Lady Bountiful

Created on 25th February 2009

Fed up with too large breasts? Specialist breast surgeon, Mr Philip Turton, explains how breast reduction surgery could transform your life

Breast reduction surgery has become very common in the last ten years as women realise that they do not have to put up with having overly large breasts. One of the most important  choices that must be made is the selection of the surgeon. Experience, an established track record, and a specialist in breast and aesthetic breast surgery are vitally important. Mr Turton performs hundreds of breast operations per year including breast reduction, breast enlargement and mastopexy,as well as major breast reconstruction after mastectomy. As a specialist in breast surgery Mr Turton is in the very best position to assess, advise and Operate on your breasts.

Women requesting breast reduction surgery now vary in age from their 20s to their 70s. There is a peak age of presentation at around the time
of the menopause. Women Often have symptoms of neck and shoulder discomfort, painful Grooving from bra straps, and Mr Turton has even had a patient Who had slipped a disc in her neck as a result of the strain From very heavy breasts.

Macromastia, as it is referred to by a specialist, often poses real Problems with some women having to buy tops in a size 18–20 and size 12–14 bottoms, or bras that cost over £80 a throw. Women often seem to carry more weight, perhaps subconsciously, to mask the disproportion in breast size.

However, other women will have successfully lost weight without seeing any reduction in their reast size.

Assessment

Your surgeon will want to ensure you are making a well informed decision for surgery and understand what it entails. After a thorough medical history and breast assessment, detailed measurements are taken. This important step is the basis of accurate planning and should never be rushed.

Patients who are over 40 will normally be offered a screening mammogram regardless of any family history of breast cancer. Your surgeon will spend some ime describing the surgery, the technique suggested, any particular risks and potential problems.

Where will the scars be?
For most breast reductions there will be a scar around the new areola margin, vertically down to the crease of the breast and along the under crease of the breast (an anchor shape scar and sometimes called the `wise pattern’). Some women with smaller breasts may be suitable for liposuction alone, though this does little to correct the often associated breast droop.

Similarly a vertical scar alone without the scar in the crease may be considered, but there may be drawbacks if it leaves a poor shape. The scar in the under-crease of the breast contributes a great deal to the reshaping if you have large breasts or breast droop and because of its position is not normally that conspicuous.

Reviewing your surgeon’s pictures of breast reduction is an important part of your understanding of the procedure; it is particularly helpful to give you an idea of how well your surgeon meets your expectations of size, shape and scars. It also illustrates the immediate dramatic improvement that surgery offers.

Important considerations

Smokers must completely abstain when having surgery under Mr Turton’s care to help rotect the delicate blood supply to the nipple and areola which is raised to a more attractive position on the reduced and shaped breast.

Often the areolae (the pigmented part around the nipple) are quite stretched in patients with macromastia (one patient’s son had unkindly referred to her 8cm areolae as ‘beef burgers’, which prompted her to do something about it). Breast reduction surgery is also an opportunity to reduce the areolae to a more attractive size.

Medication

You will need to avoid aspirin and anti inflammatory agents, and it is advisable to steer clear of multivitamins and herbal preparations prior to surgery. At the very least you should declare anything that you take  regularly or occasionally.

How much breast tissue can be removed?

Most women request a reduction to a C or D cup. This is often achieved, but above all the specialist surgeon will want to protect the blood supply to the nipple and areola throughout the operation. This means that resection of the breast tissue cannot be performed in isolation to the protection of the blood supply. It is quite usual to need to maintain the blood supply by preserving more breast tissue under the nipple in people with very large breasts. This may mean being reduced to a DD
instead of a D for example.

Loss of the nipple-areola structure is a complication to be avoided at all costs, and inexperience or overzealous reduction can put this structure at risk. Small breast reductions are really a combination of a reduction and mastopexy.

How does a breast reduction differ from a mastopexy?

Some women just have very marked breast droop but the breast size is normal or small. These patients may benefit from a mastopexy. A full ‘wise pattern’ mastopexy includes an anchor shaped incision, removal of the loose skin, relocation of the main breast tissue higher on the chest all, with repositioning of the nipple so that it is in a more youthful position. No breast tissue need be removed at all.

Does it hurt?

Oddly enough, breast reduction surgery is usually not painful but the breasts feel tender for several weeks after surgery and until the swelling as resolved. Most patients manage with simple pain killers and a support dressing or bra. Mr Turton recommends two weeks off work for most patients. Keeping warm helps to maximise blood flow to the healing tissue and nipple area. Wound infection is not common if meticulous attention to detail is given at all stages of care.

What happens to the tissue that is removed?

It can be sent to a breast pathologist for examination under a microscope. This should be discussed with you. It may reveal important underlying breast problems and even occasionally precancerous or cancerous change and Mr Turton recommends that it is sent in most cases.

How quickly will I recover?

Patients are mobile again the day after surgery and discharged after the drains are removed at 4–48 hours. You should avoid stretching and lifting for the first two weeks. You can normally return to sport after six weeks but individual cases may be quicker or slower than this. A sports  bra is normally worn for 4–6 weeks and an under-wired bra can be worn after this.