About the operation
Before your surgery
Most patients are seen in the pre-assessment clinic. This assessment may include:
• Assessing your general health and fitness before surgery by carrying out various tests and investigations. These may include blood tests and if indicated an ECG (electrocardiogram – heart tracing) and chest x-ray. Photographs will provide a record for your notes to allow a comparison of your breasts before and after surgery.
• Discussing your current medication, any allergies you may have and information on your planned treatment and hospital services.
It is important that you are completely satisfied that you have been given all the information you need and that you fully understand the risks and benefits of your surgery before you sign your consent form.
You can change your mind at any time before surgery.
On the day of the surgery your surgeon will make careful drawings on your bust to define exactly what breast tissue is to be removed and the new position of the nipple and areola (the brown area around the nipple).
This is most commonly undertaken under a general anaesthetic. The operation usually takes two to three hours to complete.
Your surgeon will use the marks made before your operation as a guide them in excising blocks of skin, fat and breast tissue. Techniques for breast reduction vary, but the most common procedure involves a keyhole-shaped incision that circles the areola, extends downwards and follows the natural curve of the crease beneath the breast (see diagram on page 7).
The glandular tissue, fat and skin is removed and the nipple and areola are moved into their new position. The skin will be brought down from both sides of the breast and around the areola, shaping the new curve of the breast. Usually the blood supply to the nipple and areola is preserved on a stalk of tissue (a ‘pedicle’) so it can be moved into its new position higher on the chest wall. If the breast is very long the nipple may be removed completely and replaced as a ‘graft’. The nipple then has to take up its blood supply again from the underlying breast tissue and dermis.
The breast tissue and skin is stitched together, usually with dissolvable stitches. The resulting scars are usually in the shape of an anchor shape with a circle around the areola, vertically down to the fold under the breast and extending, horizontally along the fold under the breast.
Most patients will be awake within half an hour of the operation finishing. Pain is controlled with medication.
It is likely you will be ready to go home the next day.
Expect to have a quiet time at home for the first week with no heavy lifting or strenuous work. It is likely you will need two to three weeks off work, and during the first two weeks you will need help with shopping, housework and care of small children and pets. You will not be able to drive for at least the first week, and possibly into the second, and then only for short journeys.
While the breasts and chest will be uncomfortable you should not be in extreme pain.
An elasticated bra with no underwiring, such as a sports bra, may make the breasts more comfortable.
You will need to see your surgical team about one week after surgery, and you should ensure you are able to see them regularly for the first few weeks, as it is common to need some regular dressings on the wounds during this time. Once all the wounds are healed it is likely the surgeon will want to see you at about three to six months after your surgery.
Light recreational activities such as walking and light exercise can usually be started after two to three weeks, gradually building up to more strenuous workouts after four to six seeks.
You should be able to return to work after two to three weeks depending upon how strenuous your work is.
Breast reduction is a big operation and when returning to work it is very common to feel tired. This can continue for up to three months.
The initial swelling of the breasts after the operation usually goes within about three months. This usually allows the initial high position of the breast on the chest to come down into a natural position.
The surgery and recovery
Risks and complications