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.
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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.
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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.
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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:
- Medical Clearance: Your primary care doctor will tell you exactly what tests or clearances you need to have done before surgery. This makes sure that you are as healthy as possible for surgery.
- Medication Review: In the weeks leading up to your surgery, we’ll give you a full list of drugs, vitamins, and even some herbal remedies that you should stay away from. A lot of the time, this includes blood thinners like ibuprofen and aspirin.
- Stop Smoking: If you smoke, you will be told to stop a few weeks before your surgery. Smoking makes healing much harder and makes complications more likely.
- Arrange for someone to drive you home after surgery and help you for the first 24 to 48 hours of your recovery.
- Prepare Your Home: Make a comfortable place to recover with everything you need close by, like books, snacks, drinks, medicine, and remote controls. You might want to wear clothes that are loose, comfortable, and easy to put on and take off.
- Instructions for Fasting: Before your procedure, you will get clear instructions on when to stop eating and drinking. You must follow these rules exactly to keep yourself safe while you are under anesthesia.
- Final Consultation: A few days before your surgery, we will have a final check-in to go over any last-minute questions and make sure all the information is correct.
Your Breast Reduction Recovery Journey
The recovery phase is a very important and unique part of your surgery experience, and our Cape Town team is dedicated to making it as quick and easy as possible. Even though everyone’s experience is different, here’s a general idea of what to expect:
Right after surgery, you will be dressed and may have drains to help you get rid of fluids when you wake up from anesthesia. Managing your pain medicine will make sure you are comfortable. You might feel sore and sleepy after this.
You can expect mild to severe pain, bruising, and swelling for the first few days. These side effects can be treated with prescription painkillers. You need to rest. Don’t do anything that requires a lot of effort or lift your arms above your shoulders.
- Clothing: You will need to wear a compression garment or a special surgical bra. This is important for reducing swelling, providing support, and promoting the best possible healing and shaping.
- Limitations on exertion: Don’t do too much physical activity for the first two to four weeks. Don’t push, pull, or lift heavy things. It is best to walk lightly to help blood flow.
- Wound Care: We’ll give you step-by-step instructions on how to keep your wounds clean and dry. During regular follow-up visits, the sutures will be taken out and your healing will be checked.
- Back to Normal: Most patients can go back to light, non-strenuous work in one to two weeks. You should usually not do any hard exercise for four to six weeks, or until our surgeon says it’s okay.
- Emotional Health: It’s normal to feel a lot of different things while you’re healing. Be patient with your body and with yourself. Our staff is here to help you with both your body and your mind.
- Long-Term Healing: The swelling will slowly go down over the course of a few weeks to months, revealing your finished product. Over time, scars will fade and become less noticeable.
Keep in mind that each patient heals at their own pace. We promise to help you every step of the way as you recover and make sure that your journey back to comfort and confidence goes as smoothly as possible.
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, also called reduction mammoplasty, is a procedure that removes extra breast tissue, fat, and skin to make your breasts more in line with the rest of your body. The main benefits go beyond how it looks. Patients often feel a lot better from chronic back, neck, and shoulder pain, have better posture, less skin irritation, and more comfort when they are active. The goal is to improve your overall quality of life and self-esteem.
Am I a suitable candidate for breast reduction? What criteria are considered?
If you have chronic pain, deep bra strap grooves, skin irritation under your breasts, or trouble doing things because of your large breasts, you might be a good candidate. Ideal candidates are generally healthy, have realistic expectations, and don’t smoke. During your private consultation, we will look at your medical history, current health, and any specific worries and goals you have to see if breast reduction is right for you.
What physical symptoms can breast reduction alleviate?
Heavy breasts, deep bra strap grooves, skin rashes or irritation under the breasts that won’t go away, and headaches caused by neck and shoulder tension can all be relieved by breast reduction.
Will breast reduction improve my posture and ability to exercise?
Yes. Taking a lot of weight off the chest often helps with posture, which makes it easier to stand up straight and comfortably. Patients can also do physical activities and work out more easily and with more pleasure.
What are the different surgical techniques for breast reduction, and what kind of scars can I expect?
The “anchor” (inverted T) pattern, the “vertical” (lollipop) pattern, and sometimes the “circumareolar” approach are all common ways to make small reductions. Scars last forever, but they are placed in a way that makes them as hard to see as possible. They usually fade and flatten over time. During the consultation, we talk about the best method for you.
How do you determine the right size for my breasts after reduction?
Working together is the best way to find the right size. Your aesthetic preferences, body type, and the amount of tissue needed for relief are all talked about during the consultation. To make sure the final size is comfortable, functional, and in line with your overall figure, different assessment tools and experience are used.
What can I expect during the consultation process for breast reduction?
During the consultation, we talk about your aesthetic preferences, body type, and the need to remove tissue. Tools and experts make sure that the final size is comfortable, useful, and looks natural.
How long do the results of my breast reduction last?
Most of the time, the results last a long time. After extra tissue is taken out, it usually does not grow back. Breast size and shape can change due to things like weight changes, pregnancy, and getting older. Keeping a stable weight and a healthy lifestyle helps keep the results.
Will breast reduction affect my ability to breastfeed in the future?
Depending on the method used and how much tissue is taken out, there is a chance that breastfeeding could be affected. If breastfeeding in the future is important, this should be talked about during the consultation so that it can affect how the surgery is done.
What are the potential risks and complications associated with breast reduction surgery?
Possible risks include bleeding, infection, bad reactions to anesthesia, changes in nipple sensation, delayed wound healing, and asymmetry. Serious problems don’t happen very often. During the consultation, all risks are talked about.
When can I resume normal activities, including work and exercise, after surgery?
Most patients can go back to light, non-strenuous work within one to two weeks. You should stay away from heavy lifting, strenuous exercise, and activities that put stress on your chest for 4 to 6 weeks. You will get a recovery plan that is made just for you.
Will I experience nipple sensation changes after breast reduction?
It’s possible that the feeling in your nipples will change. Some patients may temporarily or, very rarely, permanently lose or gain feeling. Surgical methods try to keep nerves healthy. During the consultation, this is talked about in great detail.
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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