REDUCTION MAMMAPLASTY
Breast hypertrophy (large breasts) are natural for some women due to genetics. Others, have silicone implants as an ally to make them voluminous. In both cases, excessively large breasts can cause emotional and health problems for some women. The weight of the excess breast tissue – or of the prostheses – can lead to back, shoulder, and neck pain. It can even lead to secondary neurological sequelae related to cervical problems and cause some discomfort when breathing. The bra strap can even make a groove in the shoulders, and skin infections in the folded areas are not uncommon.
Sometimes it is complicated even to lead an active and full life. To find the right size bikini and bra, you have to do a lot of research. Some blouses are tight. Exercising is hard… running then! Beach? Swimming pool? No way! It is amazing how big breasts attract attention to the point of being uncomfortable. They affect self-esteem and make you avoid social interaction. There are also psychological complaints that range from shame and feelings of devaluation (they don’t find themselves attractive) to loss of sexual attractiveness and femininity.
WHAT IT IS AND HOW IT IS DONE
Reduction Mammaplasty is the plastic surgery that, besides reducing the size and volume, reshapes the shape of the breasts so that they become harmonious according to the biotype of each woman. Each woman is unique and has her ideal result. It is one of the 5 most performed plastic surgeries in Brazil!
The patient receives general anesthesia or intravenous anesthesia. The procedure lasts 2 to 3 hours, on average, according to anatomical particularities, breast composition, amount of reduction desired, and whether there is an implant.
As for the patterns of incisions in each breast, one option is the circular one around the areola. Another is the “paddle” or “lock” pattern, where the incision is made around the areola and vertically down to the breast crease. A third option is the inverted “T” or “anchor” shaped incision pattern.
After the incision, we reposition the nipple and the areola is reduced by excising (removing) skin at the perimeter, if necessary. Underlying breast tissue is reduced, lifted and shaped. In the case of silicone breast implants, we exchange for smaller volume ones.
If necessary, we correct the asymmetry between the breasts. Occasionally, in cases of extremely large and pendulous breasts, we remove and transplant the nipple and areola to a higher position in the breast.
After we remove excess fat, glandular tissue and skin and get to the planned size, we suture the deep layers within the breast tissue to create and support the breasts. We then close the skin with sutures, adhesives and/or surgical tape.
INDICATION
Reduction Mammaplasty is a procedure indicated for women who already have fully matured breasts. In specific cases, the procedure can be performed earlier.
This surgery is indicated even if it is – just – for the uncomfortable feeling that the breasts are too large and this brings discomfort and problems in self-esteem.
It must be considered that most women would like to have full breasts, but when they limit physical activity, cause back, neck and shoulder pain, it is better to be pragmatic.
Naturally large breasts or those with bulky prostheses can also mark the shoulders in place of bra straps, cause skin irritation below the breast crease, have enlarged areolas, and become saggy and pendulous.
Surgical reduction in hypertrophic breasts may even help in posture correction. What about breastfeeding? It doesn’t interfere. The cases are rare, but there is always a risk of reducing the lactation volume due to the glandular reduction used in the surgical technique. It is worth pointing out that during pregnancy there can be changes in the breasts and consequent changes in the results of the surgery, as well as significant oscillations in weight. I always advise that the best moment to do this surgery is at least 6 months after the end of breastfeeding.
It is clear that the patient should have the Reduction Mammaplasty before she has more serious problems with her spine or addled posture, even if in her teens well before she plans to have children.
Despite the scarring, most studies show that over 95% of patients would have the surgery again and recommend it to others. The patients in these studies were more comfortable buying clothes and exercising and felt better about their self-esteem. Most reported a decrease in physical symptoms (pain and dermatitis) postoperatively.
PREOPERATIVE
It is essential to consult the SCHEDULED THE SURGERY? page which has a series of questions to talk about during the consultations, to help you with your doubts and where you will find recommendations for the day of the procedure.
If you have, it is important to talk about family history of breast cancer and to bring the latest results of previous mammograms or biopsies.
Also, in the case of Reduction Mammaplasty, there follows a checklist to help you get organized:
🅐 Prior lymphatic drainage sessions help prepare the body for surgery and reduce the risk of post-surgical complications such as infection, excessive edema, hematomas, and scar tissue.
🅑 Purchase a surgical bra from a specialized company and take it with you on the day of surgery, as it is put on immediately at the end of the procedure. Choose a very comfortable model, tight fitting but not tight, considering the reduction of the breasts.
🅒 Make sure that in this most critical period of recovery, 2 to 3 weeks, no one depends on you in the family or at work. Following the planning to the letter is intended to ensure the desired results.
POSTOPERATIVE
After the Reduction Mammaplasty, the patient is released after 12 to 24 hours of hospitalization. The pain is usually not very bothersome, but you will likely feel it for a few weeks while the swelling begins to recede.
We go through a schedule for dressing changes and the removal of the drain and stitches, which are done in the office in stages.
The first two days must be of absolute rest, essential for healing and for the elimination of liquids (seroma) through the drain. Sleep with your stomach up, with your arms along your body and torso elevated to be more comfortable.
A light diet helps support the medication which makes the stomach more sensitive. Opt for lighter food on the 1st day (fruit, soup, gelatin, fiber, liquids, etc.). From the 2nd day of the procedure on, you can eat almost anything, but food with a minimum of salt so as not to increase bloating, and mainly protein-based (meat, milk, eggs) and vitamin-based (fruit). Drink plenty of liquids. Do not go on a diet or weight loss regime until you are cleared by your doctor. Alcoholic beverages, smoking, saunas, and very hot baths must be avoided during the entire recovery period.
The surgical bra is worn for a minimum of 1 month and can be removed only for bathing. In the first baths after the surgery, if you feel dizzy, choose to use a chair. Avoid wetting the dressings, but if this happens, try to dry them carefully with a towel and/or a warm dryer at least 20 cm away.
Between the 3rd and the 7th day it is already possible to return moderately to daily activities, but without physical effort. Light walks from the 8th day on are allowed; more intense physical activities, after evaluation. Avoid heavy lifting and do not raise your arms above your shoulders for at least 15 days. After 30 days, normal routine is practically restored.
As in the preoperative period, schedule lymphatic drainage sessions from 4 to 6 weeks postoperatively. Besides eliminating the accumulation of liquid from the body, this treatment activates the immune system, helps reduce pain and discomfort, relieves bruising and swelling, and is effective in preventing and treating fibrosis and scar adhesions.
The planned result is within four to six months. The scars are permanent, but in most cases they tend to improve significantly over time, and should be quite inconspicuous after a year.
Over time, your breasts may continue to change due to aging and gravity. The results last longer if you lead a healthy lifestyle, without exaggeration, eating properly, exercising, and maintaining the ideal weight for your biotype.