Breast Reduction

Although women with small breasts may envy those with large ones, enlarged breasts (macromastia) can be a source of discomfort. Their excessive weight can cause back pain and neck pain, eventually lead to skeletal deformities or breathing problems, and result in bra straps leaving painful indentations on shoulders. Their size can cause skin irritations, as clothing is stretched to the limit and rubbed against the upper body. They make it almost impossible to lie or sleep on one's stomach.

Because they're often the first thing people notice, they can be a source of embarrassment and make a woman-or a teen-aged girl-very self-conscious, especially if she's exercising, or wearing a swimsuit or shorts and a T-shirt at the beach or pool. They often provoke jokes from strangers or co-workers.

For any or all of these reasons, breast reduction-or, as plastic surgeons call it, reduction mammoplasty-is commonly sought by large-breasted women. It may also help women with normal-sized but sagging breasts, when other procedures are not practical.

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Q. What are the details of the procedure?

A. During the reduction procedure, the surgeon removes excess fat from the breasts, along with some of the glandular tissue and skin, while endeavoring to make both breasts the same size and shape. This procedure immediately makes them smaller, lighter and less burdensome. At the same time, the surgeon may reduce the size of each areola (the darker skin that surrounds the nipple). The goal: smaller, lighter, better-shaped, and more attractive breasts that are a source of pride, not embarrassment.

Q. What else should I know about breast reduction?

A. Most of the women who undergo this type of surgery have it done to reduce their constant physical burden, and not just for cosmetic purposes. Usually, surgeons recommend that teens with this problem wait until their breasts are fully developed, so that the surgery need not be repeated later on. However, if the discomfort or the embarrassment is intolerable, the procedure can be performed earlier. But it is not recommended for women of any child-bearing age, who intend to breast-feed, because the procedure removes many of the milk ducts.

There are some risks. After the surgery, some patients can develop small sores around their nipples, but these can be treated with an antibiotic cream. The surgery leaves visible, permanent scars, but these are covered when wearing a bra (which, by the way, is often two cup sizes smaller than before). Sometimes, it's impossible to end up with two perfectly matched breasts, or with the nipples positioned precisely where they should be. Also, a few patients may suffer a permanent loss of feeling in their breasts or nipples. And, rarely, the nipples and areolas may lose their blood supply, causing the tissue to die. (But both can usually be rebuilt using skin grafts.)

As noted above, it's not a simple-or completely risk-free-operation. Also, like any surgery, there might be complications, such as infection, bleeding, or adverse reaction to the anesthesia. Still, when the procedure is performed by a superbly trained and experienced cosmetic surgeon, like Dr. Kapoor, in highly accredited and modern facilities, the risks are minimized.

Q. What's the first step?

A. Consult with Dr. Vishal Kapoor and his medical staff. After this consultation, Dr. Kapoor will examine, measure and (for reference purposes during and after surgery) photograph your breasts. Then, you and the doctor or a staff member will discuss your objectives and the variables (your age, current and desired breast size and shape, skin condition, general health, etc.) that may affect the surgery. You'll discuss the anesthesia that will be used, where the operation will take place (a hospital or Dr Kapoor's medical facility), and the cost of the procedure. Some insurance policies will cover part or all of the cost if the reduction is medically necessary; if so, they should be sent a "predetermination letter" by the surgeon. Also, you may need to have a mammogram done. And if a large amount of breast tissue is to be removed, you may be asked to donate a unit of blood ahead of time, so your own blood will be available should a transfusion be needed. As you leave Dr. Kapoor's offices, you'll be given instructions on how to prepare for the surgery: guidelines on eating, drinking, smoking, medications, dieting, and other factors that can affect the success of the procedure.

Q. What happens during surgery?

A. In most cases, the surgeon makes an anchor-shaped incision, starting around the areola. The incision extends downward, following the natural curve of the crease beneath the breast. After lifting a flap of skin, the surgeon removes excess fat and glandular tissue, trims off excess skin, and repositions the nipple and areola so they'll face forward, at the center of the breast. Then he brings down the skin from both sides of the breast, around the areola, as he shapes the breast's new contour. If there is excess fat in the armpit, it may be removed via liposuction.

Usually, the nipples remain attached to their nerves and blood vessels, unless the breasts are pendulous or extremely large. If they are, it may be necessary to remove the nipples and their areolas and graft them into higher positions, resulting in a loss of sensation in the nipples and areolar tissue. At the conclusion of the surgery, stitches are used to fasten the skin around the areola and elsewhere, in a way that minimizes scarring.

But forget all of the above, if all that's needed to reduce the size of your breasts (without reshaping them) is some fat removal. In that case, liposuction (see description) alone may do the job, leaving even fewer scars.

Q. What happens after surgery?

A. Your breasts (now showing signs of swelling and bruising) will be wrapped in an elastic bandage or in a surgical bra over gauze dressings, to help protect against infection and physical damage. A small drainage tube may be inserted in each breast, remaining there for a day or two, to remove excess blood and other fluids. Yes, there will be some pain during the first few days, especially when you move, stretch or cough, and you'll be given a prescription for pain medication. After two days, the bandages will be removed, but you should continue wearing the surgical bra for several weeks, sleeping on your back, until the swelling and bruising go down. In one to two weeks after the surgery, your stitches will be removed.

If, following surgery, your breast skin looks and feels too dry, you should apply a moisturizer several times a day, but keep the suture area dry. Your breasts may become swollen and painful when your first post-surgical menstruation occurs, but this is normal and temporary. There may also be random, shooting pains for a few months. And don't be surprised if there is some loss of feeling (caused by the swelling) in the nipples and breast skin. In most cases, this loss of feeling fades away during the next six weeks; in some patients, it takes a year or more; and in a few cases, the loss may be permanent.

Q. When will I be able to start enjoying the benefits of breast reduction?

A. That depends on how much reduction was done, the condition of your breasts before and after surgery, your activities, and other variables. If you're like most women who've undergone the procedure, here's what you can expect:

• Days 1 and 2: If you feel like it, you can start moving around, although your new breasts will ache on occasion for a few weeks.
• Weeks 1 and 2: Avoid sex, because arousal can cause your incisions to swell. For as long as six weeks, merely touching your breasts may cause pain.
• Weeks 1 to 4: Avoid lifting or pushing anything heavy, including children.
• 1st several weeks: There may be a small amount of fluid draining from your surgical wound, or some crusting. Both are normal. But if you experience bleeding or severe pain, notify your doctor promptly.
• After about 2 weeks: If it doesn't involve strenuous activity (stretching, lifting, bending, schlepping, etc.), you can return to your job and/or resume your normal social activities.
• After about 3 weeks: When you stop wearing the surgical bra 24/7, start wearing a good athletic bra for support.
• After 6 months or more: Your reconstructed breasts will finally settle into their new shape. But even then, their shape may change a bit in response to hormonal shifts, pregnancy, or if you gain or lose weight.

What about scars? Even though surgeons use techniques to minimize scarring, breast reduction scars are extensive and permanent. Often, they are red and lumpy for a number of months. Gradually, they're less visible. And sometimes they slowly fade to thin white lines. Whenever possible, the scars are in places where they're not visible even if you wear a low-cut top.

Is it worth all the discomfort in order to reduce oversized, embarrassing breasts? The vast majority of women who have had breast reduction would shout a resounding Yes! But if you're still undecided, go back to the beginning of this section and, once again, read the reasons why so many women choose this procedure. If any of those reasons apply to you, talk with the experts at Dr. Kapoor's office for more information.