Breast reduction surgery aims to create breasts with a shape and size in keeping with the rest of the woman’s body. This means reducing the amount of breast tissue itself, but also removing some skin, which has grown to accommodate the increased breast size, and repositioning the nipple areola complex, the nipple and the darker colored skin around the nipple, to the best position on the smaller breast. The operation generally takes a few hours and patients should plan on staying in the hospital for at least one night following surgery.
While there are a very large number of types of breast reduction operations, the differences between them are the area of skin and breast tissue that is removed, and the source of the blood supply for the nipple areolar complex once it has been moved into its new position. There is ongoing debate between surgeons about which type gives the best long-term shape and changes the least over time, which gives the best scarring, which leaves the most feeling in the nipple and which is least likely to interfere with breast feeding. The techniques can be divided into three main groups: Wise Pattern Breast Reduction, Vertical Scar Breast Reduction and Breast Amputation.
Wise Pattern Breast Reduction involves removing skin from the center of the lower half of the breast, and then bringing skin from the sides around to meet in the middle. This gives a good immediate shape to the breast but, following surgery, there is a scar around the nipple areolar complex, a scar from the bottom of this to the fold under the breast, and a scar lying in the fold under the breast.
Vertical Scar Breast Reduction also removes skin from the center of the lower half of the breast and also leaves scars around the nipple areolar complex and between this point to the lower half of the breast, but these techniques avoid the scar in the fold under the breast. The advantage of this is that there is no troublesome ‘T-junction’ zone in the middle of the fold under the breast but the disadvantages are that it is less suitable for larger breast reductions and the immediate result of the operation in terms of the shape of the breast is poor: the skin in the lower half of the breast is bunched up and the breast has an unnatural appearance – flat along the lower half and rounded in the top half. This does change over the first 3-6 months following surgery to a very natural breast shape and the bunching of the skin does flatten out over this time, but women considering this procedure must be prepared to accept a poor result for the first few months.
Breast Amputation is a technique used for very large breasts, in which the length of skin between the nipple areolar complex and the chest is so long that it is not possible to provide the nipple with a good blood supply and reduce the breast. It involves detaching the nipple areolar complex completely, removing part of the breast, reshaping the remaining breast and reattaching the nipple areolar complex. It is not often used for pediatric patients.
Complications of breast reduction are fairly common but, by far, the majority of complications are minor, such as a small area of wound breakdown that heals by itself with a few weeks of dressings. Other complications that can happen involve collections of blood or fluid within the breast, that may require another operation to remove, a difference between the two sides after surgery, loss of the feeling in the nipple or loss of the nipple areolar complex entirely, and a change in the breasts requiring further surgery over time, especially after pregnancy, as well as complications from any surgery such as infection, bleeding from the wounds and the risk of blood clots in the legs or lungs.
Aftercare is important for breast reduction, especially in pediatric patients. You should expect to stay in the hospital for at least one night following surgery and you will be followed up in clinic regularly shortly afterwards. It is important to continue to be reviewed as the breasts change in the months following surgery to ensure the best long-term outcome.