deep vein thrombosis), although these risks are uncommon.

The risks will be discussed in detail at your consultation. You will also be provided with detailed written information to help you make an informed decision about any surgery.

Recovery

You may well experience some pain in the first few days. However, this is not usually severe and the area only pulls and hurts when you move around or cough. Mild painkillers are all that is normally required. Occasionally, you can experience random, shooting pains in your breasts for a few months as the nerves responsible for sensation recover.

With the exception of showering, you will need to wear a good sports bra for support around the clock for several weeks until the swelling and bruising go down.

It is very important to avoid putting any unnecessary strain on the scars; you will need to avoid driving and lifting, or pushing anything heavy for at least two weeks.

Expect some loss of feeling in your nipples and breast skin for approximately six weeks. Avoid anything but gentle contact with your breasts during this time.

You should be able to return to work and other social activities within two to four weeks after surgery. Avoid purchasing any new bras for at least six weeks after your operation.

The results of breast reduction are seen and felt immediately, although it will be some months before you can judge the final result.

Breast reduction before and after surgery

This lady had suffered from neck and back pain for years. The overall reduction in breast size/height can be seen. The incision that was made around the areola (the dark skin in the nipple area) can be clearly seen at four weeks. At six weeks the scars are becoming less noticeable.

Before surgery	Six months after surgery

Before surgery	Six months after surgery

Mr Henley would like to thank this patient for allowing her photographs to be displayed for the benefit of others who may be considering cosmetic surgery.

The information provided is intended to give a brief outline of the procedure. It is not a substitute for a personal consultation with a surgeon.