Breast reduction
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Author: Xavier Tenorio

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Galerie - SeinThis procedure is also known as “Reduction Mammaplasty”. The goal is to reduce the volume and reshape the breast in order to obtain firm and symmetrical breasts and in turn, improve the patient’s quality of life.

Normal physical activity, sports and sexual life can be shortly resumed after the surgery.

The procedure includes the excision of the excess of skin, fat and glandular tissue and an adjustment of the diameter of the areola.

Definition of a breast reduction
Breast hypertrophy is characterized by an important volume of the mammary gland compared to the morphology of the patient. This excess of volume is associated in general with an elongation of the breast (mammary ptosis) and sometimes with a certain degree of asymmetry. Breast hypertrophy almost always implies a physical and functional repercussion (pains of the neck, shoulders and back, difficulty to practise sports, and for dressing). In many cases a notable psychological repercussion is also noticed.

Objectives and principles of a breast reduction
The purpose of this procedure is to reduce the volume of the breast, to correct the breast elongation and the possible asymmetry in order to obtain a harmonious result.

After the excision of the excessive mammary and fat tissue, the residual glandular volume is reorganized, concentrated and reshaped. The cutaneous envelope is the adapted to the new size and shape. Often, the resulting scars look like an inverted “T” with three components: a periareolar scar (around the nipple), a descending scar from the areola to the fold under the breast and a horizontal scar (not always necessary) located in the mammarian fold.

A breast reduction can be performed from the end of the puberty and beyond, during lifetime. A further pregnancy and breast-feeding is always possible, however, we advise to wait at least six months after the surgery. The risk of cancer is not increased.

Before the surgery (breast reduction)
A usual preoperative assessment is carried out in accordance with the federal regulations. The anaesthetist will see you at latest 48 hours prior the operation.
In addition to the usual preoperative examinations, some imagery exams may be prescribed (mammography, echography). Drugs containing aspirin have to be stopped  at least 10 days before the surgery.

Type of anaesthesia and hospitalisation
A general anaesthesia is preferred followed by a hospitalisation of one to two nights.

The surgery  (breast reduction)
The removed tissues are systematically addressed to a specialised laboratory for microscope examination (histological examination). At the end of the surgery a modelling bandage, with elastic bands is made. the surgery can  last from two to three hours.

Follow-up after a breast reduction surgery
The immediate post-operative pain is treated with appropriated medication. Swelling (oedema) and bruises (blue) are normally observed and resolve spontaneously. The first dressing is changed 24 or 48 hours after the surgery. The second dressing is lighter and easy to handle. The patient is discharged from the clinic 24 to 48 hours after the surgery, and is re-examined in consultation two to three days later.

An elastic sports bra ensuring a good application (which’s size will have been evaluated before being discharged from the clinic) is advised to be used night and day during approximately a month. Mostly in all cases we use absorbable sutures, however, if non-absorbable sutures were employed, they will be removed 10 days after the surgery. It is advisable to consider convalescence and a sick leave from 8 to 15 days. A period of two months is recommended before resuming sports.

Results of a breast reduction
The final result can only be judged one year after the surgery: the shape of the breast is then generally harmonious and symmetrical or close to symmetrical. However, most patients are very satisfied during the immediate postoperative period. Beyond the local improvement, this surgery has a favourable repercussion on the weight balance, the practise of sports, the possibilities of using adequate clothes and the psychological state.

Imperfections and complications of a breast reduction surgery
The maturation of the scars can be different from person to person, that is the reason why they are the subject of an attentive monitoring: it is frequent that the scars get a pink tint during the second and third post-operative months; they gradually flattens and get pale during one year time. They can however remain widened, or remain active for longer than a year. Scars do not disappear completely, but their aspect improves over time.
Asymmetries of volume, height, size or orientation can be seen. In all the cases, a secondary surgical correction can be made, after at least a year or two.
Complications related to the anaesthesia, will be discussed during the consultation with the anaesthetist.
Regarding the surgical procedure: choosing a qualified Plastic Surgeon decreases to the minimum these risks, without however removing them completely. Fortunately, the true complications  following a breast reduction are rare. In practise, the vast majority of the cases evolved without any problem and the patients are fully satisfied with their result.
Rare but possible complications: Infection requiring an antibiotic treatment and sometimes a surgical drainage. Haematoma formation requiring a drainage (evacuation). Decrease of the sensitivity, in particular in the nipple area, however the normal sensitivity generally reappears within 6 to 18 months. Troubles of the wound healing process seen in heavy smokers and diabetic patients.  Hypertrophic scars and even keloides, in patients with unfavourable wound healing process.

Conclusion of a breast reduction surgery
To resume, there is no need to overestimate the risks, but  it is important to become aware that any surgical operation, even apparently simple, always comprises a small share of risks.
Having a qualified Surgeon ensures you that these complications can be identified and treated effectively. I advise to preserve this document, to read again it after the consultation. Perhaps this reading will bring out new questions, that our team will be ready to answer effectively.