Breast reduction is surgery that removes excess fat, skin, and glandular tissue to reduce breast size and reshape overly large breasts. The weight of overly large breasts can cause skin to become severely stretched, and result in breasts that are pendulous or saggy. In addition, overly large breasts often lack firmness and therefore not only sag, but also are flattened on the top, with all the weight of the breast hanging like a baseball in a sock. By reducing breast size, tightening breast tissue, and removing excess skin, breast reduction can reduce, reshape, and reposition the breasts to a more normal size, more rounded shape, and natural, outward projection. Achieving a reduced size and more normal breast shape most often requires repositioning the nipple and areola during breast reduction. In some cases your cosmetic surgeon may recommend, or you may choose, to have an enlarged areola reduced.
Breast reduction candidates are generally women whose physical development has matured, generally after the age of 16 years. However, breast development, including changes in breast size, can occur throughout life. Therefore, if you undergo breast reduction at an early age, it may likely be that your breasts will continue to grow or change, and you may need or desire additional reduction later in life. In addition, good candidates for breast reduction are generally healthy women with no diseases that may impair healing such as diabetes, autoimmune diseases, or connective tissue disorders.Women who smoke, use any tobacco products, or consume large amounts of alcohol are not good candidates for breast reduction, and will be advised to stop for several weeks or months prior to surgery. If you fail to stop smoking and choose to undergo breast reduction, then you are putting yourself at a serious increased risk of complication and severely impairing your ability to heal properly. It is your responsibility to follow the instructions you are given to the letter, and to advise your cosmetic surgeon if you have not followed these instructions. Your outcomes depend on your total compliance with all of the instructions you are given.
Breast reduction is almost always performed under general anesthesia and may be performed on an outpatient basis, or you may be advised to remain in the hospital or a special overnight care facility for a day or two following surgery. Surgery requires incisions for your cosmetic surgeon to excise (remove) excess breast fat, skin, and glandular tissue. These incisions will leave visible scars on the breast, however, the scars are concealed by most bras and swimsuit tops. In general, the incision patterns include:
In cases where the skin is deeply sagging, such as in very large breasts, the nipple and areola may need to be removed completely and grafted to a more natural position. This is not at all common (with the exception of very large, pendulous breasts) and should be avoided, if possible. A nipple that is grafted will not regain sensation and there is also the risk of losing the nipple entirely if the graft does not heal. In some cases, your cosmetic surgeon may include the use of liposuction to remove excess fat in and around the breast. This is generally an adjunct procedure and is rarely used as the sole method to achieve breast reduction.
When you awaken from breast reduction, you may have small, thin drainage tubes coming from each breast, as determined by your surgeon. Your breasts will likely be wrapped in a compression or support bra, and you will experience discomfort localized to the breast region. This can easily be controlled with medication. In addition, you will be instructed to begin moving about and walking as soon as possible to reduce the risk of blood clot formation. Despite any discomfort and bandages or special garments, you will immediately notice that your breasts are lighter and smaller. All of the cautions and considerations associated with any type of surgery, and with breast surgery in general, are possible with breast reduction. In addition, it is possible that following surgery your breasts may not be completely symmetric. Minor asymmetry between the breasts is perfectly normal for most women and is often only detectable to you. However, significant asymmetry in breast size or shape is possible and may require additional surgery to correct. In addition, breast tissue is very soft and susceptible to healing with scars that can become raised, red, wide, or stressed. It is very important to follow all of the wound care instructions you are given, and instructions for wearing your support bra or compression. In the first few weeks following surgery, it is likely you will be directed to wear some form of breast support around the clock.
You should also be advised that breast reduction can variably influence your future ability to breast-feed. This is most often the case where breast size is mostly attributed to excess mammary glands and when reduction requires removing some of the mammary glands. However, it is not fully predictable whether a woman will be able to breast-feed following breast reduction. Therefore, if you are planning future pregnancies, be advised that your ability to breast-feed may be impaired. Although breast reduction techniques that do not graft the nipple and areola usually result in a normal sensation of the nipple, changes in sensation can occur with some women noting an increase, decrease, or total loss of sensation.
While it may take one to two weeks before you are ready to get back to a normal daily routine, any physical pain or discomfort caused by your overly large breast will likely improve rapidly following your breast reduction. You will definitely stand taller and have an improved posture and confidence. You may want to get into a new fitness routine and enjoy the activities that were very uncomfortable or difficult prior to your breast reduction. However, don’t engage in any physical activity until your cosmetic surgeon gives you clearance to do so. Your newly reduced breasts will need time to heal and settle into their new position. To engage in strenuous physical activity, and to push, pull, lift, or swing your arms with any force may injure delicate breast tissue as it heals. Even though your breast shape will settle a bit, you can begin shopping for new fashions and new bras as soon as you feel ready. Don’t wear underwire bras until you are advised by your physician. Remember that your new, better-proportioned figure is only enhanced by maintaining a stable weight and by good, stable support of your breasts, particularly during your fitness routine.
According to the American Society of Cosmetic Surgeons, in 2004, breast reduction was the fifth most common reconstructive cosmetic surgery procedure performed, with just over 105,592 procedures in the United States. This was a steady increase of 10,000 or more procedures over the preceding three years.The American Society for Aesthetic Plastic Surgery reported 125,600 procedures in that same year; the discrepancy is likely due to the fact that breast reduction was looked upon as a whole by ASAPS, not only as a reconstructive procedure.
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