Breast Reduction - Reduction Mammoplasty
by Dr. A.H. Nezami at Jacksonville Cosmetic Surgery Center
The excessive weight of large, pendulous breasts may cause some women associated medical problems, including: skeletal deformities, back and neck pain, breathing issues, and skin irritations. Overly stressed bra straps can create indentations in the shoulder area. These conditions may impair a woman's ability to lead an active life. In addition, many women become self-conscious. Breast reduction surgery removes excess glandular tissue, fat, and skin, and reshapes the breasts, resulting in lighter, firmer breasts proportional to the woman's body. By improving her posture, activity level and the way she feels, breast reduction surgery can boost a woman's self-confidence. While the results are permanent, the effects of the natural aging process may motivate satisfied patients to undergo a subsequent breast lift later in life.
One Month Before Surgery
Smoking patients must refrain from smoking at least one month before the surgery, and must continue to refrain for one month afterward. Smoking interferes with blood flow to the skin, which prevents rapid healing and causes tissue loss. Birth control pills and hormonal therapy in any form can increase risk of blood clot and serious complications. We ask our patients to stop taking them one month before their surgery.
Two Weeks Before Surgery
Patients must avoid certain medications such as aspirin, Ibuprofen, vitamin E, and any other blood thinning or clotting medication. Patients who are taking prescription blood thinners will require authorization from their prescribing doctor before cessation. No herbal medications should be taken without the approval of Dr. Nezami.
One Week Before Surgery
The patient will meet with Dr. Nezami for a pre-operative consultation. Dr. Nezami will review the patient's medical history, and perform the pre-surgical measurements and final examination. A surgical assistant will review the pre- and post-operative patient instructions at this time. Alcoholic beverages must not be consumed beginning two days before the surgery.
The Day of Surgery
The patient should have fasted at least eight hours beforehand. She will continue to wash her body, especially her chest, breast and under arms, with Hibiclean (as she has already been doing for three days). The patient will arrive for surgery dressed in a front opening sweatshirt and comfortable, slip-on shoes. Any jewelry, including any jewelry on pierced body parts, should be removed. She will refrain from applying deodorant or lotion on the day of the surgery.
Breast reduction surgery can take up to four hours, and is performed under general anesthesia administered by a board certified anesthesiologist. Located within the Baptist Medical Center Complex, our surgical suite is accredited by the American Association for Accreditation of Ambulatory Surgical Facilities, Inc.
The incisions for breast reduction surgery are most often made in a keyhole pattern. The areola is reduced in size, and the nipple/areola left attached to deeper breast tissue is repositioned higher on the breast. The excess breast tissue and skin is reoved. At closure, the incisions are brought together to reshape the smaller breast, while internal, dissolvable sutures are used to support the newly shaped breasts. In order to minimize scarring, only a few external sutures are used in combination with surgical tape to close the skin. In the reduction of extremely large, pendulous breasts, the nipple and areola may need to be removed from their blood supply and grafted. In every case, the incisions will outline the areola, form a line from the center of the areola down to the crease line beneath the breast, and follow along the crease line beneath the breast. The scars are permanent, but while visible early on, they will fade over time.
As with all surgical procedures, breast reduction surgery involves some degree of risk. There are some risks that are beyond the control of your plastic surgeon, no matter how expertly he performs the surgery. We recommend patients stop smoking 2 months before their surgery to prevent delayed healing.
During the breast reduction surgery, the patient is given intravenous antibiotics to reduce the risk of infection.
Usually a drain is placed on each side of the breast to prevent collection of blood.
In rare cases, abnormal bleeding can occur after surgery. In this case, the patient is returned to surgery to stop the bleeding and remove the blood.
Sensation of the nipple may change, it may become sensitive for a short time, but normal sensation will likely return. It is also possible for a patient to lose nipple sensation altogether.
The patient should arrange for a driver both to transport her home on the day of the surgery, and to drive her back to our center for her first post-operative visit. In addition, a caregiver should stay with the patient during the first 24-48 hours of recovery at home. A return to light activity is possible as soon as you feel ready, usually within a few days of surgery. To minimize the risk of blood clot, we ask patients to walk several times a day following their surgery. The stitches will be removed within five days at the first post-operative visit, and after eight to three weeks of recovery, Dr. Nezami will remove the tapes.
Post-surgical swelling may make the patient's breasts feel unnaturally tight. This condition is temporary, and the breasts will gradually soften and develop a more natural feel.
Patients can return to work after seven days of recovery, but must avoid lifting heavy objects. After three weeks of recovery, the patient may gradually reintroduce exercise. Healing will continue for several weeks as swelling dissipates and breast shape and position settles. For three weeks, a patient should avoid raising her elbows higher than her armpits.
Discomfort is well controlled by oral medication. A support bra is recommended around the clock for the first few weeks.
Dr. Nezami is available by telephone at all times, and our practice maintains a 24-hour service number: 904-399-5061. If a patient experiences any of the following symptoms, she should call Dr. Nezami immediately:
- Uneven swelling.
- More pain in one of her breasts than the other.
- Temperature that exceeds 100 Degrees.
- Pain in her calves.
- Sudden, severe chest pain.
- Shortness of breath.
- For medically necessary breast reduction, some insurance companies might cover the cost of surgery. Typically, these companies require photos and a request from your plastic surgeon explaining why he believes your breast reduction is medically necessary. Insurance companies seek evidence of: back, neck or shoulder pain caused by the heavy weight of the breast, irritation of the skin beneath the breast, or the indentations of bra straps on the shoulders. Most insurance companies that cover breast reduction require the substantial removal of breast tissue (usually a minimum of one pound per side). Some may require evidence of alternative treatment failure (physical therapy over a long period of time or significant weight loss).
- Most patients retain normal nipple sensation after surgery. In many cases, lost sensation gradually returns throughout the recovery process. There is risk of losing the sensation altogether.
- Dr. Nezami advises his younger patients to wait until the breast has reached full development (usually, at age eighteen).
- Patients who feel their breasts are too large and who experience symptoms due to the weight of the breasts may want to consider breast reduction surgery. For some patients, one breast may be much larger than the other. These patients may benefit from a breast reduction on one side, and breast lift on the other.
- Dr. Nezami requires general anesthesia for breast reduction.
- For most women, one breast reduction surgery will last a lifetime. For women with very large breasts who undergo significant weight loss, a subsequent breast lift or reduction may be required.
- In most cases, a drainage tube is used on each side. They will remain in place until the drainage is very minimal (usually three to five days).
- The patient may shower three to five days after her breast reduction procedure, but should avoid hot tubs and baths until the drains are removed and the incisions have healed completely.
- Prior to surgery, patients should not discontinue any prescribed medications without the authorization of the prescribing physician.
- Patients may travel after ten days of recovery.
- We advise breast reduction patients to always wear a supportive bra in order to prevent future droopiness.
- Patients may resume normal physical activity, including the lifting of heavy objects, three weeks following their breast reduction surgery.
- Patients may be able to breast feed after reduction surgery, depending on the specific procedure used for breast reduction. Dr. Nezami's technique involves leaving the center part of the breast and nipple attached whenever possible.
- Two weeks following your surgery, exposure to sunlight is considered safe if the incision area remains covered.
- Three weeks after breast reduction surgery, patients may gradually reintroduce their exercise regimen. At this time, heavy lifting is also permitted.
- Patient should avoid driving for the first five days after surgery and s long as they are taking pain medication.
We work with several companies that offer our patients convenient financing at the most competitive rates available. In most cases, patients can obtain approval within 24 hours.