|
Breast reduction
Large or hanging
breasts might cause aesthetic disproportion to the body appearance and a physical
obstruction when performing physical activities. Usually the discomforts are back
pain, physical burden, shaving bra-bands but also sweating, heating and eczemas
in the breast folds. Principles:
Reduction of the breast gland and its skin envelop and reshape the gland and redrape
the skin. The extent of the planned reduction and the sites for the nipples is
drawn on the breast preoperatively. Technique:
After the reduction of skin and parts of the glands, the remnants are shaped and
further shaping comes with the redraping of the skin. The scar runs around the
nipples, downward in the middle to the inframammary fold and here to the sides
like an inverted T or anchor. Depending on the correction needed, variations concerning
the scars with shorter scars or scars around the nipples only are possible. The
longer the transposition of the nipple is, the longer scars are needed. If needed,
drains are inserted and these are mostly removed the day after the operation.
A compression bandage is applied over the thorax. This should be kept for 10 days.
The possibility of feeding by breast might be decreased. The sensibility of the
nipples might be lost. Anaesthetic:
Please refer to "Breastoperations". Operating
time: 3-4 hours. What
happens afterwards?
 | In
spite of the big operation the postoperative course is rather painless. At rest
no pain is present but changes of position can cause some discomfort which is
hardly prevented with painkillers. | | 3-4
days of fatigue is common. | | The
stitches are removed after 8-10 and after 14 days. |
| You
should sleep on the back for 3-4 weeks. | | The
arms should not be elevated over the horizontal plane. |
| Cardriving
is forbidden for 10 days. | | A
sporting bra should be used all 24 hours during 3-4 weeks after removal of the
bandage. Thereafter in the daytime for a couple of months (to prevent for pulling
of the scars). | |
Physical activities should be abandoned for one month. |
| Transient
anaesthesia of the nipples for 1-2 months is common. Numbness can stay permanently.
| | Using
skintape across the scars for 2-3 months should relieve tension on the scars. |
|
Sun exposure directly to the scars should be avoided for 6 months as to prevent
for permanent hyperpigmentation and redness of the scars |
|
COMPLICATIONS
Referred unwanted biologic events can occur with a certain low frequency and must
be regarded as calculated risks. Other risks not mentioned can also occur. For
patients this must be considered before a decision for plastic surgery is made.
Bleeding:
All operations can cause postoperative bleeding. These risks increase by the intake
of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned
operation. Infection:
All operations can cause infections, which in case it happens will be treated
with antibiotics. Healing
problems: The blood supply to tissues is essential for proper healing. In
reductionplasties or larger breastplasties the nipple is transposed on long pedicles
from where the blood supply comes. In extreme transpositions the risk is greater
for disturbances that can lead to partial or full loss of the nipple (necrosis).
After secondary healing in those cases there will be scarifications that has to
be corrected at a later time. Big breasts are often fatty and fatty tissue has
sparse blood supply. Fatnecrosis can occur that leads to healing disturbances
in the deep, which prolongs healing over time. Bloodvessels in skin under tension
are strangulated and the blood supply will be decreased. The biggest tension lies
in the submammary fold where healing problems are quite common. The best prophylatics
are a bra and the use of taping. Scars can be corrected. Scarring:
All scars are red for a couple of months and they fade away during the fist year.
Direct sun or solarium against the scars should be avoided to prevent them for
permanently become red or pigmented. Loss
of sensibility of the nipple: As the nipples are transposed, the sensory nerves
to them can be cut. A transient anaesthesia is common. A permanent loss can occur.
Smoking:
Smoking does compromise bloodcirculation and healing. Smoking should be abandoned
prior to a planned operation. | This
text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska
klinik i Malmö Sweden | 
