Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to difficulty in finding clothing that fits, and partaking in sports. Bra straps may leave indentations in their shoulders. Unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.

Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

Breast reduction is usually performed both physical relief as well as cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.

In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. The procedure does leave scars, although they'll be covered by your bra or bathing suit. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. Finally, patients may experience a permanent loss of feeling in their nipples or breasts. These factors apart, breast reduction patients are some of the most content patient's in any plastic surgeon's practice.

Dr. Bolitho will describe the procedure in detail at the time of your consultation, explaining its risks and limitations. Photographs will aid the planning of the surgery, and may be required should insurance authorization be required. Some insurance companies will pay for breast reduction if it's medically necessary, provided certain criteria are met. Dr. Bolitho's office will provide assistance in pursuing insurance authorization where appropriate.

Breast Reduction Surgery

The surgery is performed under general anesthesia and usually takes about three hours. Dr. Bolitho prefers to admit his patients to hospital after breast reduction surgery for one night. Depending on the technique, drainage tubes may be placed. These will be removed the morning after surgery. You may be required to have a mammogram prior to your breast reduction surgery. You'll also get specific instructions on how to prepare for surgery. If you plan to lose any weight, it is advisable to do so prior to surgery.

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Breast tissue, fat and skin are removed and the nipple and areola are moved to their new elevated position. Liposuction is used to remove excess fat from the armpit area.

All stitches are of the dissolving type and do not require removal. Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. Dr. Bolitho has perfected techniques in breast reduction that employ minimal scars. In some cases, a technique that eliminates the scar in the crease beneath the breast may be preferable. Rarely, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.

Recovery

You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Dr. Bolitho will prescribe medication to lessen the pain.

Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for four weeks.

Dr. Bolitho will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. But you'll have much less stamina for several weeks, and should limit your exercises until your energy level returns. You'll also need a good athletic bra for support.

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.

Dr. Bolitho will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction scars are permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines.

The Results

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.

However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be ecstatic with the results.