Macromastia (large breasts) is a commonly misunderstood problem that many women face which is characterized by a variety of symptoms: from physical pain and quality of life issues to emotional and psychological distress. Breast reduction surgery is an increasingly common treatment for this condition with nearly 100,000 performed each year in North America. Variations depend greatly on the individual patient. Dr. Raj guides patients through the process from the initial consultation through the procedure and into recovery. Breast reduction, as with any kind of surgery, has risks and complications, so it’s a good idea to ask your doctor any questions you might have about the procedure.
What is Breast Reduction Surgery?
When a patient’s breasts are larger than their frame can support (macromastia) it can cause a variety of symptoms, such as pain and compression in the neck and spine. Breast reduction, or reduction mammoplasty is a procedure intended to decrease the size of the breast and help alleviate these and other symptoms by reducing the size of the breasts while maintaining a natural breast shape.
Who is a candidate for breast reduction?
Some women choose to undergo breast reduction because they are dissatisfied with the size of their breasts – which can cause discomfort or pain in the neck and back. They may have difficulty shopping for clothing or suffer from rashes under their breasts. Candidates for breast reduction should be mentally and physically healthy and at a relatively stable weight for best long-term results. Tobacco use is strongly discouraged as it can slow healing and lead to complications from surgery.
Fact: Most women with macromastia or large breasts require at least 500gm of tissue in each breast to be removed during breast reduction in order to eliminate their symptoms.
Options and Variations
There are two major considerations when Dr. Raj plans a breast reduction.
First, it is important to determine the skin incision pattern because to accommodate or cover the smaller breast, the overlying skin envelope will need to be made smaller.
Secondly, the manner in which the breast tissue will be reduced also has to be planned. Some tissue must be preserved to maintain blood flow to the repositioned nipple. This helps maintain sensation and preserve lactation capability.
Common incision patterns and techniques for breast reduction include:
Vertical Incision Method (Lollipop Breast Reduction, Keyhole Reduction)
Some patients are candidates for this method of breast reduction, where an incision is made around the border of the areola and then vertically down from the areola to the breast crease. Also commonly used as a breast lift procedure, the vertical incision method is appropriate for women who only require a moderate amount of tissue reduction.
Inferior pedicle technique (anchor pattern, inverted-T incision, Wise pattern)
The most common approach to breast reduction, an incision is made around the perimeter of the areola, vertically down the center of the breast and then horizontally along bottom seam of the breast where it meets the abdomen. The nerves and blood supply to the nipple are maintained by keeping the nipple and areola connected to the tissue in the lower portion of the breast while it is repositioned.
These techniques pose a low risk of losing sensation in the nipple and gives women a positive chance at still being able to breast feed, once their breasts have healed.
Dr. Raj evaluates each patient’s medical histories and carefully listens their concerns to determine if they are a candidate for surgery. Patients are encouraged to be frank and ask as many questions as needed to ensure that they are comfortable to proceed with cosmetic surgery. He will then provide a detailed description of the procedure covering the risks, benefits, and ideal outcomes and conduct a thorough examination. Specific measurements are taken and the ultimate goal size is determined.
The specific procedure ultimately depends on how much tissue needs to be removed in a breast reduction. Another important consideration is how much the nipple needs to be elevated. A breast reduction always lifts the nipple or transposes it to a more normal position above the inframammary fold.
During most breast reduction procedures, once the patient is under anesthesia Dr. Raj will:
Make an incision around the areola and down each breast. Most commonly he will use the anchor pattern based on the amount of tissue to be removed but may use other incisions.
Remove excess breast tissue, fat and skin according to the surgical plan.
Reshape the breast to create a natural appearance and re-position the nipple in its new location. Every effort is made to maintain the sensation and function of the nipple. In some rare circumstances, the nipple may need to be removed and relocated.
The patient is then closed with sutures, skin adhesives, or medical tape.
Before the procedure
Before the procedure, patients are given clear instructions on how to prepare for the procedure and what medications to avoid. Patients may need pre-operative testing to be completed and older patients will be required to obtain a mammogram. Typically, patients who are healthy and are non-smokers are good candidates for the procedure.
The day of the procedure
The procedure is done at an accredited surgery center or at a hospital. On the day of surgery, Dr. Raj will perform markings to plan the breast reduction technique such that the nipple will be in a more appropriate position. Afterwards, under general anesthesia, Dr. Raj will perform the procedure which will take about 2-4 hours depending on the complexity and extend of the breast reduction. Most patients can go home the same day after the procedure.
After the procedure
Patients are given detailed instructions on the recovery process. Dr. Raj recommends patients wear a support bra for 2 weeks after the procedure. They can apply soft pads or gauze over the incisions. It is normal to have bruising and swelling the first week of the procedure but that will subside with time. Patients will feel immediate relief and will noticeably have less back pain or neck pain.
All sutures are dissolvable and do not require removal. Patients can resume their normal exercise regimen 4 weeks after the procedure once the wounds have sufficiently healed. After one month, Dr. Raj teaches different techniques and modalities to minimize scarring.
Limitations, Risks, and Possible Complications
- Unfavorable scarring (wide or darkly pigmented scars)
- Changes in nipple or breast sensation, which may be temporary or permanent
- Risks of anesthesia
- Bleeding (hematoma)
- Poor wound healing or wound breakdown
- Breast contour and shape irregularities
- Skin discoloration, permanent pigmentation change
- Swelling and bruising
- Asymmetry of breasts
- Fluid accumulation (seroma)
- Excessive firmness of the breast
- Potential inability to breastfeed
- Potential loss of skin/tissue of breast where incisions meet each other
- Potential, partial or total loss of nipple and areola
- Deep vein thrombosis, cardiac and pulmonary complications
- Fatty tissue deep in the skin could die (fat necrosis)
- Possibility of revisional surgery
Why choose Dr. Raja Mohan?
Patients choose Dr. Raj to handle their breast reduction surgery for a variety of reasons.
He is knowledgeable and personable and is known for both candor and compassion. He really cares about his patients and it shows his interactions with them and in the quality of patient care he provides. Dr. Raj studies and teaches alongside the brightest surgeons and doctors in the industry as a peer and leader. This means that his patients are always able to benefit from advancements at the edge of science and surgery.
Ultimately, however, all roads end with the outcomes, and the reason most people choose Dr. Raj is because he delivers amazing results that speak for themselves.
Dallas Breast Reconstruction Consultation
If you want to learn more about breast reduction surgery and whether or not it’s the right procedure for you, please call (469) 301-1725 to schedule a consultation with Dr. Raj Mohan, board certified plastic surgeon serving the Dallas-Fort Worth Metroplex. He operates in Arlington, Grapevine, Southlake, Dallas, Plano, Frisco, Irving, and Coppell.