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Based at:
Spire Thames Valley
Hospital
Wexham Street
Wexham
Berkshire, SL3 6NH
01753 662241
Berkshire Independent
Hospital
Wensley Road
Coley Park
Reading
Berkshire, RG1 6UZ
0118 902 8130
For Appointments
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 Breast Reduction
Breast reduction is a reliable surgical procedure that gives great benefits to patients, with improvements in appearance and comfort. When considering a breast reduction you are no doubt concerned about the general embarrassment and self consciousness that over large breasts can cause but you may also be experiencing many physical symptoms, such as shoulder and back pain, breast pain, soreness of the skin underneath the breasts or painful indentation of the skin over the shoulders. Large breasts are also often a physical encumbrance, limiting the pleasure of participating in sporting and leisure activities.
A breast reduction reduces the volume of tissue in the breast and to create a pleasing shape to the new breast the nipple is re-positioned, the breast mound is re-formed and excess skin removed. A critical part of a breast reduction is the re-positioning of the nipple. The new position of the nipple is determined relative to your infra-mammary fold. Blood supply to the nipple is maintained during re-positioning by leaving the nipple connected to the breast with a strip of tissue known as a pedicle. There are many different ways that this pedicle can be created but I use either a superior or inferior pedicle. The new breast is created from tissue in the upper outer and inner parts of the breast, with excess breast tissue and skin being removed from the central and lower parts of the breast.
When the nipple is re-positioned it is often appropriate to reduce the size of the areola, which is usually stretched in the larger breast. Re-positioning of the nipple leaves a circular scar around the areola which blends in well at the junction between darker and lighter coloured skin. The difference in colour and texture at this junction camouflages the scar well. The circular scar around the areola continues downwards as a vertical scar running over the lower pole of the breast to the fold underneath the breast. Depending upon your breast size, and your wishes, a vertical scar only is required (vertical scar breast reduction) or there is an additional horizontal scar in or about the infra-mammary fold.
My favoured technique for breast reduction is a superior pedicle breast reduction, with or without a horizontal scar. In most breasts this gives me the greatest flexibility in creating the new breast size and shape and creates a more stable breast shape in the long term. If you are very large we may need to use a more traditional inferior pedicle, with a horizontal scar.
Surgery
Surgery is performed under general anaesthesia and will involve a stay of one or two nights in hospital postoperatively. On the day of surgery we will meet again and we will plan the operation by marking the new position for your nipple and the surgical incisions on your breasts. This is done with you awake and either standing or sitting. Your input for your desired size is obviously important at the stage.
The surgical wounds are closed with absorbable sutures and suture tape. We usually leave drains in the wounds which are removed before you leave hospital. You will leave hospital with a firm dressing in place or a sports bra if you able to bring one along
Aftercare
Dressings will remain in place for one week following surgery. After removal of dressings you can resume normal skin care and we will encourage you to moisturise the wounds on a regular basis. We will ask you to wear a firm sports bra at all times for the first month following surgery and then during the day for the second and third months. Providing you are wearing good support we will encourage you to resume physical activity as comfort allows.
Following general anaesthesia you should not drive for forty eight hours but I would expect you to be driving between three and five days following surgery providing comfort allows.
In the early stages we will encourage plenty of walking to maintain physical fitness and protect against venous thrombosis. Non impact work in the lower body can be commenced as soon as comfort allows, providing you are wearing support. Upper body work can be resumed between ten and fourteen days following surgery and impact work in the gymnasium between four and six weeks, with full physical activity, including jogging, being resumed after eight weeks.
I would recommend that you take two weeks off work following a breast reduction but this may of course vary depending upon the type of work that you are doing.
What you may expect after surgery
Immediately after surgery your breasts will be swollen and the breasts may be more pert than you will see in the long term. As the swelling reduces the tissues will soften and the breasts will drop into a more natural position. For the first three to six months the surgical wounds will be red and possibly raised. As the tissues mature the scars will flatten and fade over a period of six months to one year.
Nipple sensation is likely to be affected by breast reduction. Most people experience some change in sensation in the nipple, with more than half of patients undergoing a breast reduction losing all feeling in the nipple. This is not usually a problem, providing that patients are aware of this occurrence, particularly as large breasts tend to have reduced nipple sensation due to stretching of nerves.
You should not expect to be able to breast feed following a breast reduction. In an inferior pedicle technique the nipple is separated from the glandular tissue and you are therefore unlikely to be able to breast feed in the future. In the superior pedicle technique segments of breast tissue are removed with the remaining tissues maintaining continuity with the nipple. The ductal system is therefore likely to be preserved and breast feeding should be possible, although this should not be relied upon.
Losing feeling in the nipple and the impact on breast feeding are inevitable consequences of a breast reduction. If loss of nipple sensation is unacceptable to you, or if you wish to breast feed in the future, a breast reduction is not for you.
In addition to these very specific implications you need to consider the general surgical complications of a breast reduction, such as anaesthetic risks, excessive bleeding, wound infections, and poor wound healing.
Breast screening
You should continue with routine breast screening by mammography. Surgical changes will be recognisable on a mammogram but these are usually distinct from changes which may indicate cancer. You should, of course, tell the Radiographer that you have had a breast reduction in the past. It will be wise not to have a mammogram in the first three months following surgery as your breasts will be rather uncomfortable during the procedure.
If you require any further information please do not hesitate to ask.
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