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Breast Reduction

Excessively large breasts can produce many functional problems. Common complaints include neck and back discomfort, deep grooving of the shoulders from bra straps, a heavy pulling discomfort on the chest, inability to wear many types of normal clothing (especially without a bra), and rash or skin problems beneath the breasts.

Large breasts also prevent some patients from participating in exercise or athletic activities and can make breast self-examination and even mammograms more difficult.

Breast reduction procedures improve functional problems of excess breast size by:

  • Reducing the excess size and weight of the breast
  • Realigning the breast tissue and tailoring the skin envelope to lift the breast
  • Repositioning the nipple upward onto the newly shaped and positioned breast mound

Most patients experience a dramatic improvement in their symptoms soon after surgery and are able to wear many types of clothing for the first time. In addition, they can often participate in many activities that they were either unable or unwilling to do before.

Dr. Forley will carefully analyze your breasts to determine the best technique to achieve a natural, uplifted appearance with a reduced size to fit the proportions of your body. He will match the technique to your anatomy so that you will achieve the optimal outcome with the minimum of scars.

26 year old female 1 year following breast reduction surgery*Results may vary.

Is This For Me?

You should consider a breast reduction surgery if:

  • You have excessively large breasts and are uncomfortable with your size.
  • You have deep grooving of your shoulders from bra straps.
  • You have a heavy pulling discomfort on your chest.
  • You have neck and back discomfort.
  • You have the inability to wear many normal types of clothing.
  • You have experienced a rash or skin problems beneath your breasts.

The Consultation

During your consultation, Dr. Forley will first ask about your medical history, physical symptoms related to your breasts, and to describe what concerns you most about your appearance. He will discuss your preferences regarding breast size and how you would like your breasts to look. After examining you, he will discuss a range of options for incision locations and reduction techniques and recommend those that will be best for your breasts. The two primary techniques share a scar that encircles the areola and extends vertically to the inframammary fold. The inferior pedicle technique for larger breasts with more sagging and skin stretching utilizes an additional scar within the fold under the breast to enable better lifting and contouring. He will show you before and after photos so that you can get a realistic idea of what can be achieved with breast reduction surgery.

Preparation

Your pre-operative appointment will be scheduled 2 weeks prior to your surgery date. A complete review of the surgical plan as well as instructions for you to follow before and after surgery will be discussed. The procedure and location of the scars will be reviewed. Routine blood tests and a mammogram will be obtained in preparation for your surgery. A program of vitamins and supplements to optimize your healing and recovery will be provided to you during your pre-op visit. Photographs will be taken and kept strictly confidential.

The Procedure

Prior to your breast reduction, Dr. Forley will make several measurements and mark specific areas of your breasts with you sitting or standing. These markings are precise guidelines that are used during surgery. During the reduction procedure, the island of breast tissue carrying blood supply and sensation to the nipple is designed and prepared. Excess glandular tissue is removed, with the amount and location of removal depending on your desired breast size. The remaining breast tissue is then shaped with suture techniques to create the desired form. To reposition the breast mound upward, the skin of the lower portion of the breast is tightened with removal of excess skin. The areola complex is repositioned upward to the proper location on the new mound and sutured in place. Your breasts will be carefully compared in the sitting position to assure as much symmetry as possible and any additional adjustments will be made before final closure.

32 year old female 6 months following breast reduction surgery*Results may vary.

What to Expect After Your Procedure

After surgery, you will have a drain in place to remove any oozing of blood immediately after surgery. This will be removed the next day following which you will be able to shower. You will need to wear a soft bra without underwire for about 3-4 weeks after surgery.

All of your incisions will be carefully closed with stitches placed beneath the skin so that they do not have to be removed-they simply dissolve.

Following breast reduction procedures, most patients have a moderate feeling of soreness for which we’ll prescribe medication that you may need for a few days. Possible sensations of tightness or fullness from swelling will resolve gradually. You may develop slight bruising on the breasts that will resolve in about a week.

The Stages of Recovery

  • Day of surgery: Breast reduction is usually performed as an outpatient procedure in the hospital or in our accredited office surgery facility.
  • Bruising and swelling resolve: Resolve in 10-14 days with continued softening of the breasts occurring up to 6 months.
  • Return to work, social activity: 5-10 days.
  • Aerobic or strenuous activity: 3-4 weeks.

We encourage a return to normal activities very rapidly. Just don’t do any type of strenuous exercise that would push your pulse over 100 for about two or three weeks. Any aerobic activity that increases your pulse over 100 also increases your blood pressure, and could make you bleed.

Potential Risks and Complications

Risks common to all surgical procedures such as bleeding, infection, loss of sensation, and thickened scar tissue formation occur in a very small percentage of cases. When reducing the amount of glandular tissue within the breast, it is necessary to divide some of the milk ducts that converge at the nipple. For this reason, the ability to nurse may also be decreased following breast reduction. Some patients, however, have nursed successfully after reduction. We will give you more detailed information about these and other rare risks in our written information, and encourage you to discuss any which concern you during your consultation.

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1. The nipples are removed and have to be reattached. In most cases, the nipple remains attached to a pedicle or island of breast tissue that provides it with both blood supply and sensation. The pedicle is repositioned to relocate the nipple to a more elevated position that is aligned with the new breast dimensions following the reduction. In very rare cases of extreme breast enlargement, the nipple does need to be removed and replaced as a graft. In these situations, the sensation will be lost but frequently was minimal to begin with due to the stretch on the nerves that resulted from the extreme breast enlargement present. 2. It won't be possible to breast feed after the surgery if I become pregnant. Some of the milk producing glandular tissue and ducts will be removed as a result of the surgery. However, enough glandular tissue and ducts are preserved to make breast feeding possible even after surgery. Keep in mind that it is possible but by no means certain and the ability to retain the ability to breast feed cannot be determined in advance. 3. Weight loss will reduce the size of the breasts. Breasts are composed of both glandular and fatty tissue. The proportion of each varies among patients. Although weight loss is a worthwhile goal in many cases, it is difficult to predict the impact it will have on the breasts. In many instances, the breasts will remain enlarged and symptomatic regardless of the success of your efforts at diet and exercise. 4. Back pain will completely resolve after surgery. There are many reasons for back pain. The large size of the breasts is a major contributor to back pain but there may be other factors involved. Prior injuries, nerve compression, herniated disc conditions, and vertebral degenerative processes that are present will continue to cause symptoms following breast reduction surgery. 5. Breast reduction can be performed without scars. Any procedure that involves an incision in the skin produces a scar. The surgical repair and your own healing tendencies combine to create the final result. This evolves over time and can change over 12 months or more. Dr. Forley uses a layered technique of wound repair to produce the best quality scar and to minimize the risk of scar spreading and thickening. Topical silicone gel and lasers can be used after surgery to enhance the healing of the final scars. In some cases of primarily fatty breasts with minimal sagging, liposuction can be used to reduce the breasts with only small 1/4" incisions.