Throughout history, large breasts have generally been considered a sign of femininity highlighting a woman's ability to nurture. Yet a woman with significant larger breasts than the aesthetic standard of her time may be seen as abnormal or deformed. In these cases there is no doubt, that large oversized breasts can be disturbing to a woman by causing a host of both physical as well as psychological symptoms. In the former these can take the form of shoulder, neck and back pain as well as cause distortion of posture and in more severe cases make breathing difficult. Large breasts can dominate a woman's appearance and make her look unbalanced and make exercise difficult or impossible. In psychological terms, ungainly stares and rude comments make sufferers even more self-conscious which leads them to wear loose clothing to disguise their shape.

Surgical correction to reduce the size of the breasts has been performed for many years and in fact the first true surgical reduction of a female breast was probably performed in 1669 in England by William Durston. Although the main aim of the surgery is to reduce the volume and weight of the breast, cosmetic enhancement to fashion a normal shape remains equally important. The techniques have been modified and refined throughout the years in order to improve the safety as well as the aesthetic results.

If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin, certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these.

If you are significantly overweight then planned preoperative weight reduction is encouraged but this alone does not necessarily rule you out for an operation. In fact many times the achievement of reduced breast size can become a stimulus for further planned weight loss.

Depending on your age you may be required to have a mammogram prior surgery. This again will be advised at the initial consultation.

What does the operation involve?

Before going to operating room, Dr. Loeb uses a marking pen to draw on the breasts in order to determine the position and size of the newly operated breasts. Excess breast tissue, fat and skin are then removed, and the nipples and remaining underlying tissues are then moved to a new higher location, all in accordance with the preoperative markings. The nipple is usually positioned in a line level with approximately the middle part of your arm. The suture line is situated around the nipple in its new position, and extends vertically downwards to the under-breast crease. At this point, depending on the technique used, the scar may end there or alternatively may extend into the breast crease towards either side. Dr. Loeb will be able to discuss this with you at the time of your consultation.

Depending on the amount of bleeding from the surgery, drainage tubes may rarely be inserted under the breast skin at the end of the operation to remove any fluid or blood collection, which may occur immediately after surgery. Finally a firm bandage dressing is applied over the suture line.

What type of anesthetic is used and how long does the operation take?

Breast reduction is performed under general anesthetic and usually takes about 3 hours.

Do I have to stay in hospital?

99% of Breast Reduction by Dr. Loeb is done as an outpatient. You will have to stay in recovery 2-4 hours post-op.

What happens after the surgery?

You will stay in recovery 2-4 hours post-op.

After surgery it is important that you maintain good circulation in your legs and thus you will be advised to actively move the joints in your feet, knees and hips regularly.

You will notice bandage dressing around your breasts and, depending on the technique used the presence of drains. These are usually inserted under the wounds to drain any build up of blood or fluid that occasionally develops after surgery. Once the drainage is minimal (usually the next day) these drains are then removed. Your bandages are then readjusted and you are then instructed to wear a wireless sports bra for support. You will be given an appointment for follow-up 2-4 days post-op, where your dressings will be changed and you will be placed in a surgical bra.

What kind of after effect should I expect?

Following surgery you will experience considerable swelling and bruising of the breasts. The bruising usually lasts about 2-3 weeks. While most of the swelling will have dissipated by this time, some subtle swelling may still be present for up to 3 months.

After surgery you may notice that the breasts feel quite firm and taut, particularly along the edges of the incision site. This will be a result of the normal healing process laying down elements of scar tissue to facilitate healing. When this occurs, massage as instructed by your surgeon will speed up the recovery. It gradually resolves in time but may take a few months to complete.

You should expect the sensation to the skin in the nipples and surrounding skin to be reduced after surgery. This is a result of surgical trauma to the nerves in the region. Although this usually recovers in few months, permanent numbness may occur.

It is normal for breasts to be slightly uneven and this is no exception in large breasted ladies. Although every effort is made to make the breasts symmetrical, it is not always possible to achieve this exactly. Breast reduction surgery is possibly one of the most demanding aesthetic procedures. It is imperative therefore that you always talk with your surgeon in order that he has a full and proper understanding of your wishes. Try to convey, as much as possible, how little or large you would like to be following your surgery. This will minimize the possibility of having too little or too much removed.

Although the technique used by Dr. Loeb ensures the best possible continuity between the breast and nipples thus increasing the possibility of breast-feeding after breast reduction surgery, this cannot ever be guaranteed.

What the scars like?

Scars are not a complication but a normal event after any surgery. In Breast Reduction the scars are quite lengthy and may take many months to settle. You should always expect these to be red, raised, lumpy and even itchy to begin with time but they should fade and flatten. This is the natural evolution of the healing process. However it is important to keep in mind that this may take up to two years to complete. Daily massage of the scars during this time period is advised to expedite and facilitate this process. You must understand however that no responsible surgeon will ever be in a position to promise any scars ultimate appearance. Although as mentioned, scars do fade and improve in time it is unlikely however that these could ever be characterized as being mainly only "hairline" in nature.

Dr. Loeb will show you reasonable examples so you can see the scarring.

Is it painful?

For a few days after surgery, you will probably experience some moderate degree of pain, which should be well controlled with painkillers. The pain usually improves after the first 4-5 days.

What could go wrong?

While it is true when a Breast Reduction is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.

As in any procedure the risk of significant infection is always possible. This is minimized by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision sites, but usually subsides over a period of about 2 weeks.

Risks such as blood clots are rare. Early mobilization by moving around as soon after the surgery as possible reduces the considerably.

As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very occasionally, increased bleeding can lead to more significant swelling and the development of a hematoma(a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.

The nipples are preserved on a stalk of breast tissue and in the vast majority of patients they remain natural, with normal contraction and some sensitivity. Very rarely however the stalk of the breast tissue has inadequate blood vessels to maintain nipple viability and some sloughing of part, or even more rarely, the entire nipple can occur. This complication will mean that prolonged dressing will be required over the nipple area until natural healing occurs. It is then possible to reconstruct the nipple as a secondary procedure, should this be required. Thankfully with modern techniques this complication is quite remote. Stay away from smokers!

During the first 2-3 weeks after surgery, some patients may experience a minor loss of wound adhesion or even chafing of the skin at any point of the incision sites. One of the most common sites is the point where the vertical scar meets the under-breast crease. This is a temporary complication, which will require regular dressing changes initially. Eventually a scab develops over this, which subsequently separates after 3-4 weeks. A padded dressing for a period of a few weeks decreases the likelihood of this occurring. However some distortion of the skin around the scar may ensue. Further revision may be required.

How long before I get back to normal?

A breast reduction is a relatively major operation and should always be respected as such. Don't try to do too much too quickly. It is likely that a few weeks will pass before you feel yourself again. Remember variations do occur in the time individuals take to heal. As a guideline, although many people go back to light work duties by 10-14 days, other find it more appropriate to take a further 1-2 weeks to rest. Walking is helpful in the first 3-4 weeks as this improves the circulation and helps reduce the swelling, and the chance of blood clots developing. Heavy lifting or strenuous activity is prohibited in the first 6 weeks after surgery. Overall common sense rules in the recovery period. If what your doing is uncomfortable then do not do it!

Summary