Breast Reduction Surgery Information

Women that have pendulous breasts (often signifies more glandular tissue than fat)
Women who are thin (thin women tend to have more glandular tissue than fat)
Women that have excessively large breasts (liposuction normally only provides a 30-50% reduction in size)
Women that have excessively dense breast tissue (often signifies more glandular tissue than fat)
Women before menopause (during menopause fat replaces glandular tissue)

You are also at increased risk for complications if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.

Breast Reduction Information

A mammoplasty is a surgical procedure that reduces, lifts and reshapes the breasts. It can also reduce the size of the areola (the dark skin surrounding the nipple). Many women seek breast reduction to alleviate painful discomfort and other conditions (back pain, shoulder pressure, rashes, skin tags, etc.) as well as to improve the appearance of their breasts.

The procedure is usually performed under general anesthesia. The operation takes about 3-4 hours, and you may require an overnight stay or be allowed to go home the day of surgery.

During mammoplasty, the surgeon makes an incision which is normally in a keyhole pattern: a circle around the aerola and two incisions down the breast which will be closed to form one line. Fat and extra tissue are removed. The surgeon then repositions the nipple and areola to a higher position and removes excess skin from beneath the breast.

In Figure 1 the outlined areas show where skin, breast tissue, and fat are typically removed and how the areola and nipple are repositioned. The arrows show how skin formerly above the nipple is brought down and sutured together to reshape the breast. After surgery, scars will appear around the areola and in the crease under the breast.

Figure 1

In some cases, the nipple and areola are transferred as a skin graft to their new position. This is only done when absolutely necessary, since nipple sensation is almost completely lost. Drains are then placed on the sides of the breasts to drain blood and excess fluid. The drains are not removed for 1-2 days. The incisions are then sutured closed and taped.

After Surgery

On the day of surgery your chest will be painful, bruised and swollen and you may feel nauseated. Pain medication will be prescribed.

You will wear an elastic bandage or surgical bra over dressings for the first few days. The incisions will be taped to reduce scarring. You will wear an ace bandage or sports bra worn another 1-4 weeks. Do not wear an underwire bras during recovery.

According to the American Society of Plastic and Reconstructive Surgeons, the first menstruation following surgery may cause breasts to swell and hurt, and the woman may also experience shooting pains in her breasts for several months.

Recovery Tips:

Keep ice packs applied to your chest on the day of your surgery.
Sleep in an upright position. Do not sleep on your stomach for the first two weeks after surgery.
Moisturize the breasts daily (do not apply lotion to any taped areas)
To avoid unnecessary swelling or bleeding, do not bend over, strain, exercise or do any other activities that could increase pressure in your chest during the first week.
Do not shower or bathe until the drains are removed
Wear loose clothing
Drink plenty of water and be sure to get adequate nutrition
Maintain a stable weight

Risks and Complications

Possible risks and complications:
Anesthesia reaction, Asymmetry, Bleeding, Breastfeeding problems, Boxy or Flat Breast (normally occurs post-operatively as a temporary condition), Change in nipple color, Dissatisfaction with breast size (too small or too large), Fat Necrosis, Hematoma (pooling of clotted blood; risk is 3-4%), Infection (signs of infection: warmth, redness, soreness, swelling), Irregularities in position of nipples and areola, Keloid (heavy scar), Nerve Damage, Nipple loss (1%), Nipple numbness, Permanent numbness, Sensory change (4-7%), Seroma (pooling of watery blood), Skin irregularities, Skin necrosis, Wound separation

Asymmetry
Small differences in shape or size of the breasts are not uncommon following breast reduction surgery.

Fat Necrosis
"Fat necrosis is more common in larger resections. A study by Strombeck reported a 16% incidence of fat necrosis in obese patients having resections of more than 1000 g. However, the incidence of fat necrosis has been reported as low as 0.8% in 371 patients undergoing an average resection of 870 g per breast."
Source: Daane SP, Rockwell B, Breast Reduction Techniques and Outcomes: A Meta-Analysis. Aesth Plast Surg 1999;19:293-303; Mandrekas AD, Zambacos GJ, Anastasopoulous A, Haspas DA. Reduction mammaplasty with the inferior pedicle technique: early and late complications in 371 patients. Br J Plast Surg 1996;49:442–6; 35. Strombeck JL. Reduction mammaplasty by Strombeck technique. In: Goldwyn RM, editor. Plastic and reconstructive surgery of the breast. Boston: Little, Brown & Co; 1976:195–209.

Nipple Sensation
Most patients will have some change in nipple sensation following mammoplasty. This is usually temporary but could take months to return.

Wound Separation
Sometimes the incisions will pull apart. This does not require additional surgery. It is treated with moist dressings. However, if this occurs, recovery time is much longer.

Satisifaction Rates

Patient satisfaction rates range from 80% to 95%, and symptom relief is reported from 70% to 100%.

Breast Reduction by Liposuction

Liposuction reduces the breasts by removing excess fat. If there is enough elasticity in the skin, it will retract and produce a visible breast lift.

Advantages of breast reduction by liposuction over traditional methods

Less trauma to the breast
Faster recovery
Less visible scars
Fewer postoperative complications

The best candidates for breast reduction by liposuction have breasts that contain a large proportion of fat. If your breasts have more glandular tissue than fat, a mammoplasty may be more appropriate. The proportion of fat in the breast can be determined by a mammogram.

Candidates for liposuction
Types of women more likely to have more fat than glandular tissue in their breasts:

Women that do not have pendulous breasts (often signifies more glandular tissue than fat)
Women who are not thin (thin women tend to have more glandular tissue than fat)
Women that do not have excessively large breasts (liposuction normally provides a 30-50% reduction in size)
Women that do not have excessively dense breast tissue (often signifies more glandular tissue than fat)
Women after menopause (during menopause fat replaces glandular tissue)

Breast reduction by liposuction will produce a smaller version of the breasts that a woman had before liposuction. The breast's overall shape will be very similar to their shape before liposuction.

Liposuction removes fatty tissue from the breast, and mostly spares the glandular breast tissue that is responsible for milk production (breastfeeding is normally not affected). There is so little trauma to the breast tissue that mammograms usually appear normal after liposuction of the female breast. In contrast, after a mammoplasty, mammograms may show calcification and other changes in appearance.

After liposuction of the female breast, there is a gradual decrease in postoperative swelling over the subsequent 2-4 months. There may be temporary lumpiness for several weeks after surgery. This is not visible and is part of the healing processes.

Male Breast Reduction

View Male Breast Reduction Before and After Pictures

Liposuction of the male breast is one of the four areas on men most commonly treated by liposuction. The other areas are the abdomen, flanks, and facial liposuction. Men with excessive fat in their breasts are good candidates for liposuction.

The normal male breast contains both fat tissue and glandular tissue. True breast tissue in males is typically a small localized lump located immediately under the nipple that is more firm than the surrounding fatty tissue. It is easy to remove fatty breast tissue by liposuction, but much more difficult to remove glandular tissue. A mammogram can help determine the amount of glandular tissue located within the surrounding fatty tissue.

Pseudo-gynecomastia
Pseudo-gynecomastia is an enlarged male breast caused by excessive fat tissue, but a normal amount of glandular breast tissue. Pseudo-gynecomastia occurs in many men as they become older and in younger men who are relatively obese.

Pseudo-gynecomastia can be effectively treated by liposuction.

Gynecomastia
Gynecomastia is an enlarged male breast caused by excessive glandular tissue. True gynecomastia is uncommon.

Gynecomastia can be treated by eliminating the cause or by surgical excision.

Causes of gynecomastia: (not an exhaustive list)

alcoholism
effect of medications
low levels of testosterone
renal failure
testicular cancer

If a man has a single enlarged breast, it may be a breast tumor and a doctor may consider a mammogram.

Drugs
Drugs that can cause gynecomastia include:

Amiloride (Moduretic)
Amiodarone (Cordarone)
Amphetamines
Anabolic steroids
Antiandrogens (cyproterone)
Anticancer drugs (cytotoxic)
Androgens
Busulfan (Myleran)
Captopril (Capoten)
Cimetidine (Tagamet)
Clomiphene (Clomid)
Diazepam (Valium)
Diethylpropion (Tenuate)
Digitalis
Domperidone
Estrogens
Iso niazid
Ketoconazole (Nizoral)
Marijuana
Methyldopa
Metoclopramide
Nifedipine (Procardia)
Nitrosourea
Penicillamine
Phenothiazines
Phenytoin (Dilantin)
Reserpine
Spironolactone (Aldactone)
Tricyclic antidepressants
Vincristine

You'll want to discuss any connection between your condition and any drugs you are taking with your physician.