Breast reduction

Breast reduction or reduction mammoplasty is the surgery that removes breast tissue, fat and excess skin, to get a breast proportional to your body and your needs.

  • Macromastia or voluminous breasts can lead to a low quality of life through:
  • back pain,
  • deformed posture,
  • excessive perspiration and irritation of the inframammary fold,
  • sleep or respiratory problems,
  • difficulties in performing sports,
  • difficulties in finding clothes or even bras that fit,
  • emotional stress.

The purpose of the intervention is to adapt the reductive surgical technique based on of the patient’s age, as a young patient who wants to have children and breastfeed needs a different approach when compared to a patient at menopause.

Through breast reduction we aim to:

  • remove excess glandular and fatty tissue,
  • remove excess skin,
  • move the nipple areola complex to obtain a pleasant aesthetic result,
  • reconstruct the mammary gland to provide projection and volume to the breast.

A surgical consult is mandatory and has the role of understanding your dissatisfaction and expectations, associated health problems, as well as doing necessary breast measurements.

Preoperative investigations are required to determine your overall health and include:

  • breast ultrasound and BIRADS score
  • blood tests (hemogram, coagulation tests, AST, ALT, Cholesterol, Triglycerides, Urea, Creatinine, Glycemia etc)
  • Electrocardiogram (EKG), to monitor cardiac function.

Pre-operative recommendations

  • It is compulsory to stop smoking at least 2 weeks before surgery. You may only resume smoking at the end of the healing period (minimum 2 weeks).
  • You will stop eating and drinking before midnight the night before the surgery. If the surgery is scheduled in the afternoon, you will not consume food and liquids for at least 8 hours before the intervention.
  • On the day of the surgery you will not wear contact lenses, false nails / nail polish, hairpins, makeup – all of these can hide the signs needed to track your vital functions intraoperatively and may interfere with some maneuvers during intubation and detubulation.
  • You should wear light, comfortable clothes that can be easily put on after the intervention. Clothes with buttons or zippers work best, so that you don’t need to raise your arms when getting dressed.
  • You are not allowed to drive the car for a period of 1-2 weeks, so you have to make sure you have someone to take drive you home after being discharged.
  • After the intervention you will be slightly confused, which is why you should avoid making any important decisions and signing documents.
  • The post-operative diet will be a restrictive one (no foods that can cause it nausea / vomiting, bloating or any digestive discomfort) – start by drinking liquids / soups and gradually move to solid foods.
  • I encourage you to start moving soon after the surgery, initially by sitting up on the edge of the bed, then taking light strolls (always accompanied).
  • You will be released the day after the surgery, after you’ve had postoperative pictures taken, we’ve answered all your questions, and we’ve established when your next consult will happen.

Postoperative complications and risks

  • Poor healing (hypertrophic, retractive, keloid scars),
  • Infection,
  • Bruises (bruises),
  • Changes in areola and nipple sensitivity. These may be temporary or may be permanent, depending on the surgical technique used. Breast reduction through which the nipple areola complex is harvested as a graft, will lead to no sensitivity.
  • Minimal bleeding until the formation of hematomas,
  • Delayed healing (smoking, diabetes, autoimmune diseases can slow the healing process),
  • Asymmetry between the two breasts. There is no perfect symmetry, so minimal differences are to be expected.
  • Depigmentation of areoles and nipples,
  • Breast irregularities
  • Seroma (the accumulation of a clear, yellow liquid, under the surface of your skin),
  • Problems with breastfeeding,
  • Excessive firmness of the breasts,
  • Skin necrosis,
  • Necrosis of areola and nipple,
  • Deep vein thrombosis, which can cause lung and cardiac complications,
  • Persistent pain in the breast / breasts,
  • Allergies (medicines, locally applied agents, leucoplast, suture material, etc.),
  • Fat necrosis (adipose tissue is very sensitive when the vascularization is deficient, leading to its liquefaction),
  • Possibility of a second, corrective surgery,
  • Anesthetic risks.

Post-surgery recommendations

  • The first 3-5 days are the most unpleasant, when a maximum inflammation happen, its main symptoms being edema and pain;
  • After surgery you will have drainage tubes on both breasts, which are removed when the amount collected is below 50 ml. They can be removed immediately before discharge, or, if needed, when the drainage quantity is reduced (below 50 ml);
  • Follow the prescribed treatment: antibiotic, NSAID, gastric protector;
  • Expect small red spots on the surgical dressing / adhesive, they appear in the first days postoperatively. Also, postoperative edema (swelling) is normal and diminishes over time.
  • If you have one of the following symptoms: fever higher than 38 degrees C, redness that extends from the level of the incision, purulent or odorous secretions in the incision or the drainage tube, pain and intense discomfort that is not reduced by anti-inflammatories (Ibuprofen, Ketonal, Arcoxia, Tador etc), edema larger in one breast than in the other – THIS MEANS THERE IS AN INFECTION AND YOU MUST CONTACT ME (phone, sms, whatsapp, email).
  • The breasts will achieve their final shape after 6 months.
  • After the surgical adhesive is removed, the scars will be reddish / pink. In the first 6 months, you will apply healing creams through massage and pressure – 5 minutes / day in the morning and evening. Scar maturation up to 1 year. In the first year you should avoid exposing the scars to UV (sun / solar) radiation, as there is a risk of hyperpigmentation;
  • In some cases, the suture wires can be rejected by your body, in which case you should not panic, but as soon as you notice any redness and swelling, or a visible part of the wire, you must make an appointment to see your surgeon.
  • You will sleep on your back for the first 2 weeks after surgery. (Tip: Use a pillow placed under the knees to prevent lower back pain). You should not sleep face down in the first 3 months;
  • The bruises and swelling of the breasts are normal postoperatively, you should apply Arica cream on the skin (avoiding the incisions);
  • You can take shower as soon as you get home, without rubbing the steri-strips with a sponge / loofa. Do not apply oily creams or lotions on steri-strips; If you still have drainage tubes, don’t shower until they have been removed.
  • In the case of an areola graft, do not wash your breast area.
  • Do not drive in the first week;
  • THERE ARE NO WIRES, so after 2 weeks, only some patches placed over the incision need to be removed;
  • You must avoid any physical exertion in the first 2 weeks, as they can cause your pulse to spike and consequently increase the risk of bleeding;
  • Avoid using your arms (lifting, turning, pushing, etc.), because causes tension in the pectoris area, increasing the risk of bleeding and suture rupture.
  • In the first 6 weeks you should not lift more than 4 kg with one hand;
  • You are allowed to go to the gym after 6 weeks. It is mandatory to wear a bustier when exercising;
  • Smoking is contraindicated for 2 weeks postoperatively, until the steri-strips are removed;
  • Each woman’s body is unique and the recovery stages may vary, however, it takes 6 weeks on average to return to your normal activities;
  • You will have postoperative consults at 2-4-6 weeks, 3 months, 6 months, 1 year and then once every year.