Breast reduction surgery (Part 2): What does surgery involve?

Breast reduction surgery, also known as reduction mammaplasty, is a surgical procedure that removes fat, glandular tissue and skin from the breasts, achieving breasts that are lifted, smaller in size, and more in proportion with the rest of the body.

Following on from the first part, renowned consultant oncoplastic breast surgeon Ms Zoe Barber, offers an expert insight into the different surgical techniques used in breast reduction surgery, and the potential risks and complications of the operation, in this conclusion of the series.

What are the different surgical techniques for breast reduction, and what are the pros and cons of each approach?

There are lots of different surgical techniques for breast reduction surgery, and many of them come down to the surgeon's preference.

The main aim of a breast reduction is to make the skin of the breast smaller and lift the breast higher on the chest, whilst also removing the appropriate amount of breast tissue to accomplish what a woman wishes to achieve with her breast(s). For this reason, the commonest type of breast reduction that I do is a wise pattern breast reduction that involves a scar around the areola (the darker skin around the nipple), a vertical scar down the middle of the breast, and a scar across the inframammary fold at the bottom of the breast. The scar (known as an anchor-shaped scar) is hidden in the bra line. This is the commonest type of breast reduction surgery available in order to reduce a significant amount of weight from the breasts.

If, however, a woman prefers more of a lift and less breast tissue to be taken away, it's possible to do a breast reduction through a smaller scar. This involves a scar around the areola itself (the scar is hidden), or a scar that’s shaped like a lollipop (a vertical scar going down from the areola) and a circular scar around the areola.

The most important thing is that the patient and the surgeon discuss what the patient would like to achieve and whether or not that's achievable using the surgeon’s chosen type of skin pattern.

Personally, I tend to use an inferior pedicle for breast reduction surgery, because it means that the blood supply to the nipple and the areola is more robust (because it’s coming through the gland tissue of the breast and the skin coming up to it). This reduces the risk of complications with the nipple afterwards. In addition, it also means that if a woman wishes to have children and to breastfeed them in the future, there’s a chance that she will be able to do so because I haven't disconnected the ducts of the breast behind the nipple.

I use dissolvable stitches and then I place skin glue (a waterproof glue) over the top, allowing my patients to shower 48 hours after surgery. In addition, this also avoids any bulky dresses or bandages, allowing my patients to comfortably wear a bra straight after surgery.

What are the potential risks and complications associated with breast reduction surgery?

Breast reduction surgery is a major operation that involves two to three hours under a general anaesthetic and a one-night stay in hospital. Most patients need two to three weeks off work and four to six weeks before resuming normal exercise. All patients also need to wear a post-operative bra (a supportive front-fastening sports bra) day and night for at least two weeks after their surgery before they can go back to wearing normal bras. Most patients feel pretty uncomfortable for the first week after their operation, but gradually get back to normal after that.

The commonest issue after breast reduction surgery is a small problem with the wound or the incision. This means that the wound might open up a little bit or it might have a delay in healing, taking four to six weeks instead of the normal two to four weeks. This happens quite frequently, and is more likely: if lots of breast tissue was removed; if a patient wanted to achieve a greater lift on the chest; if a patient has medical problems that delay wound healing; or if a patient smokes.

Very rarely, patients can develop a haematoma (bleeding or bruising under the skin), and about 1 in 100 cases will need to undergo surgery to stop the bleeding that's accumulating under the skin within the first 24 hours after breast reduction surgery. For this reason, I ask all my patients who undergo breast reduction surgery to stay one night in hospital.

I personally don’t use drains after breast reduction surgery, so my patients don’t have to worry about having any plastic tubes attached to the breast themselves.

Very rarely, the blood supply or the nerve supply to the nipple can be disrupted as part of the surgery. Very rarely, this can lead to the nipple being lost, after a scab is formed and the nipple falls off. There are techniques available to reduce this risk, and I employ all of these techniques. However, it’s important to know that the risk is more common in: women who start off with larger breasts and have a large volume of breast tissue taken away; women who have diabetes; and women who smoke.

Occasionally, blood clots can develop in the legs or lungs. For this reason, my patients wear stockings during their surgery and during their recovery at home afterwards.

Most patients are very pleased with the outcome of their breast reduction surgery, but some aren't happy with the size, shape, or symmetry of their breasts afterwards. For this reason, it’s important that patients work closely with their surgeon before their operation to work out exactly what they want and exactly what their surgeon can achieve, so that everybody is happy with the result of the operation.

How do you ensure that the patient's aesthetic goals are met after surgery?

Before the operation, I work together with my patients to ensure that they will be as happy as possible with the results of their breast reduction surgery. I'm very honest about what is achievable, and I am able to show before and after photos of previous patients to show what my own real patients look like after their operation.

It’s also really important to talk to other surgeons - and I’m very happy to recommend names – if patients feel that they are better able to achieve their goals.

I’ll be honest when I don’t think that I can achieve a patient’s goals, and therefore, potentially recommend against having an operation if I feel that these goals won’t be achieved.

Ms Zoe Barber is a highly regarded consultant oncoplastic breast surgeon who specialises in the full spectrum of breast surgery.

If you’re considering breast reduction surgery and you would like to consult your options with an expert, don’t hesitate to book an appointment with Ms Zoe Barber via her Top Doctors profile today.