Breast Reduction Procedure
Exciting new developments in the field of breast reduction surgery have been incorporated into our practice. Liposculpture reduces the amount of incisions needed so minimal incisions are now possible. On select cases, a laser can be used.
General Information
Reduction mammaplasty is designed to improve the appearance of overly large breasts. This procedure reduces the size and reshapes the breasts and is also designed to relieve symptoms of pain and discomfort in the shoulders, neck and upper back.
Breast reduction surgery is usually performed in our outpatient surgical facility or in a hospital, which requires a two to three day stay. The procedure takes approximately 3 to 5 hours, depending on the complexity of the surgery.
As part of your evaluation, photographs will be taken prior to surgery. Photographs are as important to the plastic surgeon as x-rays are to the physician in other medical specialties. These photographs are part of your confidential medical record, and will be used to assess the degree of improvement that has been achieved following surgery. Mammograms (a type of X-ray) of the breasts are sometimes included in the pre-operative assessment of the patient. These studies are done to ensure that there is no breast disease present before surgery.
The Anesthesia
Breast reduction surgery is performed under a "light" general anesthetic (patient is asleep). This technique provides excellent operating conditions while affording maximal patient comfort and safety. The anesthetic is administered by a board certified anesthesiologist, who remains in attendance throughout the operation. Prior to surgery, our anesthesiologist will provide additional information and answer any questions you may have. Required monitoring, anesthetic delivery and emergency equipment are present at all times.
Pre-Operative Preparations
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work needs to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to a local one in your area; we do not provide these services. It will be required that all pre-op paperwork be in our office 1-2 weeks prior to surgery.
1. It is a required that someone drive you home upon discharge. Also arrange for transportation to and from our office for your post-operative appointments until we give you permission to drive.
2. DO NOT take aspirin or aspirin-containing products for 2 weeks prior or 2 weeks after surgery.
3. An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
4. If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.
5. Bring loose-fitting, front-opening clothing with you the morning of surgery to wear home.
The Surgical Procedure
Marking and measuring the breasts is an important part of the preparation for surgery. These markings are made before the anesthesia is given and with the patient sitting fully upright. They are used as guidelines for the incisions during surgery when the patient is in a reclining position.
The surgical procedure consists of removing part of the skin and underlying tissue of the breasts, moving the nipple upward and reshaping the remaining tissues into a smaller, higher configuration. Scars left by this procedure are generally predictable and although they tend to fade with time, they are permanent. There is a circular scar around the nipple, a scar in the fold under the breast, and a vertical scar connecting them. No scars are present above the nipple.
Occasionally, revision of the scars is necessary to obtain the optimum cosmetic result. These revisions are minor and can be carried out in the office under local anesthesia.
Possible Complications
Complications are rare and usually respond promptly to proper treatment, without affecting the final result.
BLEEDING: If bleeding occurs after the operation, it may accumulate in the breast and require opening the wound to remove the blood and prevent further bleeding.
INFECTION: This occurs rarely and usually responds to antibiotics.
NUMBNESS OF THE NIPPLE: This is almost always temporary and sensation can be expected to return. On rare occasions, however, it may be permanent.
LOSS OF A NIPPLE: Complete or partial, this is extremely rare, but has been reported on occasion. Should this happen, a reconstructive operation can be performed at a later date, with satisfactory results.
What to Expect After Surgery
Although strong pain is rare, a degree of discomfort is to be expected. For this, the doctor will prescribe medication to use during hospitalization and at home. Many patients like to spend a night in a medical facility, where nurses tend to their needs, although it is not required.
Some swelling will occur but usually begins to subside by the third or fourth day. Some degree of swelling may persist for weeks or even months.
Extensive bruising may appear for the first week, but will subside over the next several weeks.
A SURGICAL BRA is applied at the time of surgery and is worn for about a week after the operation. Steri-strips covering all incisions are removed and replaced by the nurse in 5-6 days. After two weeks, a comfortable sports bra can be worn. Avoid wearing underwire bras that would create extensive pressure on incisions.
Social and work activities should be quite limited for two to three weeks after surgery. If your job requires lifting, pushing, etc., a longer recuperation period may be necessary. Driving should be avoided for one week after surgery.
It is generally recommended that following this operation, women do not attempt to nurse. Nursing may cause the breasts to enlarge again, thus eliminating the effects of surgery. Of those who try, find they are unable to do so because much of the glandular tissue has been removed, preventing adequate milk production.
Post-Operative Care
Avoid raising your arms over your head for 2 weeks. Avoid any strenuous exercising or lifting for 6 weeks.
Avoid lying on your abdomen for 2 weeks. Optimal sleep position is elevated on your back with 2 pillows. Keep a pillow under each arm, and a pillow under your knees.
Showering is usually permitted after 72 hours. Do not attempt to peel off the steri-strips (if applicable); the nurse will change those. Soaking in the bathtub is not recommended for two weeks.
The surgical bra is worn day and night for two weeks. Then a comfortable, yet supportive sports bra can be worn.
Arnica gel can be applied to bruised areas (avoiding any incisions) soon after surgery.
Resumption of Physical Activities - General Rules of Thumb: Two, Four, Six Rule
First week:
TAKE IT EASY!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks:
take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks:
light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks:
resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
