What are the other names for the procedure?
- Bilateral Breast Reduction Surgery
- Reduction Mammoplasty
- Surgical Reduction of Breast
What is the Breast Reduction surgical procedure?
A Breast Reduction surgical procedure involves reshaping the size of breasts, by removing excessive breast tissue. It is also known as a Reduction Mammoplasty surgery.
What part of the body does the Procedure involve?
The Breast Reduction surgical procedure involves the human breasts.
Why is the Breast Reduction surgical procedure Performed?
A Breast Reduction Surgery may be performed for any of the following reasons:
- During reconstruction of the breast(s)
- To correct oversized breasts
- For cosmetic purposes
- Relief from back and neck pain in women with macromastia (enlarged breasts)
What are the Alternative Choices for the Procedure?
An alternative to Breast Reduction surgery is breast liposuction, where only the fatty tissue is removed, as opposed to both fatty and glandular tissue removal in a regular Breast Reduction surgery. Though liposuction may offer quick recovery and less scarring, it can sometimes result in sagging breasts.
What are the Recent Advances in the Procedure?
- The recent advances in Breast Reduction are the use of liposuction, which is less invasive as opposed to an open surgery
- Use of lasers to make incisions decreases scarring of the surgical incisions
What is the Cost of performing the Breast Reduction surgical procedure?
The cost of Breast Reduction procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Breast Reduction procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://www.mayoclinic.org/tests-procedures/breast-reduction-surgery/basics/definition/prc-20021706 (accessed on 06/23/2016)
http://www.plasticsurgery.org/reconstructive-procedures/breast-reduction.html (accessed on 06/23/2016)
Prior to Breast Reduction surgical procedure:
How is the Breast Reduction surgical procedure Performed?
A Breast Reduction surgical procedure is performed once the incision type and position of the new nipple is decided.
- The surgeon makes an incision between the proposed new nipple location and existing nipple location and removes the skin. Another incision is made below the nipple and the excess breast tissue removed
- The nipple is then repositioned to its new location and the skin sutured and bandaged
- In some cases, the surgeon may reduce the areola skin around the nipple too
- Sometimes, a drain may be left at the incision site to drain any fluid or blood that may accumulate under the sutures
- The same procedure is followed on the other breast
Where is the Procedure Performed?
The Breast Reduction surgical procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged, as per the instruction of the physician.
Who Performs the Procedure?
A Breast Reduction Surgery is performed by a plastic surgeon, assisted by an anesthesiologist.
How long will the Procedure take?
The Breast Reduction Surgery may take anywhere between 1-2 hours.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Breast Reduction procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Breast Reduction Surgery using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed before the Breast Reduction surgical procedure?
- Before a Breast Reduction Surgery, the individual may need to undergo a mammogram test, blood and urine analysis
- The physician determines the extent of medical tests that are necessary
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Breast Reduction Surgery?
- How is it performed?
- Am I a candidate for Breast Reduction Surgery?
- Will reduction of the breast(s) help me in any way?
- How will my breast appear, post-surgery?
- How will the breast appear, after pregnancy and breastfeeding?
- What are my choices, if I am not happy with the surgery?
- Will the surgery affect milk formation and breastfeeding?
- Will the procedure cause any loss of sensation in the breast or nipple?
- What are the risks involved?
- What are the possible complications that may arise, during recovery?
- What are the costs involved?
- Who are the medical personnel involved in the procedure?
- How many such procedures have you performed?
During the Breast Reduction surgical procedure:
What kind of Anesthesia is given during the Procedure?
General anesthesia is administered during the Breast Reduction surgical procedure.
How much Blood will you lose during the Procedure?
The amount of blood loss is generally minimal, but if complications arise during the Breast Reduction Surgery, it could lead to a further loss of blood.
What are the possible Risks and Complications during the Breast Reduction surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible complications that may arise during a Breast Reduction surgical procedure include:
- Excessive bleeding
- Injury to the surrounding structures
- Anesthetic complications
What Post-Operative care is needed at the Healthcare Facility after the Breast Reduction surgical procedure?
At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.
After the Breast Reduction surgical procedure:
What are the possible Risks and Complications after the Breast Reduction surgical procedure?
Following are some of the complications that might arise after a Breast Reduction surgical procedure:
- Scarring: Sometimes, excessive scarring called keloid formation, might occur
- Surgical wound infection: Collection of fluid which is infected results in abscess formation
- Hematoma, or a pocket of blood clot in the wound
- Seroma: It is a collection of fluid that is not infected
- Discoloration of healing skin
- Altered sensation in the breast and nipple
- Unevenly positioned nipples
- Depending on the surgical procedure, some women may face an inability to breastfeed
- Wrinkling of the skin
What is the Prognosis after the Surgery?
The prognosis after a Surgical Reduction of Breast procedure is generally excellent.
When do you need to call your Physician?
Do contact your physician if any of the following are noted after the Breast Reduction procedure:
- Pain around the surgical wound
- Swelling and redness
- Bleeding or fluid drainage
What Post-Operative care is needed at Home after the Breast Reduction surgical procedure?
The following post-operative care is needed at home, after a Breast Reduction procedure:
- Gently wash the surgical wound with a mild soap
- Avoid non-prescribed medication; complete the course of prescribed medications
- Do wear a well supporting bra, as per your physician’s advise
- Resume daily activities, as early as possible (per your doctor’s instruction)
- Avoid strenuous activity for up to 6 weeks after surgery
- Women over 30 years of age must get a mammogram done, 6 months after the surgery
How long does it normally take to recover fully from the Procedure?
It takes about 4 weeks to recover completely from the Breast Reduction Surgery. However, it may take around 12 weeks for the breasts to attain their final shape.
What happens to tissue (if any taken out) after the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from pathologist regarding the tissue taken out during Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Breast Reduction surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The hospital
- The plastic surgeon
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
The patient is advised to inquire and confirm the type of billing, before the Breast Reduction Surgery is performed.
Helpful Peer-Reviewed Medical Articles:
Munhoz, A. M., Montag, E., Arruda, E. G., Aldrighi, C., Gemperli, R., Aldrighi, J. M., & Ferreira, M. C. (2006). Critical analysis of reduction mammaplasty techniques in combination with conservative breast surgery for early breast cancer treatment. Plastic and reconstructive surgery, 117(4), 1091-1103.
Corduff, N., & Taylor, G. I. (2004). Subglandular breast reduction: the evolution of a minimal scar approach to breast reduction. Plastic and reconstructive surgery, 113(1), 175-184.
Roehl, K., Craig, E. S., Gómez, V., & Phillips, L. G. (2008). Breast reduction: safe in the morbidly obese?. Plastic and reconstructive surgery, 122(2), 370-378.
Clark, C. J., Whang, S., & Paige, K. T. (2009). Incidence of precancerous lesions in breast reduction tissue: a pathologic review of 562 consecutive patients. Plastic and reconstructive surgery, 124(4), 1033-1039.
Nahai, F. R., & Nahai, F. (2008). MOC-PS (SM) CME Article: Breast Reduction. Plastic and reconstructive surgery, 121(1S), 1-13.
Spear, S. L., Rottman, S. J., Seiboth, L. A., & Hannan, C. M. (2012). Breast reconstruction using a staged nipple-sparing mastectomy following mastopexy or reduction. Plastic and reconstructive surgery, 129(3), 572-581.
Rogliani, M., Gentile, P., Labardi, L., Donfrancesco, A., & Cervelli, V. (2009). Improvement of physical and psychological symptoms after breast reduction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62(12), 1647-1649.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA