Breast Reduction Surgery

Few will disagree that women who undergo breast reduction surgery (reduction mammaplasty) are amongst the most satisfied patients in any plastic surgery practice. Breast reduction may be achieved through open surgery, liposuction, or a combination of techniques. Numerous studies have validated the improved quality of life that follows this surgery. Backache, neck and shoulder ache, poor posture, bra strap pain, and limited ability to participate in sports are just some of the reasons why women with large breasts seek help.

Currently, there are essentially 3 different surgeries (and variations there-of) available to patients seeking breast reduction. I will concentrate of the 2 “open” surgeries most commonly performed, but it may be useful to know that liposuction (liposuction only breast reduction, LOBR) is occasionally an option for patients requesting moderate breast improvement / volume reduction. Ideal patients for this surgery, are those with little or no ptosis (droop) and breasts that are predominantly composed of fatty tissue(as opposed to breast tissue itself, which is quite fibrous). The effect of liposuction is to decrease breast volume, but little or no lift is achieved. It does however, offer some patients volume reduction with little or no obvious scarring. It may also be of use in patients presenting for a second breast reduction.

ANATOMY

A breast is composed of a skin envelope, containing a “parenchyma” composed of varying proportions of fatty tissue and breast / fibrous tissue. As you will read below, some breast reduction techniques focus mainly on altering the skin envelope and use this to shape the underlying content.

More recent techniques have shifted this focus to concentrate on shaping the breast content (parenchyma) and allowing the skin envelope to re-drape. This “philosophy” of moving away from skin tightening and towards effecting change through manipulation of deeper tissues is also found in modern facelift techniques.

TRADITIONAL/LONG SCAR/WISE KEYHOLE REDUCTION

Developed in 1956 by Dr Wise, this is probably still the commonest method used for breast reduction today. Like all surgeries, it has some advantages, as well as some disadvantages.

Advantages: It is easy to perform, easy to teach and easy to learn. It involves the application of a “fixed” skin pattern design which results in an “anchor” type of scar on the breast (around the areola, a vertical scar to the breast fold, and a long scar underneath the breast, in the fold, from side to side). It can be used for small reductions, lifts, as well as very large reductions, and the results are generally good.

Disadvantages: The major disadvantage is the extent of the scarring, the quality of which can be good or bad, depending on the patient’s skin type, and wound healing ability. In addition, the breasts are occasionally slightly under projected, and tend to “bottom out” with time – this may well be due to the fact that the breast content is not specifically addressed in this surgery, but rather, the shape of the content is determined by the skin pattern design which removes excess skin in both the vertical and horizontal planes.

SHORT SCAR/VERTICAL MAMMAPLASTY

In an attempt to decrease the scar burden of the Wise pattern reduction, some innovative plastic surgeons (notably from France) looked at ways to perform a breast reduction without the need for a long horizontal scar in the breast crease.

This vertical breast reduction has undergone several refinements over the years, and is only more recently gaining wider acceptance. I was fortunate enough to attend a course in San Diego in 2003 given by Dr Elisabeth Hall-Findlay who has refined the technique, and whose method I tend to follow when doing this surgery.

Advantages: Interestingly, the main reason for pursuing this operation (i.e. the shorter scar) is not the major benefit of the surgery. Although the scar is shorter (and the operating time somewhat less) the main advantage appears to be the improved breast projection gained from shaping the parenchyma (content) by using sutures in the breast substance to maintain this projection over time. Conceptually, this is a “breast content shaping” operation, rather than a “skin shaping” operation. In addition, the breast base is narrowed somewhat, and the breast fold is lifted.

Disadvantages: The operation is more difficult to teach, to learn and to perform, as no “fixed pattern” is used – hence some degree of experience is needed. That said, this operation does have a slightly higher minor revision rate (small scar revisions etc) than the Wise pattern , even in the best hands. Another disadvantage is that this technique is not suitable, in my opinion, (and hands!) for larger reductions (over about 500g per side), where I still tend to favour the Wise pattern. Lastly, patients need to be made aware that the breasts will often take a minimum of 3 months to look more natural – they usually have a slightly odd shape early post- op, and the skin of the lower pole is often pleated (much like a curtain pushed together on a rail) initially.

Despite these “trade-offs”, the improved projection, lesser scarring, and probable better long term stability of results, make this an attractive option in well selected patients.

Preparing for Your Breast Reduction Surgery

Getting ready for your breast surgery, whether it’s an augmentation or a reduction, is a crucial step towards a successful outcome. Our goal is to ensure you feel informed, calm, and fully prepared.

Here’s what you need to know and do before your procedure in Cape Town:

Medical Clearance: You’ll receive specific instructions regarding any necessary pre-operative tests or medical clearances from your general practitioner. This ensures you’re in optimal health for surgery.
Medication Review: We’ll provide a detailed list of medications, supplements, and even certain herbal remedies to avoid in the weeks leading up to your surgery. This often includes blood thinners like aspirin and ibuprofen.
Stop Smoking: If you smoke, you’ll be advised to stop several weeks before your surgery. Smoking significantly impairs healing and increases complication risks.
Arrange Support: Plan for a trusted friend or family member to drive you home after surgery and assist you during the initial 24-48 hours of your recovery.
Prepare Your Home: Set up a comfortable recovery space with essentials within easy reach (water, snacks, books, medications, remote controls). Consider comfortable, loose-fitting clothing that’s easy to put on and take off.
Fasting Instructions: You’ll receive precise instructions on when to stop eating and drinking before your surgery. It’s vital to follow these carefully for your safety during anaesthesia.
Final Consultation: A few days before your surgery, we’ll have a final check-in to answer any last-minute questions and confirm all details.

Your Breast Reduction Recovery Journey

The recovery period is a vital and unique part of your surgical journey, and our team in Cape Town is dedicated to supporting your comfortable and efficient healing. While individual experiences vary, here’s a general overview of what to expect:

Immediate Post-Surgery: You’ll awaken from anaesthesia with dressings and potentially drains to help with fluid removal. Pain medication will be managed to ensure your comfort. You’ll likely feel groggy and some soreness.
First Few Days: Expect swelling, bruising, and mild to moderate discomfort, which can be managed effectively with prescribed pain relief. Rest is paramount. Avoid lifting your arms above your shoulders or engaging in any strenuous activity.
Garment Wear: You’ll be instructed to wear a special surgical bra or compression garment. This is crucial for reducing swelling, providing support, and promoting optimal healing and contouring.
Activity Restrictions: For the first 2-4 weeks, limit physical activity. Avoid heavy lifting, pushing, or pulling. Light walking is encouraged to promote circulation.
Wound Care: We’ll provide precise instructions on how to care for your incisions, keeping them clean and dry. Regular follow-up appointments will monitor your healing progress and remove any sutures.
Returning to Routine: Most patients can return to light, non-strenuous work within 1-2 weeks. Strenuous exercise should typically be avoided for 4-6 weeks, or until cleared by our surgeon.
Emotional Well-being: It’s normal to experience a range of emotions during recovery. Be patient with yourself and your body. Our team is here to support you emotionally as well as physically.
Long-Term Healing: Swelling will gradually subside over several weeks to months, revealing your final results. Scars will fade and soften over time.

Remember, every patient heals at their own pace. We are committed to guiding you through each stage of your recovery, ensuring a smooth path to renewed comfort and confidence.

Find Comfort & Confidence with Breast Reduction Surgery

Tired of discomfort and self-consciousness? Imagine a life with less physical strain and renewed freedom. Schedule a private consultation with Dr. Paul Skoll, an expert breast reduction surgeon in Cape Town. We’ll discuss how breast reduction can bring you lasting relief, improved posture, and a more comfortable, balanced silhouette.

A few commonly asked questions

What is breast reduction surgery, and what are its main benefits?

Breast reduction surgery, medically known as reduction mammoplasty, is a procedure designed to remove excess breast tissue, fat, and skin to achieve a breast size that is more proportionate to your body frame. The main benefits extend beyond aesthetics; patients often experience significant relief from chronic back, neck, and shoulder pain, improved posture, reduced skin irritation, and greater comfort during physical activities. Ultimately, it aims to enhance your overall quality of life and self-confidence.

Am I a suitable candidate for breast reduction? What criteria are considered?

You might be a suitable candidate if you experience physical discomfort due to large breasts, such as chronic pain, deep bra strap grooves, skin irritation under the breasts, or limitations in activity. Ideal candidates are generally in good overall health, have realistic expectations, and are non-smokers. During your confidential consultation, we will thoroughly assess your medical history, current health, and discuss your specific concerns and goals to determine if breast reduction is the right option for you.

What physical symptoms can breast reduction alleviate?

Breast reduction is highly effective in alleviating a range of physical symptoms. The most commonly reported improvements include significant relief from chronic upper back, neck, and shoulder pain caused by the weight of heavy breasts. Patients also find relief from deep indentations or grooves in the shoulders from bra straps, persistent skin rashes or irritation in the inframammary fold (under the breasts), and headaches directly related to neck and shoulder tension.

Will breast reduction improve my posture and ability to exercise?

Absolutely. Many patients find that the significant weight removed from their chest immediately improves their posture, making it easier to stand taller and more comfortably. This physical relief also translates into a greater ability to engage in physical activities and exercise without discomfort or self-consciousness. Patients often report being able to participate in sports, running, and daily activities with much more ease and enjoyment.

What are the different surgical techniques for breast reduction, and what kind of scars can I expect?

Several surgical techniques are used in breast reduction, each chosen based on your unique anatomy and desired outcome. Common techniques include the “anchor” or “inverted T” pattern, the “vertical” or “lollipop” pattern, and sometimes a “circumareolar” approach for very minimal reductions. While breast reduction does involve incisions and permanent scars, our focus is on placing these strategically to be as inconspicuous as possible. Over time, these scars typically fade and flatten. We will discuss the specific technique best suited for you and show you where your incisions will be placed during your consultation.

How do you determine the right size for my breasts after reduction?

Determining the ideal post-reduction size is a collaborative process. During your consultation, we’ll discuss your aesthetic preferences, your body frame, and the amount of tissue necessary to remove to achieve physical relief and optimal proportion. We use various assessment tools and our extensive experience to ensure the final size is not only comfortable and functional but also beautifully balanced with your overall figure, aiming for natural-looking results.

What can I expect during the consultation process for breast reduction?

How long do the results of my breast reduction last?

The results of breast reduction surgery are generally long-lasting. Once the excess tissue is removed, it does not typically grow back. However, factors such as significant weight fluctuations, pregnancy, and the natural aging process can influence breast size and shape over time. Maintaining a stable weight and a healthy lifestyle can help preserve your results for many years.

Will breast reduction affect my ability to breastfeed in the future?

While advancements in surgical techniques aim to preserve the milk ducts and nerves, there is a possibility that breast reduction surgery can impact the ability to breastfeed. The extent of this impact depends on the technique used and the amount of tissue removed. If future breastfeeding is a priority for you, please discuss this thoroughly during your consultation, as it will influence the surgical approach we recommend.

What are the potential risks and complications associated with breast reduction surgery?

As with any surgical procedure, there are potential risks, though serious complications are rare. These can include bleeding, infection, adverse reaction to anaesthesia, changes in nipple sensation, delayed wound healing, and asymmetry. We take every precaution to minimize these risks and will discuss them in detail during your consultation, ensuring you are fully informed and confident in your decision.

When can I resume normal activities, including work and exercise, after surgery?

Most patients can return to light, non-strenuous work within 1-2 weeks, depending on the nature of their job. Strenuous exercise, heavy lifting, and activities that put strain on the chest should be avoided for at least 4-6 weeks. We will provide a personalized recovery plan tailored to your specific healing progress and lifestyle.

Will I experience nipple sensation changes after breast reduction?

Changes in nipple sensation are a possibility after breast reduction. Some patients may experience a temporary or, in rare cases, permanent decrease or increase in sensation. Our surgical techniques aim to preserve nerve integrity as much as possible to minimize this risk. This is an important topic we will discuss thoroughly during your consultation.

What is the typical breast reduction cost in South Africa?

The cost of breast reduction surgery in South Africa is not a fixed price, as it depends on several factors, including the surgeon’s fee, anaesthetist’s fee, and hospital costs.

For a detailed and transparent quotation tailored to your specific needs, the best step is to schedule a personal consultation. During this confidential meeting, we will assess your case and provide a comprehensive breakdown of all costs.

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