Breast Reduction Surgery

What is Breast Reduction Surgery?

Breast reduction, also known as reduction mammoplasty, is a surgical procedure to remove excess fat, tissue and skin from the breasts and is key in treating Macromastia.

Why is Breast Reduction Surgery Required?

Macromastia can result in several complications due to the additional size and weight of enlarged breasts, which includes

shoulder grooving and
chronic pain in the neck, shoulder and upper back,

which might require pain killers. This can result in reduced quality of life. Macromastia can cause both behavioural and physical issues and reduced quality of life.

Other issues that can benefit from breast reduction include difficulty finding proper clothes, chronic rash under the breasts, restricted physical activities and poor body image due to the larger breasts.

Who is Breast Reduction Surgery Suitable for?

Breast Reduction in macromastia is suitable for any individual who is:

Aged 18 and above.
Not suffering from chronic conditions such as hypertension and diabetes,
Have a BMI of 35kg (per metre squared) with a stable weight for 12 months, and
Experiencing psychological and visible physical issues related to macromastia.

Why Consider Breast Reduction Surgery?

Breast Reduction surgery is often chosen for patients with Macromastia. Macromastia is a condition where an individual’s breast size is disproportionally large compared to their other body dimensions.

Breast Reduction surgery is effective in managing symptoms caused by macromastia, such as neck, shoulder and back pain.

Benefits of Breast Reduction Surgery

Breast reduction surgery can be used during breast cancer surgery in large-breasted women and is a type of oncoplastic procedure. After the cancer is excised, the breast is reduced and reconstructed into a smaller breast with a nipple lift. Sometimes a secondary pedicle may be needed to fill in the tumour bed.

The benefits of breast reduction surgery include:

Improved quality of life such as less neck, shoulder and back pain associated with macromastia,
Fewer complications from radiotherapy, e.g. chronic breast lymphoedema and pain. The final breast is much smaller and therefore less prone to long-term side effects than a large breast treated without a reduction,
Greater patient satisfaction. Most patients are extremely happy with their breasts after a reduction,
Superior oncologic margins. This is due to resecting much larger volumes compared to a simple lumpectomy,
Superior cosmetic result. The breast is reshaped as opposed to a simple lumpectomy where the breast parenchyma is re-approximated. This also corrects breast ptosis. The final breast often looks better than the original breast.

Pedicle Breast Reduction Types

Using pedicle methods of breast reduction, nipple-areola sensation and milk production are typically preserved. The pedicle method refers to the location of the blood and nerve supply - not where the incisions are placed.

Pedicle Breast Reduction is the most common method of breast reduction. Types of pedicle Breast Reduction include:

Inferior pedicle- the blood and nerve supply from the bottom of the breast.
Superior pedicle - from the top of the breast.
Central pedicle - from the centre of the breast.
Lateral pedicle - from the side of the breast.
Bi-pedicle - from two locations, mainly used in cancer surgery.

Free Nipple Graft Procedure

In the case of very large breasts, patients are sometimes faced with the Free Nipple Graft procedure (FNG). The pedicle, along with its blood and nerve supply, must be severed, and the nipple-areola complex is detached and grafted back on after the reduction is completed. Function and sensation are lost with this method.

Breast Reduction Skin Incision Types

Skin incision types for Breast Reduction Surgery include:

Vertical Scar: This is a breast reduction procedure where your surgeon makes an incision around your areola and vertically down to the crease, in the shape of a lollipop. This is indicated in those who require only a moderate reduction in size. It results in less scarring than the traditional technique (which requires an additional incision along the breast crease) and fewer complications. However, the technique may not be suitable for larger breasts as it does not allow the removal of large amounts of tissue and skin and may leave a small fold of skin at the bottom of the vertical scar.
Wise Pattern Scar: (Anchor Incision Pattern): This is the most common incision pattern for breast reduction done today. The incision allows more skin to be used and more tissue to be removed. It is the incision of choice for large breast reductions or very floppy breasts.

Preparation Before Breast Reduction Surgery

Breast Reduction is an inpatient procedure performed by a plastic surgeon. To prepare for the surgery, the patient should be adequately counselled to ensure that the informed consent is fully understood.

A complete history and physical examination are completed to determine eligibility for the procedure, which will include lab tests and a mammogram. The patient and doctor discuss their expectations and probable final shapes of the breasts after the surgery.

The patient is also advised to stop smoking and use anti-inflammatory medicines, including aspirin, before treatment to reduce the chances of bleeding.

Steps in Breast Reduction Procedure

Breast Reduction surgery is performed under general anaesthesia. The steps include:

The Surgeon marks the incision lines on your breasts and takes relevant measurements in line with the preoperative consultation.
Administration of general anaesthesia after the patient has been placed in a horizontal position in the operation theatre,
Once you are asleep and lying down, the landmarks change as the breast assumes a different shape from what we observe when you are standing.
Your surgeon will measure the height of the nipple and estimate the volume of the breast to be removed.
The surgeon makes a circular incision around the areola that extends downwards.
By liposuction or further incisions, the extra fat, breast tissue and skin are removed to reduce breast size to a pre-determined size.
After repositioning the nipple and its surrounding areola, the surgeon finalises the new shape of the breast and closes up using sutures.
A gauze dressing is used to cover up the breasts, and the patient is shifted to recovery after being awoken from anaesthesia.
In certain cases, a drainage tube may be added to allow the removal of excess fluid and blood.

The complete procedure can take 2-3 hours, depending upon breast size and other factors.

Drainage tubes may be in place to eliminate any blood that may accumulate. These drains are removed within 2-3 days of the surgery.

What Should I Expect After Breast Reduction Surgery?

Immediately after the procedure, the patient is shifted to a room. Once stable, the patient is discharged on the same day or after spending a night at the hospital.

The patient will also be prescribed pain medication and antibiotics as instructed.

For the first few weeks, the breasts might be extra sensitive and tender, and there also can be swelling and bruising. The surgeon will advise the patient to limit physical excursions for up to a month and allow the breasts to heal.

The surgeon will also recommend the patient make timely follow-up visits to remove stitches and monitor recovery. In certain cases, the patient is also recommended to use a compression bra to aid in the healing process.