Breast Reduction Surgery is a surgical procedure performed under general anaesthesia in a hospital.

A specialist anaesthetist monitors your safety throughout the duration of the operation while the Surgeon reduces the volume of the breast, removes excess skin, lifts the breast tissue and nipple to a higher position and sculpts the breast to make it smaller, shapely and perkier.

It usually takes 3- 4 hours with an overnight stay. Some patients have drains that are removed the next morning before being discharged with pain medication, antibiotics, a supportive bra and post operative instructions. Across Australia, the majority of breast reduction operations are performed by Plastic Surgeons

Yes, you do need a full General Anaesthetic for a Breast Reduction Surgery.

That decision is made by your Plastic Surgeon. Since the majority of Breast Reduction patient stay overnight, it is natural that the surgery is performed in a hospital.

In any case, the surgery is best performed in an accredited and licensed operating theatre for your safety. As of March 2017, NSW Health has issued directives to ensure all Cosmetic Surgery is performed in hospitals and day surgery facilities that are licensed and accredited to perform cosmetic surgery.

That decision is made by your Plastic Surgeon based on clinical information obtained at the first consultation. After taking all things into consideration, your plastic surgeon will decide if you are suitable to go home the day of your operation.

I don’t use drains but I know of some plastic surgeons that do.

Yes, all the sutures are dissolving ones. There may be one or two sutures that require trimming (in a similar manner to cutting your hair very short) at your post operative visit.

Yes, you will need Antibiotics at the time of surgery followed by a course for five days.

Yes, you will bruise after breast reduction surgery. If you have liposuction performed to the sides of your breast you will notice that the bruising will extend along your sides. Thankfully, this settles with time.

Excessive bleeding following breast surgery can cause a large clot in the breast. This clot does not get into the venous system and spread elsewhere in the body.

Unlike clots in the leg or lung this is not life threatening. It should however be removed urgently which means having another operation.

There is a temporary reduction in the sensation of the nipple following breast reduction surgery that thankfully returns to normal.

Complete loss of nipple sensation after breast reduction surgery is fortunately rare. On some occasions patients experience hypersensitivity for a short period, thankfully this settles well.

Absolutely. A Specialist Pathologist subjects the tissue that is removed, to microscopic testing for Breast Cancer. The final report will be available at your first postoperative visit.

Immediately following the operation, a surgical bra is ideal. The surgical bra has the opening in front that makes it easy to do up the bra and undo it without straining your breast or shoulder.

In addition it has a broad base that gently supports the lower pole of the breast. After 2- 3 weeks when you feel more comfortable you can switch to a sports bra or similar. An underwire bra should only be worn after about 3 months.

You can wear an underwire bra 3 months following your surgery. The “underwire” in the bra can irritate the scar and affect its appearance.

We usually see you one week following the operation. A second visit may be necessary at two weeks followed by six weeks.

A lot of the swelling will settle within 6-12 weeks following breast reduction surgery. A very small amount of swelling can persist for up to 12 months.

You may experience swelling or tenderness in your breasts immediately after surgery. There may be some pain for a few days, made worse by activity that is controlled by pain tablets.

You will be given instructions about caring for the wound and dressings. You will be advised to take antibiotics and pain medications.

You will also need to restrict your activities. Patients are advised to avoid strenuous activities involving shoulder and chest movement for the first four weeks. However, most patients resume most light regular activities immediately after surgery.

Dissolving stitches are commonly used and any sutures that need trimming is done at the first post op visit. Scarring is prominent initially as it is red and raised.

The scars feel hard like a cord and are usually itchy. As time goes on the scar will gradually lighten or fade away, usually over a period of twelve months.

No, it is not advisable to massage your breasts after breast reduction surgery. Because massage implies deep massage. Vigorous massage can disrupt deep stiches and affect the final results.

This is a common observation following surgery or liposuction. The soft feel that one is accustomed to is replaced by firmness after surgery.

This firmness is not uniform and hence feels ‘lumpy’. These usually settle between 6 – 12 months following the Breast Reduction Surgery.

The majority of patients heal well with good scars after a breast reduction. Scars form quickly but mature slowly over 18 months.

Typically scars are raised, hard and red for the first 12 weeks due to the ingrowth of blood vessels and collagen. Over the next 12 months the scar softens, reduces in size and gradually changes colour to become paler.

Options to treat scars after Breast Reduction

• Micropore tape: This works well and is easy to apply and user friendly for patients as it does not require much care. The tape needs to be changed once every week. You can bathe or shower with the micropore tape. It acts as a barrier and avoids friction between the scar and clothing.
• A good supportive bra: This is also known to be quite effective in reducing scars because it reduces wound tension that can improve scar formation.
• Topical silicone sheets and gels: The surgeon will prescribe them depending on the scar. The gel should be applied twice a day for 3 months. The silicone sheet should remain in contact with the scar for 3- 4 months for best results.
• Steroid injections: These work well in the case of either hypertrophic or keloid scars. More than one injection may be required.
• Avoiding the sun: Doctors advise protecting the incisions from the sun to avoid pigmentation issues with scars. You can use an SPF lotion or cover the scar carefully with proper clothing to avoid direct sun.

If scar reduction attempts haven’t worked well, surgical scar revision may be the most appropriate option. Time is a critical factor and scars will improve with time.

Lollipop scar is shaped like a lollipop hence the name. The circle goes around the areola and the vertical scar starts at the 6 o'clock position of the areola and goes straight down towards the breast crease.

Anchor scar has all the elements of a lollipop scar PLUS a long scar in the breast fold (inframammary fold) that extends from the centre of the chest to the side of the chest.

A lollipop scar has less scar ‘real estate’ hence is better. The scar around the areola heals very well and in 12 months is barely visible as it sits at the border between pigmented and non pigmented skin.

The long scar in the ‘breast fold’ seen in the anchor scar takes longer to fade and can remain prominent for a very long time. The part of the scar between the breast and the centre of the chest is prone to keloid scars.

It is essential to tape your scars for a minimum of 3 months. However it is desirable to continue taping for up to 6 months. The tapes prevent friction between the scars and clothing.

Scar irritation due to friction can trigger more scar formation so that they are more noticeable for longer.

Silicone Gel is the one I recommend. There are many Brands of Silicone Gel for scars. This does not require a prescription and you can get it at your local pharmacy.

Some Plastic Surgical practices may have them in stock. If you are taping your scars there is no need for creams.

I recommend all scar treatments to be used for a minimum of 3 months. You may continue to use it up to 6 or even 12 months but it is not necessary beyond 12 months.

Not everyone needs ‘touch up’ surgery but some do. The common ones are scar revision surgery to improve the appearance of the scar and excision of excess skin.

Yes you can have a mammogram after Breast Reduction surgery. We recommend that you have one before your surgery, so that you have a baseline image.

Shopping for better fitting clothes and bras is an exciting part. But to get the right size you should wait for the most of the swelling to settle. Most of the swelling would have settled between 3-6 months following surgery.

It depends on how your breast will respond to changes in the future. In particular the breast will respond to pregnancy, breast feeding, weight loss, weight gain and ageing.

Your breast will droop and become saggy with these changes and the right surgical procedure is a breast lift to restore your breasts.

Yes, it is possible to have Breast Implants in the future should it be necessary.

Your breasts will increase in size when you put on weight. Lets see why. Your breasts are made up of Breast Glands and Fat. The breast glands produce milk and the fat supports and pads these glands.

The fat content in the breast increases during puberty, pregnancy and menopause resulting in the corresponding enlargement of the breasts.

In addition when you gain weight the fat content of the breast will increase and the breast will enlarge and the skin will stretch.

I am 30 years old and have 2 children. I have always had large breasts and since having my children they have become larger and saggy, I am currently a G cup. For years I have suffered with next and shoulder pain and I can never seem to purchase a comfortable bra no matter what the price is. Would a breast reduction alone help or would I most likely need a lift as well.

ANSWER TO PATIENT #1:

Thanks for your question. A Breast Reduction is a 2 in 1 operation and does include a breast lift.

After pregnancy and childbirth Breasts sag and large breasts sag more. This is because the skin stretches which then cannot shrink back to pre-pregnancy state. The larger the breasts get during pregnancy the more stretch marks.

Large breasts affect the biomechanics of your spine and shoulder starting from your neck down to your back. That would explain your symptoms.

Having breast reduction surgery will give you a smaller, perky breast that can help your neck and shoulder pain, increased comfort, better fitting clothes, bras and swimsuits and an increased ability to exercise.

There are numerous scientific studies that confirm the physical and psychological benefits of Breast Reduction Surgery. They include improved posture, improved gait, less stress on the spine. Patients improve their sense of wellbeing and self esteem.

A Breast Reduction is a 2 in 1 operation and does include a breast lift and is aimed at giving you a smaller perkier breast. It is a surgical operation that takes about 3-4 hours and is performed in a hospital under General Anaesthesia usually with an overnight stay.

Breast Reduction surgery costs vary and being in a Health Fund will certainly help with your out of pocket expenses.

My daughter is 19 next month, is very petite size 6-8 and 5ft tall but has 10E bra size (even at this size the bra is not really the correct fit for her). She is out of proportion. On a recent swimsuit shopping trip she left the shops really upset crying and cranky as the tops are not big enough and if they are, they are hideous. Do you think it is too early age wise to consider breast reduction surgery?

ANSWER TO PATIENT #2:

Yes, your daughter can have a breast reduction at 19 and enjoy all the benefits that include improved comfort, better fitting clothes, bras and swimsuits, ease of exercise and being comfortable in social settings.

Breast Reduction surgery is not uncommon in this age group. Patients in this age group share all the concerns that your daughter has expressed.

Patients who were big breasted as teenagers, when they have their Breast Reduction operation later on in life usually remark "I wish I had this operation sooner”.

Breast feeding after breast reduction may not be possible or if possible may be inadequate requiring supplementation by “formula milk” feeding.

Supporting scientific evidence suggests only 29% of people who have Breast Reduction surgery can breast feed. You have to give this some thought prior to considering surgery for your 19 year old daughter.

I had a breast reduction done in 1979. Since menopause (I'm now 56 years of age), my breasts have become bigger - 14DD or E. Is at all possible to have a second breast reduction so I can get smaller breasts again. (I had been moved to a B cup before). Many, many thanks for your advice.

ANSWER TO PATIENT QUESTION #3

Yes it is possible to have a second Breast Reduction and experience all the benefits as you did the first time. Second time around, the risks are higher especially with nipple, and fat dying but the benefits outweigh the risks.

If you have some information of your first operation, please bring it along to your consultation.

Breast tissue responds to hormone changes at puberty, pregnancy and menopause. With age, there is an increase in the fat component of the breast increasing the weight and size of the breast.

The loose skin and weak ligaments are unable restrain the heavy Breast and as a result the symptoms affect your activities of daily living. A breast reduction surgery is a good solution as it reduces the size of the breast and improves the shape by a lift.

My breasts have always been large but they feel empty and deflated since I finished breast feeding and I was interested to know if I can have the excess tissue removed and implants put in to lift and 'fill' them?

ANSWER TO QUESTION PATIENT #4

The changes you have witnessed are common following pregnancy and breast feeding. A breast lift with or without implants would be effective in addressing your aesthetic goals.

If you were happy with the volume and size of your breasts when you wear a bra, then a Breast lift WITHOUT implants would be appropriate.

Here, instead of removing excess breast tissue and using an implant to replace the lost volume, we use the excess breast tissue and reposition it so that it increases the size of the breast. This procedure is called a Mastopexy (Breast Lift).

If you are NOT happy with the volume and size of your breasts when you wear a bra, then a Breast lift WITH implants would be appropriate as your native breast tissue has inadequate volume.

Once the breast tissue is repositioned a Breast Implant is used to further increase the size and improve shape. This procedure is called a Mastopexy Augmentation.