Large breasts can cause problems in many aspects of a woman's life. When they are larger than the usual standards of attractiveness in our society, the breasts are considered aesthetically displeasing. A full breasted woman may appear heavier than she really is and she may have difficulty obtaining stylish clothing. In some cases, it may even be difficult to find a properly fitting bra. Often, women with large breasts feel very self conscious. Teenagers may not develop proper poise and posture as they try to hide the fullness of their breasts, a subject they are unlikely to discuss freely with their parents.
The actual weight and bulk of the breasts may cause physical problems and symptoms which compound the feeling of unattractiveness. There can be a feeling of uncomfortable fullness, neck or back pain, and shoulder grooving. These symptoms may contribute to limited performance in certain occupations and in sports. Finally, large breasts can also be difficult to assess for lumps or masses, thus making cancer detection much more difficult for the patient or for her physician.
The goal of reduction mammaplasty is to reduce, recontour and reshape the breasts. The breasts are made smaller. The nipple areola complex is repositioned upward, and if indicated, reduced in size. Excess skin and breast tissue is removed from the lower and outer portions of the breast.
A preoperative plan is made which allows both the surgeon and the patient to share in the decision as to the proposed size of the breast after surgery. The surgeon will attempt to make the breasts as identical as possible, but some asymmetry may remain. Furthermore, it is not possible to predict exactly how large the breast will finally be after surgery. Healing results in some progressive change in breast size, since some swelling may be present for several months following surgery.
Incisions are made in the lower breast resulting in three scars: one around the nipple, which usually heals very nicely; a vertical incision from the nipple to beneath the breast, which remains visible; and finally, an incision in the fold beneath the breast (not used in short scar method). Breast tissue is sculpted using a combination of sharp dissection and occasional liposuction. The nipple remains attached to the deeper breast tissue. The remaining breast is folded around the nipple and its attachments and the incisions are closed. Care is taken to close these incisions as carefully as possible. Nevertheless, patients must realize that resultant scarring is as much a factor of tissue response as it is surgical skill, and occasionally wide scars can form despite a nice overall breast shape. Fortunately, with time, these scars do tend to blend into the normal skin, becoming less noticeable.
Although it takes some time for final healing and shaping of the breasts to occur, the initial recovery is typically well tolerated and easier than expected for most patients. There is some soreness after the operation and pain medicine is required, but patients usually are fully ambulating the day after surgery. Generally the patient may return to work five to eight days after surgery, although full activity or extremely vigorous exercise should not be undertaken for four to six weeks.
Wide scars and slow healing are the most common problems seen postoperatively. Other possible complications include asymmetry of the breasts, hematoma, infection, loss of nipple sensation and scarring or necrosis of the nipple. Although pain is usually moderate, prolonged pain, soreness or numbness is possible. It is important that the patient understand that minor revisions may be necessary after surgery in a significant number of cases.
