Excessive breast tissue generally is the result of two major factors. Genetically there may be a developmental excess of breast tissue ranging from relatively mild excess not fitting with body proportion to massive hyperplasia that may be both distressing and uncomfortable. The second major cause is hormonally mediated from pregnancies. It is normal to have an element of enlargement with lactation; however, if there is not reasonable reduction back to normal this may result in an abnormal excess of tissue.
The major problems are those of size as well as position. Although it is possible to have excessive tissue and otherwise normal position more often than not there is some degree of droopiness present. This needs to be carefully assessed and addressed with the reduction option. In virtually all cases breast reduction is inherently a breast lift as well. Often there is also some excess of fatty tissue (not breast tissue) above and to the sides of the breasts often creating a fullness under the armpits. This is treated with liposuction at the time of the reduction.
Overly large and droopy breasts may result in a number of problems including painful weight and back problems, difficulty finding well fitting clothing, bra strap indentations at the shoulders, and potential rashes and irritation under the breasts.
Breast reduction does involve external incisions as untimely a tighter "skin envelope" needs to be created to fit the smaller breast volume and to provide support. The most common technique incorporates a "Weiss pattern" known as an anchor style incision. This results in an incision around the nipple allowing for its lift and positioning. there is a vertical incision under the nipple and this joins an incision place in the crease of the breast (infra mammary fold). The length of the incision in the fold is affected by the degree of reduction although it is possible to reasonably minimize this. With normal healing the incisions are generally faint and aesthetically quite acceptable.
Breast reduction is performed on an outpatient basis in our Medicare and AAAHC accredited facility with anesthesia provided by our MD anesthesiologists. Most individuals feel well enough to go home approximately 1 hour after the procedure. Although meticulous as a procedure this is quite gentle surgery and as such we see only minor bruising and swelling in most cases. We provide a support garment to be used for approximately the first 3-4 weeks after which a comfortable no underwire brassier is appropriate. In most cases a drain is placed to minimize the risk of any fluid collection under the tissue- this is generally removed after 1-2 days.
There is generally surprisingly little discomfort with many of our patients in fact not needing medication. It is possible and encouraged to be up and about the next day with common sense limitations that will be reviewed in detail.
The risks of breast reduction include the initial rare possibility of a hematoma (excess bleeding) or infection. There is a risk to the blood and nerve supply of the nipple that could potentially result in loss of tissue or a decrease in sensation. The incisions although generally well healing could heal with scaring or widening or possible pigment change. These risks are dramatically increased in smokers making it absolutely mandatory that one has ceased completely at least 3 weeks prior to the procedure and continues to not smoke during the healing phase.
We strive to achieve the best symmetry and shape possible however virtually no one is perfectly symmetrical.
Reduction surgery is often extremely satisfying with the elimination of many of the physical and aesthetic problems. Patients are generally surprised at the relative ease of recovery and their ability to resume activities quickly.