Breast Reductions

The size, shape and symmetry of a woman’s breast are often closely tied to her feelings of self esteem and self image. Breasts that are too large for the body frame present the following problems – emotional & physical issues, poor posture development, local health symptoms as well as lifestyle changes.

Most women find an amazing relief from symptoms related to large breasts – they find it easier to shop for bras, clothes, T-shirts and swimwear. There is a boost to self esteem and confidence as they come to terms with their new breasts and body image. When considering breast reduction surgery, there are several elements to be considered. The following links provide important information on breast reduction;

• Why consider breast reduction
• Goals to reach
• Breast Reduction Assessment
• Possible Complications
• Post operative Care

Why consider breast reduction:

The size, shape and symmetry of a woman’s breast are often closely tied to her feelings of self esteem and self image. Breasts that are too large for the body frame present the following problems

Emotional aspects -

• Girls being teased at school, resulting in increased self consciousness.
• Women having difficulty finding clothes or brassieres that fit well and are comfortable.
• Finding that some men do not make eye contact when talking to them, instead tend to focus their eyes on their breasts.
• Feeling ‘top heavy’.
• Embarrassment with bouncing breasts when running
• Finding most aerobic exercise too uncomfortable, even in a sports bra.
• Too embarrassed to go swimming in public places.

Physical symptoms -

• Headaches or migraines.
• Neck aches and muscle spasm.
• Shoulder pain with ‘grooving’ caused by the weight of the breasts on the bra straps.
• Dermatitis (intertrigo) in the lower fold of the breast, especially in hot weather or hot climates.
• Backache
• Dyspnoea (shortness of breath) – especially if asthmatic.
• Bra strap pressure on the brachial plexus (nerve) causing numbness in fingers or tingling of little fingers.

Poor posture develops -

• Shoulders are often pulled forwards in an attempt to mask the large size of the breasts.
• A hump (dowager’s hump) develops at the base of the neck.
• A degree of scoliosis by the sheer weight on the neck and spine.

Local symptoms -

• Decreased sensation of nipples and areola may be present.
• Prone to inverted nipples.
• Difficulty in breast-feeding.
• Self examination more difficult, preventing the detection of small tumours.
• A mammogram examination is more difficult and requires more than the standard two films taken to include all the breast tissue.

Lifestyle changes -

• Inability to exercise because of self consciousness or physical discomfort can aid the onset of obesity.
• Poor body image can result.
• Sporting activities are often avoided, as are intimate relationships.

Goals to reach

The Goals of Breast Reduction, include;

• To reduce your breasts to a size that is in a better proportion to the rest of your body, especially to your shoulders, as abdominal fat can be modified.
• To obtain a good lasting shape with fullness superiorly and medially.
• To place the nipple / areola complex in the correct position, equidistant from the midline and at the apex of the breast mound.
• To correct ptosis (falling or drooping of the breast tissue and nipple-areola complex).
• To improve symmetry if asymmetry presents.
• To keep scars to a minimum or hidden on the under surface of the breast. If there is a tendency to form thick (hypertrophic) scars or keloid scars, silica gel sheeting can be applied continuously after healing has occurred.
• To maintain normal function with normal (or improved) sensitivity of the nipple / areola complex and the possibility of being able to breastfeed, even if in reduced amounts.
• To feel more comfortable, find it easier to buy a well-fitting bra, and to feel more confident.

Breast Reduction Assessment

North Adelaide Medical Centre Breast Reduction Assessment includes;

• Complete a family history of breast cancer.
• Proper medical history.
• Full examination of breasts, looking for lumps, skin changes, asymmetry, position of nipple / areola complex.
• Baseline mammogram if over 35 years of age and ultrasound if younger.
• Full discussion of risks and possible complications.
• Discussion of indicated technique.
• Emotional assessment – loss of breast tissue, especially if the result and shape is not acceptable, may lead to a degree of grief and change in body image, especially if the abdomen is protuberant. This may cause further emotional turmoil as changes in lifestyle become necessary.
• Pre-operative preparation includes stopping the oral contraceptive pill and smoking one month before surgery. Medicines that can affect clotting eg aspirin, anti-inflammatory and herbal medications are stopped two weeks prior to surgery.
• Realistic expectations need to be present. Any surgery always leaves scars. Most of the time they will be acceptable and will start fading after six months.

Possible Complications

Complications or Risks possibly involved in Breast Reduction, include;

Early complications are the following -

• Skin separation over the inverted T junction (8%)
• Partial loss of nipple / areola sensation (rare)
• Nipple necrosis (0.8%) with diminished blood supply to the nipple or venous congestion with very long pedicles (> 25 cms)
• Post-operative haematoma or seroma (fluid collection)
• Infection – intra-operative antibiotics are given.
• Skin bruising
• General anaesthetic complications eg pneumonia

Late complications include the following -

• Scars may become hypertrophic (raised) (3.3%). A silica gel dressing can be applied or re-excision may become necessary (uncommon).
• Shape may need revision – insufficient resection at medial and lateral ends may require further elliptical resections at three months under local or general anaesthetic.
• Fat necrosis (0.8%)
• Dermoid cyst (0.3%)
• Carcinoma (0.2%) – all breast tissue is sent for histology.
• Lactation – one study showed that 72% were able to breastfeed with decreased capacity.

Post operative Care

Post Operative Care for Breast Reduction, include;

• Drains are usually removed after 24-48 hours depending on the amount of drainage.
• Dressings are replaced with hypafix after steri-strips removed and Betadine applied. Hypafix replaced every 2-3 days.
• Wear a special brassiere continuously for 3-4 weeks.
• Minimise home activities for the first week.
• Moderate exercise over the next few weeks and full activities at 6 weeks.