Breast reduction surgery is a reconstructive operation rather than an aesthetic one, although it appears to be one of those cosmetic operations aiming to correct the external appearance of a woman. An overly large, sagging breast may cause back and neck pain as well as kyphosis. Numbness may occur since the bra exerts pressure on the nerves of the upper limb. Breathing difficulty could also arise. Rashes and wounds can be seen within the breast crease due to the continuous chafing of breast skin against the chest skin. Daily physical activity may be limited. In addition, a large breast may cause difficulty in selecting what to wear as well as self-dislike and subsequent social and psychological problems.

Breast reduction surgery gives breasts a natural appearance, also eliminating the problems stated above and facilitating the individual’s life. There may be various reasons as to why breasts can be large. Genetic factors, hormonal changes or some diseases might cause the formation of large breasts that are incongruous with body proportions. An existing problem may be aggravated by weight changes, breastfeeding and gravity effect. Young girls can also have increased breast tissue and associated overly large breasts.

Pre-Operation
You should see a plastic surgeon if you intend to undergo a breast reduction operation or want to get information on the operation. During your first examination, you should clearly explain your expectations in addition to why you consider to undergo such an operation and your expected result from the operation. Your surgeon will first listen to what you have to say, learn about your personal and family medical history and then examine you. After the examination, your surgeon will discuss with you on matters such as the size and shape of your breasts, the condition of your skin, your age, marital status, planned future pregnancy and the new position of the areola. You should not hesitate to ask for clarification on points that are not clear to you. Your surgeon will then inform you on the details of the operation in addition to the scar, nipple and areola sensitivity, breastfeeding, type of anaesthesia and the risks of the operation. It may help with your decision to see the photos of patients who previously underwent the same operation.

Preparing for the operation
In addition to the compulsory pre-op blood tests and chest x-ray, the patient should have mammography and, if necessary, ultrasonography. Conditions such as hypertension, smoking, drug habituation and diabetes should be discussed. Blood transfusion is usually not needed in breast reduction surgery. In cases when it is necessary, your own blood that is taken 5 to 7 days before the operation can be used (autotransfusion). You will need someone (such as a close relative or friend) to help you on the operation day and the next couple of days. Breast reduction surgery must be performed in the hospital and may require 1 to 3 days of hospitalization.

Operation
In breast reduction surgery, the overly large breast tissue is reshaped in accordance with the person’s body proportions. Excessive breast tissue and the skin above are resected. The areola is carried to the place where it should be. The operation is performed under general anaesthesia in an operating room at a hospital. The operation takes 2.5 to 4 hours. No matter which method is employed, there will definitely be a scar around the areola. In addition, according to the method employed, an inverted T-shaped scar that goes from the mid lower portion of the areola downwards will be visible. The lower part of the T-shaped scar will be aligned with the breast crease. However, a recent surgical technique has been able to eliminate the breast crease scar. It only leaves a 4.5 to 5-cm scar around the areola that goes from the mid lower portion of the areola downwards. These scars are initially visible but then become indistinct. The degree of scars after the operation depends on the size of the breast, the surgical method employed and the tendency of the patient’s skin to scar. Some patients say they have topless sunbathe after the operation. In some special cases involving excessively large breasts, it may not be possible to perform the surgical methods explained above. In that case, techniques in which the areola can be carried independently are employed and such techniques also leave the inverted T scars mentioned above.

Post-operation
Post-op period is usually comfortable. Pain is minimal. Movements of the upper limb may be restricted. A bra-like dressing is applied on the breasts or some surgeons prefer to allow their patients to wear their bras after the operation. Usually, tubes called drains are inserted into both breasts but these are removed within 24 to 72 hours. A separate dressing is placed on the areola. The dressing is opened 2 days later to check the wound. 7 days later, all dressing will be removed. Sutures are removed 7 to 10 days later. The patient stays in the hospital for 1 to 3 days. The patient wears a sports bra for 6 weeks. Massage is recommended. There may be initial swelling after the operation in addition to areolar numbness and a purplish color change on the breast skin. These will heal shortly.

Return to normal life
The patient may go back to work a week later. Avoiding intensive exercise is recommended for 3 weeks. Breast reduction surgery generally produces good and permanent results, fixes the mental health of the patient and her partner, makes them livelier and specifically facilitates the way a woman dresses. The newly-shaped breast reflects a long-term stability but weight changes, pregnancy, breastfeeding and gravity may cause an increased volume and sagging in breasts.

Risks associated with breast reduction operations:
As it is the case in all surgical operations, breast reduction operations also have their own risks associated. Although most of the patients undergoing this operation do not suffer from surgical complications, it is important that you are informed on risks in advance. Your personal decision will be much based on your knowledge about the risks and benefits of the operation. You should discuss each and every risk individually when your physician tells you about them. Hemorrhage: It is very rare but hemorrhage can still be the case in the pre-op and post-op period. The drains placed in the breasts after the operation serve the purpose of both checking any possible hemorrhage and preventing increased blood volume within the breast tissue. You should not take aspirins or similar drugs starting from 10 days before the operation. Such medications may increase the tendency of bleeding. Infection: It is a highly extraordinary case. Most surgeons administer protective antibiotics at the beginning of the operation. Changes in areolar and skin sensitivity: There may be a temporary reduction in the sensitivity of such areas. Scars: All surgical procedures leave a scar before healing. Usually, the nature of scars cannot be determined in advance. In some cases, scars are unnoticeable, but some patients may develop scars inside the skin and deep tissues and some others may even need surgical correction or other treatments. Dissatisfaction: You may not be satisfied with the size and shape of your breast. Despite marking a very little possibility, this is still possible. Pain: Your neck, back and should pain may persist after the breast reduction operation. In rare cases, scars developing inside the skin and deep tissues of the breast may cause pain. Hardness in breast: Hardness due to scar or fat necrosis inside the breast may rarely be observed. This cannot be anticipated. Delayed wound healing: This is rarely the case. It may take more time for some areas on the breast skin or areola to fully recover. Frequent dressing may be required. Problems with wound healing are more frequent in patients who smoke. Asymmetry: Most women have natural breast asymmetry. The shape, size and symmetry of the breast and areola might differ. Breast diseases: Breast diseases or breast cancer might develop in any period of an individual’s life irrespective of the breast reduction operation. Individuals should have regular checks for their breasts no matter whether they are operated or not. Breastfeeding: Some women undergoing breast reduction operation can breastfeed but it may be difficult to anticipate whether this will be possible. If you want to have a child and breastfeed, you should discuss the matter with your surgeon before undergoing the breast reduction operation. Allergic reactions: Although it is very rare, there are known cases of developing local allergies to the plaster, suturing materials or pomades used. Need for additional surgery: It is possible to speak of multiple factors that impact on the long-term results of breast reduction surgery. Loose, pendulous or sagging breasts may require additional surgery.

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