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Breast Reduction / Bilateral Reduction Mammoplasty

A bilateral reduction mammoplasty (aka breast reduction) is a procedure that aims to relieve patients from symptoms of having large breasts. Common ailments from patients include neck, shoulder or back pain, skin indentation from bra straps, rashes in the breast fold, inability to exercise, and self-consciousness.

The technique that I use is called a Wise Pattern technique. This typically involves removing breast tissue from the lower, middle and outer portion of the breast and repositioning the nipple. This reduces the volume of breast tissue, whilst also producing a “lift”. It results in a scar around the nipple (circular), a vertical lower scar and horizontal breast fold scar (upside ‘T’ or anchor).

The sutures are all dissolving, although there will be a few knots on the outside that will be trimmed 2 weeks post op. In order to improve scarring, I like to have sticky bandages (Hypafix) covering the wounds for 2-4 weeks after surgery. It is critical to wear a sports bra continuously for the first 4 weeks post-surgery to relieve tension on the wounds.

Step 1 of a Breast Reduction
Step 2 of a Breast Reduction
Step 3 of a Breast Reduction

You may hear me use the term “pedicle” when explaining the operation. The pedicle is the area of remaining tissue attached to the nipple that gives the nipple its blood supply to survive. That area of tissue can originate from below (inferior pedicle) or upper inner (superomedial) portion of the breast. My decision on which pedicle to use is generally determined by shape and size of the breast.

Risks

General complications from the operation include infection, bleeding (haematoma), Deep vein thrombosis, pneumonia, scarring and wound complications. Perfect symmetry is not achievable but I will aim to have both breast looking as similar as possible. Unfortunately, symmetry may change overtime due to aging or changes in body weight.

Nipple necrosis is where the skin of the nipple has poor blood supply resulting in tissue death. This can vary from a small scab-like area to, in extreme cases, a black nipple. The management of this complication can be as simple as dressings and oral antibiotics, but is more serious cases could require surgical excision/debridement (in the operating theatre).

The “T-junction” is the point where the vertical scar meets the horizontal scar (bottom point of an anchor). This region notoriously has poor healing as it is where the blood supply as the furthest distance to travel and is on the most tension. If the wound breaks down in this area, it is usually managed with simple dressings and antibiotics. This may result in a thicker scar but is usually hidden in the breast fold.

Post-operative care

Post operatively expect to have a drain in each breast to help siphon fluid or blood. These are typically removed on the ward without pain on day 2 post surgery. Thick sticky bandages (hypafix) will be over the wounds and will need to remain dry and intact for two weeks. This means that when showering at home, water should not flow directly down your chest, only run down your back. You may wash your chest with a damp flannel. This is to limit the risk of infection. Most patients only require regular paracetamol for pain relief, however you may be given a small supply of strong pain-killers to use for severe pain at home.

When discharged home it is critical that you wear your post operative/ sports bra all day (only remove when washing) for the first 4-6 weeks. This helps provide support, relieving tension on the wounds to improve scarring and reduce pain. You must refrain from any vigorous activity/exercise but I encourage being mobile to reduce the risk of DVT. Regular slow-paced walking is best until you have your first wound check at two weeks. Driving is best avoided for at least 1-2 weeks post op, depending on your recovery.