Macromastia or bulky breasts can cause a low quality of life by:
- back pain,
- deformed posture,
- excessive sweating and irritation of the inframammary fold,
- sleep problems or respiratory problems,
- difficulties in performing sports,
- difficulties in finding suitable clothes or bras,
- emotional stress.
The aim of the intervention is to adapt the reductive surgical technique according to the patient’s age, so that a young patient who wants to have children and breastfeed undergo a different approach, compared to a menopausal patient.
Breast reduction aims to:
- remove excess glandular and adipose tissue;
- remove excess skin;
- move the nipple-areola complex to obtain a pleasant aesthetic result;
- reconstruction of the remaining mammary gland to provide projection and volume to the breast.
The clinical examination is mandatory and has the role of understanding your dissatisfaction and expectations, associated health problems, as well as to perform breast measurements.
Preoperative investigations are needed to determine your health and include:
- breast ultrasound with BIRADS score;
- blood tests (blood count, coagulogram, GTO, GTP, Cholesterol, Triglycerides, Urea, Creatinine, Blood sugar, etc.);
- Electrocardiogram (EKG), for monitoring heart function.
Paraclinical investigations may vary depending on the associated pathologies that will be discussed during the examination.
Pre-operative recommendations
It is mandatory to stop smoking at least 2 weeks before the intervention. You can restart smoking at the end of the healing process (minimum 2 weeks).
After midnight (00:00) the day before the surgery you will not eat or drink anything. If the intervention is scheduled in the afternoon, you will not consume food and liquids at least 8 hours before the intervention,
On the day of the operation, you will not wear contact lenses, false nails / nail polish, hairpins, make-up – all of these can mask signs necessary to monitor your vital functions intraoperatively and can interfere with some maneuvers in the operating room.
You will arrive at the clinic wearing light, comfortable clothes that can be easily worn after the operation. It is preferable that the clothes have buttons or a zipper, so that you will not have to to raise your arms while dressing up.
You are not allowed to drive the car for a period of 1-2 weeks, so you must make sure that there is someone to transport you from the clinic at the time of discharge.
After the intervention you will be slightly confused, which is why you should avoid any important decision, signing documents, etc.
The postoperative diet will be a dietary one (without foods that can cause nausea / vomiting, bloating or any digestive discomfort) – start by drinking liquids / soups and gradually switch to solid foods.
I encourage you to start postoperative mobilization, initially getting up at the edge of the bed, then taking light walks (! Accompanied).
You will be discharged the day after the intervention, when control pictures will be taken and we will schedule the future follow-up visits.
Postoperative complications and risks
- Deficient scarring (hypertrophic, retractile, keloid scars),
- Infection,
- Bruising (ecchymosis),
- Changes in areola and nipple sensitivity. They may be temporary or permanent,
- Minimal bleeding until hematomas form,
- Delayed healing (smoking, diabetes, autoimmune diseases can slow down the healing process),
- Asymmetry between the 2 breasts. There is no perfect symmetry, so minimal differences are expected,
- Irregularities in the breasts,
- Seroma (accumulation of a clear, yellowish liquid under the sutures),
- Problems in breastfeeding,
- Excessive firmness of the breasts,
- Skin necrosis,
- Areola and nipple necrosis,
- Deep vein thrombosis, which can cause pulmonary or cardiac complications,
- Persistent breast(s) pain,
- Allergic reactions (drugs, topically applied agents, plaster, suture material, etc.),
- Adipose tissue necrosis (adipose tissue is very sensitive when vascularization is deficient, leading to its liquefaction),
- The possibility of a revision intervention(s),
- Anesthesia related complications.
Postoperative recovery
The first 3-5 days are the most unpleasant, when inflammation is at its highest, manifested by edema and pain;
Postoperatively you will have drainage tubes in both breasts, which are removed when the amount collected is below 50 ml/24h. Their removal can be done immediately before discharge, or until the drainage amount is reduced (below 50 ml/24h);
Follow the drug treatment: antibiotic, NSAIDs, antiacid;
Expect small reddish spots on the bandage / surgical adhesive; they appear in the first days postoperatively. Also, postoperative edema (swelling) of the breasts is normal and attenuates over time.
If you have one of these signs: fever above 38 degrees C, redness that starts in the incision and spreads, purulent or foul-smelling secretions in the incision or drain tube, intense pain and discomfort that is not relieved by anti-inflammatory drugs (Ibuprofen, Ketonal, Arcoxia, Tador etc), greater edema in one breast than the other – THEY REPRESENT SIGNS OF INFECTION AND YOU MUST CONTACT ME (phone, sms, what app, mail).
The breasts will get their final shape after 12 months.
After removing the surgical adhesive, the scars will be reddish / pink. In the first 6 months you will apply healing creams by massage and pressure – 5 minutes / day in the morning and evening. The maturation of the scars lasts up to 1 year. In the first year you should avoid exposing the scars to UV radiation (sun / solar) as there is a risk of hyperpigmentation;
Occasionally, sutures may be repelled by your body. Do not panic as soon as you notice redness and swelling or one end of the thread; you will schedule a meeting at the clinic.
You will sleep on your back for the first 2 weeks postoperatively. (Tip: use a pillow placed behind the knees to prevent lower back pain). It is contraindicated to sleep on your stomach for the first 3 months;
Bruising and swelling of the breasts are normal postoperatively; apply Arica cream to the skin (without applying to the incisions);
You can take a shower as soon as you get home. Protect and do not rub the the steri-strips with the sponge. Do not apply creams or oily lotions over the strips; In case of the presence of drain pipes, you will have to wait until they are removed;
Breast washing is contraindicated in case of an areola graft;
I recommend against driving in the first week;
THERE ARE NO SUTURE WIRES, so after 2 weeks, only some patches placed over the incision will be removed;
In the first 2 weeks you should avoid any physical activity; it could increase your pulse and consequently increase your risk of bleeding;
It is not advised to use the arms (lifting, rotating, pushing, etc.), because it causes tension in the pectoral area, increasing the risk of bleeding and rupture of the tissue;
In the first 6 weeks you must not lift more than 4 kg with one hand;
You are allowed to go to the gym after 6 weeks postoperatively. It is mandatory to wear a bustier when doing sports;
Smoking is prohibited for 2 weeks postoperatively, until the steri-strips are removed;
Every woman’s body is unique and the stages of recovery may vary, however, on average 6 weeks after surgery you should be able to return to your old habits;
Regular check-ups at 2-4-6 weeks, 3 months, 6 months, 1 year and then once / year postoperatively.
