Breast Reduction and Breast Lifting (Mastopexy)

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Frequently Asked Questions:

Who will benefit from breast reduction/mastopexy surgery?

Breast reduction surgery and breast reshaping (or mastopexy) have many similarities although in the latter technique the breasts are largely just reshaped and the volume is minimally reduced whereas in breast reduction surgery the primary aim of surgery is to reduce the volume of the breasts while secondarily reshaping and lifting up the breasts. Breast reduction is also known as reduction mammoplasty. Large breasts can be an embarrassment to ladies and also render the buying of clothes difficult and furthermore ladies often complain of pain in their shoulders from their bra straps or from neck and back pain because of the general encumbrance of large breasts. These ladies will benefit from breast reduction. Ladies who have lost large amounts of weight or have had a number of children and/or the passage of time may notice a sagging of the breasts. The firmness and pertness that they once had is no longer the re and if no reduction of volume is required then these ladies may benefit from a breast uplift (mastopexy) however sometimes these ladies can equally benefit from breast augmentation with breast implants. Depending on a patient's desires and their individual anatomy these options can be assessed with Mr Fogarty so as to marry up your personal preferences with your anatomical characteristics (see breast augmentation section).

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Background information on breast reduction and Mastopexy

Breast reduction and mastopexy surgical techniques are all aimed to reduce the excessive amount of breast skin (mastopexy) and/or breast tissue (breast reduction). Because breast tissue is glandular and is not predominantly made up of fat this is why liposuction, in isolation, cannot be used to reduce breast volume. As part of the rejuvenation procedure the nipples must be moved to a more youthful position on the breast and thus all techniques will leave a scar around the areola (dark pink area around the nipple itself). Then from the areolar scar there is usually a vertical scar directly beneath this. Depending on the size of the breast reduction there may be a horizontal scar at the bottom of this vertical scar that lies at the junction between the breast and the chest wall itself. In other words it looks like an inverted 'T'. With mastopexy however this horizontal scar is seldom required. Occasionally with patients requiring a mastopexy they may just require a scar just around the areola and not require the vertical scar, however this can only be carried out in a minority of patients as time has shown that just having a areolar scar, this tends to stretch leaving what appears to be like enlarged areolae. Underneath the skin envelope of the breast the excess glandular tissue can be removed as in the breast reduction or it may be reshaped as in a mastopexy. The key to carrying out this and leaving a youthful breast is to preserve enough glandular tissue that carries with it the blood supply to the nipple and allows the nipple to be elevated. Thus there is often a physical limit to how much breast tissue can be effectively removed as excessive resection of breast tissue can increase the risk of complications and leave an unaesthetic result.

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What to expect at the breast reduction consultation?

At your consultation Mr Fogarty will see you and take a full history looking especially for any medical factors that may influence the surgery and ensuring your safety. He will be able to exam you with the help of a female chaperone and preoperative photographs may be taken. Taking your desires into consideration with all the features of your medical history and physical examination will allow any potential choices of procedure to be discussed. Mr Fogarty believes that there should be no pressure on a patient to make a decision whether they want surgery and they are thus at liberty to contact his secretary at a later date or if they need to come back for another consultation there would be no fee for this.

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What is involved during breast reduction/mastopexy procedure?

All surgery is performed by Mr Fogarty and will involve being put asleep under a general anaesthetic. Mr Fogarty normally works with a number of consultant anaesthetists who would also work in the NHS at the Royal Victoria Hospital, Belfast Surgery can take between 2-3 hours to perform and after surgery all wounds are stitched with dissolvable stitches. Usually a very small soft silicone drain is placed within each breast, and this helps to drain any excessive blood or fluid that would otherwise build up and mar the cosmetic result. An overnight stay is all that is required as the surgery is relatively pain free. The morning after the surgery the drains can be removed at the bedside. The breasts are dressed with waterproof dressings that do not have to be changed until the first postoperative visit, one week after surgery. The dressings will allow showering of the lower half of the body, as they are esse ntially splash proof.

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What will happen after my breast reduction/mastopexy surgery?

After this surgery it is usual to stay overnight as this gives most patients peace of mind that they are being looked after by qualified nursing staff who can observe for any early complications or administer appropriate medication. Furthermore if there are any worries regarding pain or sickness after anaesthesia these can be dealt with. The morning after the surgery the small soft drains that are in each breast can be removed at the bedside prior to discharge home. You will be discharged with some antibiotics, painkillers and anti-inflammatory tablets to speed up your recovery and you will be asked to wear a bra of your desired cup size before going home as this will reduce any discomfort.

You should arrange for a friend to drive you home but most patients find that breast reduction surgery is not very sore and are able to cope with normal daily activities around the house. The wounds will be dressed with waterproof dressings that are splash proof and thus one can shower the lower half of the body and even wash your hair. There will be bruising and some degree of swelling but most of the bruising will have resolved within the first two weeks after surgery. One week after surgery a wound check is carried out at Mr Fogarty's clinic but all stitching is with dissolvable sutures so no sutures need to be removed by the nursing staff.

A sports bra is desirable to support the breasts as underwired bras can irritate the scars. The sports bra should be worn continuously for the first 6 weeks. For most occupations ladies can return to work within 2 weeks but vigorous exercise and activities should be refrained for the first 6 weeks after surgery. Mr Fogarty will review you again at 6 weeks after the surgery when a large degree of the swelling will have settled but at this stage the scars will still be slightly red. It will take 3-6 months before the breasts assume their final appearance and Mr Fogarty usually will review you finally at this stage.

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What are the potential complications after breast reduction/mastopexy?

The complications after breast reduction/mastopexy surgery are well recognised and many things are done to minimise the risk of complications, but like all medical procedures one cannot eliminate the risk altogether. In chronological order the potential complications that may occur include the following:-
Bleeding/haematoma; after surgery small blood vessels may suddenly start to bleed as ones blood pressure can rises. Any small degree of bleeding will be dealt with by the drains but if there is a greater degree of bleeding then blood will build up underneath the breast and this is known as a haematoma. If this were to occur it would be in the first 6-8 hours after surgery and this is why patients are best to stay overnight after their operation so the nursing staff can observe for any early signs of this and take appropriate action. If a haematoma were to develop then one would have to return to theatre that night and have the blood clot removed. This should not have any adverse consequences overall and would not require a blood transfusion. (Risk for haematoma 1%)

Infection; as with all surgical procedures there is always a risk of infection. Most infections arise from organisms within the patients hair follicles within their skin. Many things are done to minimise the risk of infection but overall the risk is low (1-2% of cases). If infection were to occur this will usually readily treated with antibiotics.

Wound breakdown (dehiscence); usually wounds heal quite rapidly over the first 2 weeks following surgery. Occasionally however if there is any reduced blood supply to the skin and/or infection, the wound may not heal. Usually when this happens it is only over a small area, approximately 1-2 cms at most, and tends to happen where the blood supply is the worst. In case of a breast reduction which has got an inverted 'T' scar (see background information above) this would be at the lower end of the vertical scar where it meets the horizontal scar at the chest wall. If there was a degree of wound breakdown this is managed by applying dressings over the wound and donning ones brassiere over the top of this. The dressing may then be showered off on a daily basis and a new dressing reapplied by the patient. It may take a number of weeks for the wound to heal and in such circumstances the scar maybe wider than one would otherwise desire and then scar revision further down the line could correct this.

Nipple necrosis(death); the design of a breast reduction/mastopexy allows one to move a low lying nipple upwards into a more youthful position. To do this one must preserve the good blood supply to the nipple on the remaining breast tissue. Because of anatomical variation and other factors, importantly smoking, there is a risk that there is not enough blood gets to the nipple and the nipple could die (necrosis). The risk of the entire nipple dying is less than 1% but it is possible that only part of the nipple could die and the risk of this is again less than 1%. Because smoking is a significant risk factor in causing nipple necrosis it is wise to stop smoking at least 6 weeks prior to surgery.

Nipple numbness; most patients will have a degree of nipple numbness for a while after surgery but this is usually temporary and good recovery of nipple sensation tends to occur after any where between 6 months and 2 years. There are of course some cases where patients may have complete loss of nipple sensation and this can occur in up to 25% of patients.

Breast feeding; patients who are considering having children and wish to breast feed would be best to defer any breast surgery until their family is complete. Not only is this to permit the breast feeding but also if there is any change in breast shape or size with pregnancies then this can be addressed with surgery after ones family is complete. After breast reduction surgery or mastopexy one cannot guarantee that one is able to breast feed in the future although it is technically still possible as the breast ducts are still attached to the nipple.

Fat necrosis (death); Like nipple necrosis insufficient blood supply to the fat of the breast can cause the fat to die. This manifests itself as lumpiness of the breast tissue and occurs in less than 5% of patients. The lumpiness that is felt after fat necrosis is transient and goes away in the fullness of time.

Revisionary surgery; because wound healing and bodily responses are involved in the scar maturation and wound healing process there is always a small chance that there may be the need for secondary procedures to give the best possible result whether there be residual asymmetries between the breasts or unsatisfactory scars. The chance of this happening are approximately 1-2%.

Deep venous thrombosis; any operation carries with it a small risk of developing a blood clot in the lower legs that is known as a deep venous thrombosis (DVT). If a DVT were to develop then this can travel to the heart and be potentially fatal. The risk of a DVT after this type of surgery is extremely small, less than 1 in 10,000 risk. Patients on the oral contraceptive pill would be at a slightly increased risk because the pill can increase the clotting of the blood. Although the risk is reduced by stopping the pill, overall the risk of a DVT is still very small, and thus it is not absolutely essential to stop the pill and indeed if ladies were to stop the pill they may be at risk of pregnancy, which in itself carries with it a high risk of developing a DVT !

Scars; can be extensive after breast reduction surgery but most ladies happily trade this for better shape and reduced encumbrance due to large breasts. Like any scars, they tend to be red in the first few months after surgery and they are often firm to the touch but they fade in colour and become pale white and are less noticeable over a period of 6-12 months after the operation. Very occasionally some people may be pre-disposed to forming lumpy scars and this is a condition known as hypertrophic scarring. There are lumpy scars that continue to grow and get bigger and this is called keloid scarring. The risk of either of these happening is relatively small, occurring approximately 1 in 300 patients. Patients who develop keloid scarring would benefit from silicone taping of their scars and/or steroid injections into the scar tissue itself.

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Breast Reduction/mastopexy Surgery Summary Points

      Type of anaesthesia              General

      Duration of surgery                2-3 hours

      Hospital stay                          1-2 days

      Return to driving                    7 days

      Return to work                       2 weeks (light clerical type work) but up to 6 weeks for very vigorous activities

      Resolution of bruising ;           2 weeks

      Return to physical
      activities eg gym/vigorous
      exercise ;                               2 weeks

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Notes for patients undergoing breast reduction /mastopexy surgery 6 weeks pre-operatively If you are going to stop the oral contraceptive pill prior to surgery, do so by this stage, taking alternative precautions against pregnancy. If you have not stopped the contraceptive pill prior to surgery the technique can be altered to minimise your risk of blood clot in the legs (DVT) Ideally stop smoking at this stage. 2 weeks pre-operatively Stop taking any aspirin or aspirin containing products as these may increase the risk of bleeding. Also any non steroidal anti inflammatory drugs (NSAIDs) such as Brufen or Volterol such should be stopped, as should any Vitamin E tablets or multi vitamins containing vitamin E. 1 week pre-operatively It is advisable to take 1 gm vitamin C twice a day to improve wound healing. Some patients also find homeopathic remedies such as Arnica may reduce bruising. One should also purchase a good sports bra of the size that you desire to be, so this can be worn after the surgery. Night before surgery/
morning of surgery
If your surgery is planned for the morning it is wise to have a shower the night before the surgery with a medicated shower gel/surgical scrub (e.g. hibiscrub /hydrex) and wash ones hair. Nail polish should be removed prior to surgery for the anaesthetic equipment requirement. The day of surgery You will be going home today and will have been given some tablets to take home, (antibiotics and painkilling tablets). NB if you have any allergies, especially Penicillin, please let Mr Fogarty's secretary know in advance. You should wear your sports bra going home for support. A friend should drive you home. Day 2 post-operatively It is OK to shower today but just showering the lower half of ones body and using a face cloth to clean the upper half of the body, avoiding getting the bandages over the wounds too wet. You should be able to wash your hair today and again avoiding getting the bandages too wet. 1 week post-operatively You should be reviewed today for a wound check at Mr Fogarty's clinic. The bandaging will be removed and while there are no sutures to be formally removed there are sutures in the nipple that dissolve underneath the skin and thus allow the sutures to be plucked/rubbed away approximately 10 day s after surgery. You may have the wounds re-taped for extra support and improved scarring. You may resume driving at this stage and may be able to return to work if this is light in nature. 6 weeks post-operatively You will have a review again at Mr Fogarty's Outpatient Clinic and the vast majority of any swelling and skin tightness will have settled by this stage. If you have been advised to wear a sports bra continuously this can be dispensed with at this stage and just worn as required. An under wired bra can be used now at this stage but they are best avoided prior to the 6 week stage as they can exert some pressure on the incision line. Most patients do not need to be seen again after this stage unless they have any concerns.

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POST OPERATIVE ADVICE SHEET - BREAST REDUCTION SURGERY

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