Reduction Mammaplasty (Breast Reduction)

There are two variations of breast reduction that are the basis of the vast majority of surgeries. In general terms, the classic caudal pedicle, where the blood supply comes from below, and the superomedial pedicle, where the blood supply comes from above. Both these techniques produce a “lollipop” scar around the areola and down the front of the breast. The length of scar in the fold under the breast may vary in length between these techniques, but this is not the scar that is visible.

Dr Darrell Perkins has extensive experience with both techniques, which he routinely performs. Both the superomedial and caudal pedicle have technical advantages in different patients, who invariably have unique breasts and unique clinical circumstances.

Dr Darrell Perkins strongly believes in matching the patient’s individual goals and physical characteristics with the operation that is best suited to achieve those goals, balanced against any potential for complications.

As incisions are required to effectively perform a breast reduction, scars are inevitable where both the glandular breast tissue and excess skin are removed. However, the scars are generally a minimal factor in governing patient satisfaction due to the functional relief the surgery brings.

Very rarely, an effective breast reduction may be achieved with liposuction alone and avoid the classic scars. For a satisfactory result this requires very careful patient selection.

The scars resulting from breast reduction surgery do fade with time, although there are steps and techniques which can be employed during the post-operative period to optimise their appearance. Scarring is very individual, and is dependent most importantly on genetics and skin type.

• Just like any other operation, recovery after undergoing breast reduction surgery is very individual.  Some patients are appropriate to undergo breast reduction as a day-only procedure. Most patients will elect to stay in the hospital for one or two nights.
• Upon completion of the surgery patients are placed in a compression bandage.  The bandage is generally removed two days post-operatively when the patient is then placed in a crop top.
• Drains will be placed in the wounds and instructions for use will be provided.
• Once recovered and ready for discharge, post-operative instructions covering wound care, medications and follow up appointments will be given.
• If day-only surgery, it is essential that a responsible adult collect the patient and stay with them for the first 24 hours following the surgery.
• Bruising and swelling are normal following the surgery and will subside over the first few weeks.  A degree of discomfort, particularly when moving or coughing, can be expected for the few first days after the surgery.
• Patients will be able to carry out most normal non-strenuous activities around the house in 2 – 4 days, and many patients will return to work if they have a desk job after 1 or 2 weeks. Patients are usually able to drive a car a week or so after their surgery.
• It is important that patients avoid activities that involve bouncing the breasts, such as jogging and aerobics, for about 5 – 6 weeks following breast reduction surgery. At this time, patients will begin wearing a proper bra that can provide the support needed.
• In the majority of cases, patients must work their way back to their normal activity level, but in most circumstances it is a matter of being sensible in what activities should be undertaken.

All patients will require appropriate screening for breast cancer prior to undergoing breast reduction surgery at our practice. In general terms, women over the age of 35 should usually have a current mammogram prior to the procedure. Younger patients may require investigations dependent upon their family history and risk factors.

During a reduction mammaplasty, all of the removed tissue is sent off for histopathological examination to exclude any cancer or precancerous changes in the breast tissue that has been removed.

Following a breast reduction, patients can undertake a screening mammography program as appropriate for their age and risk factors. Patients should normally have a mammogram about a year after the procedure as a baseline for comparison to other scans in the future.

The detection of breast cancer by mammography is still as effective after breast reduction surgery as it is before the procedure. We commonly perform breast reduction surgery on the opposite breast for those women who have had a mastectomy for breast cancer.

Very large breasts can affect the ability to breastfeed. Usually, during breast reduction surgery, a significant proportion of the glandular breast tissue is left attached to the nipple/areola, and in ordinary circumstances this may provide enough milk to allow the mother to breastfeed. There is a slight reduction in the ability to breastfeed post-operatively, but most women who are able to breastfeed prior to surgery are still able to.

Even with the highest standards of practice, all surgical procedures carry a level of risk and the potential for complications. In addition, every individual will have a different risk profile depending on their general health, age and the complexity of the procedure.

During the consultation Dr Perkins will explain the possible complications and risks of the specific procedure to provide the necessary information to enable you to weigh up the benefits, risks and limitations of the surgery.  The following are some of the risks associated with this procedure.

• Specific risks include asymmetry, change or loss of sensation in nipple/areola, loss of nipple/areola tissue, hypertrophic or keloid scarring, lumpiness due to fat necrosis.
• General risks involved in any surgery include post-operative infection, excessive bleeding, pain/discomfort, haematoma (blood collection), seroma (fluid collection), adverse reaction to anaesthetic, unsatisfactory scarring. Read more about general risks and complications of surgery.