Francois J Duminy

PLASTIC & RECONSTRUCTIVE SURGEON

Breast Reduction - Conventional

What is Breast Reduction?

Breast Reduction is the Surgical removal of Excess Breast Tissue, Fatty Tissue and Skin from the breasts in order to leave the patient with smaller, firmer and more shapely breasts that match the rest of her anatomy in a more balanced way.

The tissue is removed in such a way as to leave the Nipple and Areola attached to the body by a bridge of tissue so that nerves and blood vessels to the nipple are preserved. This tissue bridge is called "The Pedicle"

Surgical Breast Reduction cannot be performed without making incisions. Incisions will always result in scars, but we aim to control those scars so that they develop into thin, soft and level lines that are unobtrusive.

 

Benefits

1. A new feeling of freedom.

2. The ability to wear the clothes they have always wanted to wear.

3. Improved ability to exercise, take part in sports and control their weight more effectively.

4. “Cure” of upper and lower backache.

5. Improved pre-menstrual breast pain.

6. “Cure” of rashes in the breast folds.

7. Improved self-image leading to greater confidence and thus greater success in their pursuits.

 

Negative aspects.

Commonly general anaesthetic is provided for surgery and this carries possible dangers including Deep Vein Thrombosis and Pulmonary Embolism. The risk factor is low and is estimated to be 9 times less dangerous than driving in a motor vehicle.

Please note that in our practice it is now much more common to do Breast Reductions under Local Anaesthetic and Conscious Sedation. There are many advantages to this method.

At present you are free of scars, after surgery scarring is inevitable. Development of scars varies from person to person. Our aim is to finally achieve mature scars that are thin, soft, pale lines. To help you in this, please refer to our section on scar care.

Following this type of surgery, it is usually not possible for women to breast feed their babies and lactation should be suppressed. However, to postpone surgery for this reason is not always advisable as women with large breasts are often not able to feed successfully as they tend to have poor milk production and the baby is often not able to suckle easily when the breasts are too large.

Many patients experience either increased or decreased sensitivity in the nipple post surgery. In the vast majority of patients this returns to normal within six months

Post-operatively you will notice that the shape of the breasts is not normal but this will settle as gravity pulls the remaining tissue into its correct place.

At the end of the scar there may be a lump or irregularity. This is likely to be incorporated as the breasts settle. If it remains it is easily corrected at a later date by a small local anaesthetic procedure.

 

Complications

We try at all times to avoid complications by taking every precaution available to us and by employing meticulous techniques. Complications, however, will sometimes occur even in the hands of the most careful surgeon.

As with any surgical procedure the wounds may become infected which may prolong your stay in hospital for treatment which might include drainage, dressings and antibiotics.

A bleed may occur after surgery and it may be necessary to return to the operating theatre to stop such a bleed.

Pain is sometimes experienced in "patches" over the breasts. Occasionally there are firm areas associated with pain, this may be due to fat necrosis and it settles as the necrotic tissue is reabsorbed.

Sometimes very sharp pains of a very short duration occur. These pains are known as lightning pains and their occurrence disappears after a few months.

A very rare, but disastrous complication which we try to avoid at all costs is necrosis of the nipple. If the nipple loses its blood supply and dies, it may have to be removed. If this were to happen, the nipple would have to be reconstructed in the same way as is done when a breast is reconstructed following cancer surgery

 

How to Prepare for Surgery

  • Arrange a consultation with the surgeon (Make a consultation booking)
     
  • At Consultation you will find out if you are a suitable candidate for the procedure (not everyone is )
     
  • Usually, you will be able to try some implants in your bra, so it is a good idea to bring an unpadded, underwired bra of the size you would like to be. Remember, we cannot change your chest size, if you are a 32, you will stay a 32, but your cup size will be increased by the implant. So, bring a bra that fits your chest properly and has cups of the desired size. We will then be able to see how much extra volume you will need to fill that bra and also what type and size of implants would suit your needs.
     
  • Obtain a quote for the procedure so that you can plan finances.
     
  • When you are ready, schedule an operation date and pay your booking deposit
     
  • Prepare your body:
    • Keep fit
    • Stop smoking!
    • Being at your ideal body mass is desirable, but not always possible - in our experience, most patients become re-motivated and more mobile after this surgery and weight loss occurs as a natural consequence
    • Prepare your breast skin by using a pregnancy cream such as Dermastine regularly to help prevent stretch marks
    • Stop taking anticoagulant medications such as Disprin, Aspirin, Ginko Biloba, Evening Primrose oil, Omega 3 Salmon Oil, Flaxseed Oil, Arnica and Vitamin E at least 10 days before your procedure. (If these substances have been prescribed by your doctor, then please discuss with your surgeon and the prescribing doctor whether they should be stopped) .
    • Do NOT sunburn/sunbathe your breasts pre-operatively, if your upper body shows signs of sunburn, the procedure will be postponed
    • Buy an underwired bra of the correct discussed size and another one which is one cup size larger to accommodate early swelling.
       
  • Schedule an appointment with one of our Registered Nurse Practitioner Consultants who will
    • Re-discuss the details of the procedure with you.
    • Give you an opportunity to ask questions
    • Give you a pack containing useful items for the peri-operative period.
    • Give you an appropriate prescription for post-operative medication.
    • Go through the informed consent document with you

       
  • Pay the remainder of the procedure fee at least one week before the procedure to facilitate ordering of prostheses and special materials, drapes and instruments
     
  • On the day before surgery, you should have an appointment to visit Dr Duminy who will take measurements and mark your breasts. He may also do your pre-operative photographs at that time.

 

Immediate Pre-Op Checklist

  • Arrange to be transported too and from the procedure
  • Make a note of accompanying person's contact details to hand to us
  • Stay "Nil Per Mouth" for 6 hours before your scheduled procedure time
  • Shower head to toe with medicated shampoo to reduce the bacterial load on the skin
  • Wear loose clothing
  • Pack your Bras
  • Give yourself enough time for a relaxed approach.

 

Post-Operative Care

  • Wear your Underwired Bra day and night for one month - This keeps your breasts stable and well positioned during the critical early healing period
  • You may be asked to wear an elastic "Care-Fix" strap over your bra to add further stability
  • Waterproof dressings will allow you to shower from day 1. Bathing and swimming allowed only after 7 days
  • Attend your "dressing change" consultation with the Registered Nurse Practitioner and pay careful attention to the "scar taping" instructions that you will be given.
  • Tape your scars correctly for 4 to 6 months ("if we support the scars, they will not need to support themselves" and they will therefore remain as thin flat lines rather than becoming ridges)
  • After 1 month, you can stop wearing the bra at night, but you must continue to wear it every day when you are up and about.
  • When exercising, wear a Sports Bra such as a "Triumph Shock Absorber " over your underwired bra.Good support of the healing internal "scars" is vital.
  • Enjoy your new appearance with confidence.

 

What you may expect while you are in hospital if you are choosing to have the procedure under General Anaesthetic

In the usual case, where there are no complications, you will spend 2 nights in hospital. You will be admitted in the morning before surgery.

The anaesthetist will usually also visit you.

A Private ward, if required, must be specially requested.

Surgery will take place when your turn comes and you will be in theatre for approximately two hours.

After surgery you will have well padded dressings over your chest and there will be special drains to ensure that no blood collects in the tissues. These drains will be gently and carefully shortened and removed by the nurses over the next two days.

Discharge from hospital will be two days after surgery once the drains have been removed.

 

After hospital - your Ongoing Responsibility.

You may have difficulty in driving and in picking up heavy objects such as children for 2 to 4 weeks.

Your breasts will need to be well supported post surgery and the best is a firm bra that fits well.

At first you should be able to use your old bras as the dressings will help to fill them.

After a week, try to obtain or borrow a bra with a larger cup than you will eventually require as the breasts will be swollen and possibly tender, later you can buy a bra that is the correct size for you.

The practice nurses would be happy to assist you in determining the correct size for you.

Sports bras provide very good support and are ideal for wearing over your underwired Bra.

Bra support, combined with the scar care regimen will ensure that you have the best scars possible together with a "new you" of whom you can be proud.

To get the most pleasing results you must give your body the best opportunity to recover.
Rest well, eat healthy foods and take special care of your breasts. We are always available to help with any problem.