Breast reduction (mammoplasty)

Mammoplasty - breast reduction - characteristics

"Too much, it's unhealthy" - there is more truth in this famous saying than one would suppose. Exceptionally large breast sizes may and may appeal to some male representatives, definitely dissatisfied with their possession may be their owner. Problems associated with too large breasts can be distinguished quite a lot. The first can be problems with everyday functioning. Such a patient may have difficulty fitting clothes or a bra, it may also be difficult to do different sports. Exceptionally large breasts can also be a source of health problems. Large amounts of thoracic glands tissue constitute an extraordinary burden on the spine, which may even lead to degenerative changes within it. Patients may experience spine, neck or shoulder pain. On the skin of the arms - as a result of the compression straps - there may be skin irritations that can even develop into chronic wounds. Psychological aspects that may be associated with having excessively large breasts should also be taken into consideration. Such patients may not only experience complexes, but may also experience serious mental disorders - patients dissatisfied with their appearance may be isolated from society, even depression may develop.
Patients who experience the above-described problems may be offered breast reduction (mammoplasty). This can be done both on the path of minimally invasive liposuction and through surgery - the choice depends in this situation not only on the preferences of a given patient, but also on the condition of her breast glands.

Mammoplasty - breast reduction - benefits

hanks to the reduction of the breast (mammoplasty) it is possible to eliminate the complaints of the patient, such as back and neck pains. Patients who experienced complexes associated with their appearance before surgery can become more confident and more satisfied with how their body looks when they go. Thanks to mammoplasty, it is also possible to obtain younger looking, firmer breasts.

Indications for the procedure

Mammoplasty - breast reduction may be indicated for those patients who:
• there is a significant asymmetry regarding the size of both breasts,
• large breasts cause various symptoms, such as pain in different parts of the body or skin changes in the bra straps,
• complexes resulting from excessive breast size,
• the size of the bust is inadequate to build the rest of the body,
• bust causes limitations in everyday functioning (e.g. related to difficulties in choosing clothes or practicing sports).

Contraindications for the procedure

The surgical reduction of the breast is not performed primarily in those patients who have not yet fully developed breast tissue - this treatment is contraindicated in underage persons. The patient's overall poor condition may also be a contraindication - as an example of individuals who may not be able to undergo surgery, systemic infections, but also arterial hypertension or diabetes (especially when the course of chronic diseases is uncorrected).
It is also forbidden to perform the surgery in patients with predisposition to breast cancer, in women with skin lesions within the breasts and in pregnant and breast-feeding patients. Other contraindications to the procedure are severe blood coagulation disorders and mental disorders (especially the high degree of mood disorder and dysmorphophobia, i.e. the unit in which the patient is convinced of the wrong appearance of some part of his body, the appearance of which does not deviate from the norm).

Breast reduction – before the procedure

Before breast reduction (mammoplasty) a medical consultation takes place. Its purpose is to thoroughly examine the patient and determine whether and which treatment will be needed for the patient. For this purpose, basic measurements are made, such as the assessment of the height and weight of the patient, as well as the structure, shape and size of her breast glands. Before the operation, the patient may be asked to perform basic tests such as chest X-ray, breast ultrasound (or mammography depending on the age of the patient), ECG or general urine and blood counts.
During the consultation, the patients are asked about the medicines they are taking. It should be clearly stressed that the patient should inform the doctor about all preparations - including those that are available without a prescription. This necessity results from the fact that there is a need for temporary withdrawal of certain drugs before mammoplasty. Particular attention is given in this case to drugs that reduce blood clotting (e.g. aspirin or warfarin) and hormonal preparations, such as oral contraceptives or hormone replacement therapy. Depending on the various aspects (including the condition of the patient and the doses of medication he takes), these measures must be discontinued sometimes two weeks before the date of surgery, and sometimes even three months before - specific information is provided during consultations before breast reduction .
Before the mammoplasty, the patient may also be asked if she smokes cigarettes. This question is important because if you answer yes to the patient, you will be advised to stop smoking. This is due to the fact that the effect of nicotinic is to reduce the oxygen content in the body - and this in turn translates into an increased risk of poor tissue healing after breast reduction, as well as the risk of prolonging the convalescence period after the procedure.
The doctor may also ask the patient if she plans to become pregnant in the future. During pregnancy and breastfeeding the breasts may undergo some changes, so it may be beneficial to postpone the operation until the time when the patient will no longer give birth. This aspect is also important due to the fact that during mammoplasty there may be damage to structures associated with the secretion of food - the effect may be the inability to breastfeed after surgery.
The main goal of consultations is to determine which breast method the patients will be diminished. In a situation where the size of the bust is mainly related to excess body fat, it is possible to reduce it by liposuction (popularly referred to as fat suction). However, this method allows only a slight change in the size of the breast, additionally liposuction is carried out in such patients, in which there are no other problems (such as excessive breast size), such as loss of skin firmness. The second option available is surgical mammoplasty, during which both adipose tissue and breast gland are removed from the inside of the breast, and there is also the possibility of resection of excess skin. Surgical procedures are recommended for patients who have unusually large breasts, as well as those who have excess skin around the breast - surgical mammoplasty allows the effect of younger looking, more tense bust.
The final stage of consultations is to plan the date of the procedure. It would be beneficial if the patient remembered the date of her last menstruation, and the information about the standard length of the menstrual cycle in a given patient is also important. In the case of determining the date of mammoplasty, this is important because the procedure is most preferably carried out within a week, up to two after the onset of menstrual bleeding.

Type of anaesthetic

The most commonly used during breast reduction is general anaesthesia. In a situation where liposuction is used to reduce breasts, both general and local anaesthesia may be used.

How is the procedure performed?

The exact course of breast reduction depends on the method used to perform the procedure. In the case of liposuction, the procedure takes up to several tens of minutes and is based on the removal of excess fat from the inside of the breast. Local or general anaesthesia is used to perform liposuction. This procedure is essentially an outpatient procedure - on the same day the patient can return home.
Surgical breast reduction is slightly different. In this method, only general anaesthesia is used - due to this, the patient should not eat for at least 6 hours before the procedure.
After entering the patient into a state in which she will not feel pain or any other discomfort, it is possible to proceed to the essential stage of the procedure. Nipples are made within the breast - they usually include an incision around the nipple, as well as a cut in the lower part of the breast. The cuts are made in such a way that the possible traces of the surgery are as little visible as possible. After gaining access to the inside of the breast it becomes possible to remove fatty elements and glandular breasts, if necessary, the excess of the skin is also removed.
With significant breast reduction, the size of the mammary shell may also be reduced, if necessary it is also moved. The whole procedure takes three to four hours, after it is over, hospitalization usually takes no more than three days.

Time and course of convalescence

After the procedure, the patient stays in the hospital for a short time. After leaving it for about 7 days, the patient should save extraordinarily - all efforts, except for walks, are contraindicated during this period. Return to work is possible after one, sometimes two weeks - before the procedure it is worth discussing with your doctor to plan your absence at work. After surgery, you may have hematomas, as well as pain - in order to control them, you can take painkillers. The mentioned ailments have the highest intensity within a few days after surgery, later they disappear spontaneously. The sutures that were established during the surgery are removed within 10-20 days of its being travelled. The most important limitations of ordinary everyday functioning usually cease to apply within four weeks of the mammoplasty.

Breast reduction– results

The result of mammoplasty is breast reduction. How much the glands will be reduced depends on the liposuction technique chosen - a smaller change in their size can be obtained by liposuction, while the surgery allows a significantly larger reduction in the size of the bust. In the case of surgical mammoplasty, not only the size, but also the overall appearance of the breast can improve - thanks to the appropriate manoeuvre concerning the skin, it is possible to both raise the bust and improve the firmness of its skin.
The effects of mammoplasty appear gradually. Initially, the patient may even start to be afraid, because after the operation the breasts may still be quite large - it is, however, associated with gradually receding postoperative breast oedema. The effects of the treatment can be assessed basically after 2-3 months - that's when they become clearly noticeable. The whole regenerative processes take place even longer, for up to 12 months from mammoplasty, and it is at that time that the final result of her travel can be assessed.

Recommendations after the surgery

Patients with mammoplasty receive the following recommendations:
• a special bra should be worn for about two to six weeks (its use is aimed at maximizing the obtained results of mammoplasty, the recommended time of wearing such a bra may differ in different patients),
• you must avoid prolonged immobility (as after any operation, immobilization would increase the risk of thrombotic problems),
• you must abstain for four weeks from a significant physical effort,
• there is a need to avoid exposing the breast to solar radiation for half a year after the treatment (the sun could make the post-operative scars clearly visible).
Even before the surgery, it is worth taking care of someone who will be able to take the patient home. After the surgical operation of the breast reduction, the patient will not be able to drive the car herself.

How long do the results last?

The results of mammoplasty are essentially permanent. Over time, breasts may, however, undergo body aging processes and become less firm, as well as tend to fall. The results of the surgery are also influenced by diet and related changes in body weight - in a situation when the patient gets a significant increase in body weight, it is possible that excessive fat tissue will also appear in the breasts, which will result - even despite the surgery - to re-enlarging them.
Pregnancy and breastfeeding may also worsen the results of mammoplasty. In these periods of woman's life, the changes also affect the breast - the physiological is that during the development of the intrauterine child the breast glands are enlarged. For this reason, breast reduction is recommended to those patients who do not plan to have children in the future after the surgery.

How to avoid complications after the procedure?

How to avoid complications after the procedure?
In order to avoid complications after mammoplasty, first of all, follow the recommendations of post-operative treatment received from the doctor.
To reduce the risk of thrombotic complications, patients should avoid staying still - even a simple activity such as simply walking around the house reduces the risk of this (sometimes life-threatening) condition. Avoiding significant effort for the first four weeks after surgery reduces the risk of tissue damage. Patients who smoke cigarettes should try to quit smoking - smoking can impair the healing of the operated breasts. An important recommendation is also about wearing a special bra - this should be done exactly for the time that the doctor will recommend. The early return to work is inadvisable - the patient should undertake to perform professional duties at the earliest one, sometimes two weeks, and only when the doctor clearly allows her.

Possible complications

Complications that may appear after breast reduction are:
• hematomas within the breast glands,
• death of nipple tissue,
• postoperative wounds,
• impaired sensation in the breast,
• inability to breastfeed in the future (related to damage to structures responsible for the production and secretion of female food),
• asymmetry or other disturbances in breast shape,
• deep vein thrombosis of the lower limbs, pulmonary embolism (these complications are possible after any other surgical procedure).

Recommended additional treatment

Mammoplasty - breast reduction is a procedure that allows you to achieve satisfactory results on the size of the breasts. Operating mammoplasty and liposuction were previously described as independent methods of breast reduction, but it is possible to use them together for the purpose mentioned.

Author: Tomasz Nęcki, MD
Literature:
Shrirang Purohit, "Reduction mammoplasty", Indian J Plast Surg. 2008 Oct; 41 (Suppl): S64-S79; W. Noszczyk (ed.), "Surgery", ed. PZWL, Warsaw 2005; A. Currie, K. Chong, GL. Davies, "Using medical mammoplasty to extend the role of breast-conserving surgery in women with larger or ptotic breasts", Ann R Coll Surg Engl. 2013 Apr; 95 (3): 192-195.

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