Breast reduction is a procedure to remove excess mammary tissue and make the breasts smaller. In the majority of cases this will also result in a lift, moving the nipple back to a more youthful position and restoring the balance and natural contour of the breast.
scars
In the vast majority of breast reductions the scars will be around the areola, from the areola to the infra-mammary fold and along the fold. These scars are permanent, but with careful post operative management they usually fade over 6 to 18 months. In smaller reductions the scar along the fold can sometimes be shortened, but this scar is well hidden in the fold.
Risks
With all surgery there is a risk of infection or poor wound healing (resulting in raised to lumpy scars). In a breast reduction the most vulnerable part of the wound is at the T junction in the centre of the infra-mammary fold where we are asking the skin to heal from three directions. this area can sometimes take longer to heal and require dressings. There is a risk of bleeding in the immediate post operative recovery which may require a return to theatre to wash out a blood clot. In some cases you might require drains which can usually be removed the following day.
The entire operation is designed to preserve the blood supply and nerve supply to the nipple, however there is a theoretical risk of interruption to either or both. In almost all cases there will be some change in the sensation to the nipple, either more or less sensitive, but loss of sensation is very rare.
Although there are reports of women managing to breastfeed after a reduction, it is better to assume that this will not be possible. If this is something that you are keen to maintain it is best to wait until you have completed your family before proceeding to surgery.
Sometimes the blood supply to small areas of the fatty tissue in breast can be altered through the rearrangement of the remaining tissue. When this happens those areas can undergo fat necrosis. If the area is small then the fat turns to oil and is reabsorbed by the body, however, it can illicit an inflammatory response and may require antibiotics. If this occurs it will be within a week or two of surgery.
Post operative recovery
You should be able to go home the day after your surgery. You will need a wound check and change of dressings a week later. I recommend that you wear a supportive, non-underwire bra, day-and-night for the 6 weeks after your surgery. During that time you must refrain from exercise, heavy lifting, and driving. Even after that period I recommend that you wear a supportive bra during exercise. My preferred partner in this is Lipoelastic who will help you size your new bra before surgery.
Wounds are usually dry within a week, and can normally be dressing free within a fortnight. In most cases sutures are dissolvable, but there are some cases when I decide that a non-absorbable suture is required in which case it will be removed at two weeks. The process of looking after your scars to get the best possible result takes much longer than that and with need moisturising, massage and sun exposure protection for up to a year.
Longevity
A breast reduction can only turn back the clock, it cannot stop time. Immediately after a reduction gravity will start to take effect and the process of ptosis (droop) will begin again. The reduction in the weight of the breast will make this less pronounced than before surgery.
Breast Cancer screening
It is my preference that you consent to have the tissue that is removed sent away for histology. I believe that this is the gold-standard for care. If you are over 40 years of age I would recommend that you have a baseline screening mammogram in the 12 months prior to surgery. A breast reduction does not interfere with your normal breast cancer screening program, but you must inform the screening service that you have had a reduction at your next appointment. I would also advise that you keep your GP aware of any surgery you undergo.