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Breast Reduction Surgery

Breast reduction surgery, also known as reduction mammaplasty, is a procedure used to remove excess fat, tissue and skin from the breasts. If you have large breasts, you might choose to have breast reduction surgery to ease discomfort or to achieve a breast size proportionate to your body.

Breast reduction surgery might also help improve your self-image and self-confidence and your ability to participate in physical activities.

If you're considering breast reduction surgery, consult a board-certified plastic surgeon. It's important to understand what breast reduction surgery entails — including possible risks and complications — as well as set realistic expectations
Why it is Done:
Breast reduction surgery is meant for women who have large breasts and want to resolve issues such as:

  • Chronic back, neck and shoulder pain
  • Chronic rash or skin irritation under the breasts
  • Deep grooves in the shoulders from bra strap pressureRestricted activity
  • Poor self-image related to large breasts
  • Difficulty fitting into bras and clothing
  • Difficulty sleeping
What You Caan Expect:
Breast reduction surgery is usually done under general anaesthesia, either in a hospital or outpatient surgical facility.
 
During the procedure
The specific technique used to reduce the size of your breasts may vary. Generally, the surgeon makes an incision around the areola and down the breast. Excess breast tissue, fat and skin are then removed to reduce the size of each breast.

In most cases, the nipple and areola remain attached to the breast. If your breasts are very large and droopy, however, your nipple and areola might need to be removed and then reattached at a higher position on your breast as a skin graft.
After the procedure
Your breasts will be covered with a gauze dressing or bandages. A tube might be placed under each arm to drain any excess blood or fluid. Your surgeon will likely prescribe medication for pain as well as antibiotics to decrease your risk of infection.

For the first days or week, your breasts will probably feel tender and sensitive. They might also be swollen and bruised. Your surgeon might recommend an elastic compression bra initially to protect the breasts.
 Risks

Risk

Breast reduction surgery has the same risks as any other type of major surgery — bleeding, infection and an adverse reaction to the anesthesia. Other possible risks include:
1.Scarring
2.Loss of sensation in the nipples and skin surrounding the nipples (areolae)
3.Difficulty or inability to breastfeed
4.Differences in the size, shape and symmetry of the surgically altered left and right breasts, which might lead to further surgery to improve appearance The risk of poor wound healing seems to increase with the amount of breast tissue removed. However, it isn't clear that women with a higher body mass index are at greater risk of complications from breast reduction surgery.

How to Prepare

Your plastic surgeon will likely:
1.Evaluate your medical history and overall health
2.Discuss your expectations for breast size and appearance after the surgery Provide a detailed description of the procedure and its risks and benefits, including likely scarring and possible loss of sensation.
3.Examine and measure your breasts
4.Take photographs of your breasts for your medical record
5.Explain the type of anaesthesia used during surgery
Before breast reduction surgery, you might also be asked to:
1.Complete various lab tests
2.Get a baseline mammogram
3.Stop smoking for a certain period of time before and after surgery 4.Avoid taking aspirin, anti-inflammatory drugs and herbal supplements to control bleeding during surgery

Ask your surgeon whether you'll be able to go home the day of the surgery or whether you'll need to spend a night in the hospital. In either case, arrange for someone to drive you home after surgery.

Breast Augmentation

Breast augmentation — also known as augmentation mammoplasty — is a surgical procedure to increase breast size. During breast augmentation, breast implants are placed under the breast tissue or chest muscles.

For some women, breast augmentation is a way to enhance self-image and self-confidence. For others, breast augmentation is part of breast reconstruction after surgery for breast cancer or other conditions affecting the breast.

If you're considering breast augmentation, consult a plastic surgeon. Make sure you understand what surgery involves, including possible risks, complications and follow-up care.
Why it is Done:
A woman's reasons for choosing breast augmentation are highly personal.

Breast augmentation might help you:
  • Enhance your breast appearance if you feel your breasts are too small or you're concerned that one breast is smaller than the other
  • Adjust for a reduction in the size of your breasts after pregnancy
  • Reconstruct your breast after having breast surgery for cancer or other conditions
  • Improve your self-image or self-confidence
 Risks

Risk

Breast augmentation poses various risks, including
1.Scar tissue that distorts the shape of the breast implant (capsular contracture)
2.Breast pain
3.Infection
4.Changes in nipple and breast sensation, usually temporary Implant leakage or rupture
5.Correcting any of these complications might require additional surgery, either to remove or replace the implants.
 how-to-prepare

How to Prepare

Initially, you'll consult with a plastic surgeon about your preferences for size, feel and overall appearance of your breasts. The surgeon will describe specific types of implants — smooth or textured, round or shaped like a teardrop, saline or silicone — as well as options for surgical techniques.
1.Breast implants won't prevent your breasts from sagging. To correct sagging breasts,
2. Breast implants aren't guaranteed to last a lifetime. Implant rupture is a possibility.
3. Mammograms might be more complicated. If you have breast implants, routine mammograms might require additional, specialised views. You might need routine MRI scans. etc

Breast Reconstruction with Breast Implants

Breast reconstruction is a surgical procedure that restores shape to your breast after mastectomy — surgery that removes your breast to treat or prevent breast cancer.

One type of breast reconstruction uses breast implants — silicone devices filled with silicone gel or salt water (saline) — to reshape your breasts. Breast reconstruction with breast implants is a complex procedure performed by a plastic surgeon.

The breast reconstruction process can start at the time of your mastectomy, or it can be done later. The breast reconstruction process usually requires two or more operations — and several visits to your doctor — to insert, position and fill the breast implants.

Breast reconstruction won't re-create the exact look and feel of your natural breast. However, the contour of your new breast may restore a silhouette similar to what you had before mastectomy.
What you can expect
Breast reconstruction begins with placement of a breast implant or tissue expander, either at the time of your mastectomy surgery (immediate reconstruction) or during a later procedure (delayed reconstruction). Breast reconstruction often requires multiple operations, even if you choose immediate reconstruction.

Breast implants: A breast implant is around or teardrop-shaped silicone shell, filled with salt water (saline) or silicone gel. Once restricted because of safety concerns, silicone gel implants are now considered safe.
 
Tissue expanders: Tissue expansion is a process that stretches your remaining chest skin and soft tissues to make room for the breast implant. Your surgeon places a balloon-like tissue expander under your pectoral muscle at the time of your mastectomy. Over the next few months, through a small valve under your skin, your doctor or nurse uses a needle to inject saline into the valve, filling the balloon in stages.
Nipple reconstruction
Breast reconstruction may also entail reconstruction of your nipple, if you choose, including tattooing to define the dark area of skin surrounding your nipple (areola).
 Risks

Risk

Breast reconstruction with a breast implant carries the possibility of complications, including:
1.Implant rupture or deflation
2.Increased risk of future breast surgery to replace or remove the breast implant
3.Changes in breast sensation
4.Infection
5.Bleeding
6.Scar tissue that forms and compresses the implant and breast tissue into a hard, unnatural shape (capsular contracture) Correcting any of these complications may require additional surgery. If you need adjuvant radiation therapy, you might not be an ideal candidate for breast implant reconstruction. Radiation therapy often leaves the skin and underlying tissue discoloured or damaged. In such cases, doctors tend to recommend breast reconstruction with a tissue flap instead.
 how-to-prepare

How to Prepare

Before a mastectomy, your doctor may recommend that you meet with a plastic surgeon. Consult a plastic surgeon who's board certified and experienced in breast reconstruction following mastectomy. Ideally, your breast surgeon and the plastic surgeon will work together to develop the best surgical treatment and breast reconstruction strategy in your situation. Your plastic surgeon will describe your surgical options and may show you photos of women who have had different types of breast reconstruction. Your body type, health status and cancer treatment factor into which type of reconstruction will provide the best result. The plastic surgeon provides information on the anaesthesia, the location of the operation and what kind of follow-up procedures may be necessary. Your plastic surgeon may recommend surgery on your opposite breast, even if it's healthy so that it more closely matches the shape and size of your reconstructed breast. Before your surgery, follow your doctor's specific instructions on preparing for the procedure. This may include guidelines on eating and drinking, adjusting current medications, and quitting smoking.

Breast Lift

A breast lift — also known as mastopexy — is a surgical procedure to change the shape of your breasts. During a breast lift, excess skin is removed and breast tissue is reshaped to restore firmness and raise the breasts to a higher position.

You might choose to have a breast lift if your breasts sag or your nipples point downward. A breast lift might also boost your self-image and self-confidence.

A breast lift won't significantly change the size of your breasts. However, a breast lift can be done in combination with breast augmentation or breast reduction.
 
Why it's done
 
As you get older, your breasts change — losing elasticity and firmness. There are many causes for these kinds of breast changes, including:
 
  • Pregnancy. During pregnancy, the ligaments that support your breasts might stretch as your breasts get fuller and heavier. This stretching might contribute to sagging breasts after pregnancy — whether or not you breastfeed your baby.
  • Weight fluctuations. Changes in your weight can cause your breast skin to stretch and lose elasticity.
  • Gravity. Over time, gravity causes ligaments in the breasts to stretch and sag
A breast lift can reduce sagging and raise the position of the nipples and the darker area surrounding the nipples (areolae). The size of the areolae can also be reduced during the procedure to keep them in proportion to the newly shaped breasts.

You might consider a breast lift if:
 
  • Your breasts sag — they've lost shape and volume, or they've gotten flatter and longer
  • Your nipples — when your breasts are unsupported — fall below your breast creases
  • Your nipples and areolae point downward
  • Your areolae have stretched out of proportion to your breasts
  • One of your breasts falls lower than the other.

 A breast lift isn't for everyone. If you're considering pregnancy at any point in the future, you might delay getting a breast lift. During pregnancy, your breasts could stretch and offset the results of the lift.

Breastfeeding is a consideration as well. Although breastfeeding is usually possible after a breast lift — since the nipples aren't separated from the underlying breast tissue — some women might have difficulties producing enough milk.

While a breast lift can be done on breasts of any size, women with smaller sagging breasts will likely have longer lasting results. Larger breasts are heavier, which makes them more likely to sag again.
 
During the procedure:
 
Techniques used to remove breast skin and reshape breast tissue vary. The specific technique your plastic surgeon chooses will determine the location of the incisions and the resulting scars.

Your doctor might make incisions:
 
  • Around the areolae — the darker area surrounding the nipples
  • Extending downward from the areolae to the breast creases
  • Horizontally along the breast creases
The procedure typically takes two to three hours.
 
After the procedure:
 
After a breast lift, your breasts will likely be covered with gauze and a surgical support bra. Small tubes might be placed at the incision sites in your breasts to drain any excess blood or fluid.

Your breasts will be swollen and bruised for about two weeks. You'll likely feel pain and soreness around the incisions
In the first few days after a breast lift, take pain medication as recommended by your doctor. Avoid straining, bending and lifting. Sleep on your back or your side to keep pressure off your breasts.
Avoid sexual activity for at least one to two weeks after the breast lift. 
Drainage tubes placed near your incisions are typically removed within a few days. When your doctor removes the tubes, he or she will also probably change or remove your bandages.
Continue to wear the surgical support bra around the clock for three or four days. Then you'll wear a soft support bra for three or four weeks. Your doctor might suggest using silicone tape or gel on your incisions to promote healing.

While you're healing, keep your breasts out of the sun. Afterwards, be careful to protect your incisions from sun exposure.
 
 
 Risks

Risk

A breast lift poses various risks, including:
Scarring. While scars are permanent, they'll soften and fade within one to two years. Scars from a breast lift can usually be hidden by bras and bathing suits. Rarely, poor healing can cause scars to become thick and wide.
Changes in nipple or breast sensation. While sensation typically returns within several weeks, some loss of feeling might be permanent. Erotic sensation typically isn't affected.
Irregularities or asymmetry in the shape and size of the breasts. This could occur as a result of changes during the healing process. Also, surgery might not successfully correct pre-existing asymmetry.
Partial or total loss of the nipples or areolae. Rarely, the blood supply to the nipple or areola is interrupted during a breast lift. This can damage breast tissue in the area and lead to the partial or total loss of the nipple or areola.

Difficulty breastfeeding. While breastfeeding is usually possible after a breast lift, some women might have difficulties producing enough milk. Like any major surgery, a breast lift poses a risk of bleeding, infection and an adverse reaction to anaesthesia. It's also possible to have an allergic reaction to the surgical tape or other materials used during or after the procedure.
 how-to-prepare

How to Prepare

Initially, you'll talk to a plastic surgeon about a breast lift. During your first visit, your plastic surgeon will likely:

Review your medical history. Be prepared to answer questions about current and past medical conditions. Tell the doctor if you have a family history of breast cancer. Share the results of any mammograms or breast biopsies. Talk about any medications you're taking or have taken recently, as well as any surgeries you've had.
Do a physical exam.

Discuss your expectations. Explain why you want a breast lift and what you're hoping for in terms of appearance after the procedure. :
Schedule a mammogram.  
Stop smoking. Smoking decreases blood flow in the skin and can slow the healing process. If you smoke, your doctor will recommend that you stop smoking before surgery and during recovery.
Avoid certain medications. You'll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
Arrange for help during recovery. Make plans for someone to drive you home after surgery and stay with you as you begin to recover. You might need someone to help you with daily activities, such as washing your hair, during your initial recovery.