Breast Reduction

Breast reductions can be performed on both male & female clients.  Below is an overview of the procedures & the benefits attained by those receiving the treatment.

Female: 

Definition: This is an operation by which the breasts are reduced to a more aesthetically pleasing & smaller size. 
 
Why do patients request breast reduction?:  There are varying reasons patients request reduction mammoplasty. Most cases are because of ‘large’ breasts. Large breasts cause back pain, backache, shoulder ache, prominent shoulder straps, recurrent infections underneath the breasts. 
Some patients do complain of inability to find clothes that fit as the upper part of the body becomes disproportionate to the lower part of the body. They may find the size embarrassing & wear very baggy clothes. They may also find body hugging clothes difficult to wear. 
Outdoor sports such as swimming may become very difficult as the patient is embarrassed about their size. 
Another reason is to correct asymmetry (when one breast is obviously larger than the other breast)
 
Anaesthetic: General anaesthesia
 
Technique: There are different methods of breast reduction but the two most popular methods are the use of the inverted ‘T’ shaped incision or the use of the vertical incision. At the operation the nipple is left attached to part of the breast & it is lifted to a higher position that is more aesthetically pleasing. Excess breast tissue is then excised & sutures are used to mould the remaining breast tissue to look like a breast again. Absorbable sutures are usually used to close the wound, in other words the sutures do not need to be removed though some of the knots may need to be cut off two weeks after the operation. A drain is inserted on each side of the breast which is removed before discharge.
 
Duration of operation: 2 to 3 hours
 
Duration of admission: 2 to 3 days
 
Post-Op care: Patients are usually fitted with stockings on their legs to reduce the chances of forming blood clots in the legs & they are administered a daily injection of a blood thinning drug while on admission.  
On discharge, support bras are supplied which make the breasts feel more comfortable & take the weight of the breasts off the shoulders. This is because following the surgery, even though the breasts are smaller, they do swell up & the swelling takes a few weeks to go down. 
 
Risks/Complications: There are problems with any operation.Bleeding which can lead haematoma or blood clot collection (which may require a trip back to theatre to stop the bleeding).  
Infection can occur. Prophylactic (preventive) antibiotics are usually administered to avoid this. 
Wound dehiscence or breakdown can occur. It is usually superficial & treated with dressings. 
The feeling around the nipple can become altered because of this operation. It may affect both nipples or just one nipple, but more commonly most patients retain their sensation. 
The blood supply to the nipple may occasionally become compromised which can result in partial or total loss of nipple skin. This is more likely to happen in patients with very large & pendulous breasts where the distance the blood has to travel to the nipple is long. At the consultation if there is a risk of that, the person will be warned & another technique will be used which is called a free nipple graft which will reduce the chances of this happening.  
There may be a difference in height between the nipples. 
There may be a difference in size between the breasts. These differences are usually minimal.
Scars are usually red & gradually fade & become faint over several months to years but in some patients the scars may become raised & lumpy. 
Breast feeding may be difficult after this operation. More commonly breast feeding is still possible following reduction mammoplasty, however, augmentation with other sources e.g. cows’ milk may be necessary. 
Dog Ears, these are folds at the ends of the scars which may require excision under local anaesthetic usually at about six months from date of surgery. 

Fat necrosis, Small areas of the fat that does not receive good blood supply may become firm & lumpy. These & the internal scarring can be confused with cancer so you may be advised to have an x-ray a few months after the operation to have a baseline for further comparison.

 

Male: 

Definition: Gynaecomastia is a very common condition which affects up to two-thirds of men. One side can be affected but more commonly both. In a vast majority of cases there is no known cause. However, certain drugs and medical problems have been associated with gynaecomastia. 
(Drugs; Anabolic steroids, Marijuana, some anti-hypertensives, oestrogens). 
The corrective procedure involves removal of excessive fat & glandular tissue from the breast & sometimes excessive skin to a more aesthetically pleasing & size in keeping with the male gender. 
 
Why do men request correction? 
There are varying reasons patients request reduction. 
Most patients complain about feeling embarrassed in presence of their peers or the opposite sex.  
Outdoor sports such as swimming may become very difficult. Some men change uncomfortably in public changing rooms for e.g. may turn their backs to other people while changing or take late showers when no one is around to see. 
Some complain that they do not feel masculine. 
They avoid body hugging clothes & go for very baggy outfits.
  
Anaesthetic: General anaesthesia
 
Technique: The procedure usually involves a combination of excision of excess breast tissue (using a small incision in the brown or pink area around the nipple called the areola which hides the scar very well) and liposuction to remove excess fat & make the edges of excision smoother.
Sometimes a drain is inserted on each side of the breast which is removed before discharge.
 
Duration of operation: 2 hours
 
Duration of admission:  Same day to overnight stay 
 
Post-Op care: On discharge, pressure garment vest are supplied which make the breasts feel more comfortable, reduce post operative swelling & helps the tissues come together contracting the skin over the surgical site. The pressure garments are to be worn for 6 weeks. They can be worn concealed underneath the normal clothing.
Pain killers & antibiotics are also administered.
 
Time of work: 5 to 7 days
 
Risks/Complications: There are problems with any operation. Bleeding which can lead haematoma or blood clot collection (which may require a trip back to theatre to stop the bleeding). 
Infection can occur. Prophylactic (preventive) antibiotics are usually administered to avoid this. 
Seroma or fluid accumulation can occur. This requires aspiration in clinic. Sometimes it has to be done a few times before it dries up. 
Sensation: The feeling around the nipple can become altered or lost causing permanent numbness. 
Contour irregularity: this can occur because of the liposuction. Also ‘saucer’ or ‘dinner plate’ deformity can occur (depression). 
Vascular compromise: The blood supply to the nipple may occasionally become compromised which can result in partial or total loss of nipple skin. 
Scars are usually red & gradually fade & become faint over several months to years but in some patients the scars may become raised & lumpy. Scar management treatment with silicone gel is usually started early to prevent this.