Setting

The operation is always performed under general anaesthetic and usually involves a hospital stay of about 2-3 days.

Duration

2.5-3 h

Surgical Technique

The breast consists of both fatty and glandular tissue. As the body ages the glandular tissue decreases and the amount of fatty tissue outweighs. In order to reduce the size and weight of the breast both skin and breast tissue need to be removed. This allows the remaining tissue to be reshaped and tightened and the nipple and areola, which are invariably to low in hypertrophic breasts, to be elevated. It is very important though to leave a bridge of tissue (so-called “pedicle”) to the nipple/areola in order preserve their blood and nerve supply.

Skin incision

Similar to a mastopexy or breast lift, the skin incision will follow a so-called “keyhole-pattern” going around the areola and then vertically down to the breast fold. If there is a lot of excess skin, the incision may even need to be extended along the breast fold which results in an anchor-shaped scar.

None of the scars however lie above the nipple-areola complex and will therefore remain concealed in a bra or bikini. 

 

 

New breast size

A breast reduction is not primarily about aesthetics. Its aim is to significantly reduce the size of the breast and therefore alleviate associated symptoms. The final size will be discussed with you prior to surgery, based on your existing breast size, body shape and desires. Bra cup sizes are not standardized measurement units but can be helpful as a general reference.

Suture material

The skin incisions are usually closed with self-absorbing sutures.

Aftercare

You will be encouraged to wear a fitted bra day and night for 4-6 weeks after surgery.

The dressings can usually be left intact until your first follow-up appointment with your surgeon. The wounds will be covered with water-proof dressings allowing you to get the area wet in the shower.

You will be able to resume most every-day activities within the first few days after surgery. We recommend refraining from sport or any strenuous upper body activities for at least 6 weeks after surgery.

Follow-up

Regular follow-up appointments with your surgeon will be scheduled at 2 weeks, 6 weeks, 3 months and 1 year after surgery. 

As with every surgical procedure breast reduction is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.

General complications of all surgical procedures include:

Bleeding/Hematoma, infection, thrombosis (including pulmonary embolism)

The most common surgical complications after breast reduction include:

- postoperative bleeding, hematoma

- infection

- unsightly or asymmetric scars

- delayed wound healing or wound breakdown

- decreased or altered sensation of the nipple/areola

- small tissue excesses, “dog-ears”

- asymmetry (size, shape, position of the nipple)

Rare complications of breast reduction include

- Fat necrosis

- partial or total necrosis/loss of the nipple-areola complex

- skin slough or necrosis

Do I need to stop my own medication prior to surgery?

Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.

Does my GP need to perform or organize any special tests before surgery?

Usually not. The surgical team including the anaesthetist will need to be aware of any preexisting conditions (especially cardiovascular or lung diseases) which may be associated with an increased anaesthetic risk. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.

Do I need to stop smoking before surgery?

We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.

Is my risk of breast cancer increased after surgery?

No. Your risk of developing breast cancer is the same before and after surgery.

Will I still be able to have a mammography after surgery?

Yes. Regular breast cancer screening as recommended by your gynecologist can and should continue as before surgery.

Will I be able to breast feed after a breast reduction?

It is possible. Approximately 20% of normal healthy women, who haven’t had any breast surgery are not able to breast feed. Since only some of the breast tissue and milk ducts are removed or cut during surgery it often is possible to breast feed after reduction surgery. In many cases however it may not be enough to satisfy a baby entirely. Statistically, approximately 60% of women can breast feed to some extent after surgery.

Can you correct breast asymmetry with a breast reduction?

Nearly all women naturally have a certain degree of breast asymmetry. Differences in breast size can be corrected by adapting the amount of tissue that is removed. Often the basic shape of the breast and consistency or distribution of the glandular tissue amongst the fat tissue is different in each breast, making it impossible to reach 100% symmetry after surgery.

Are there any activities I won’t be able to do after surgery?

It is usually recommended not to engage in any activities straining the upper body for 4-6 weeks after surgery. These include lifting heavy objects (greater than 20kg) and physical activities such as jogging. Once the healing period is over there are no restrictions.

How long before I can go back to work after surgery?

This depends on your work. Light duties, such as office jobs can usually be resumed after about a week. Lifting heavy objects and activities that strain the upper body and chest muscles should be refrained from for at least 6 weeks. Especially if you have small children it is important for you to plan and ensure enough support for their care other household chores during your recovery period.

Will I get a sick certificate for the time I am off work?

If your health insurance is covering the procedure you can be issued a sick certificate.

If the procedure is purely aesthetic you will have to take leave of absence from work for the surgery and recovery period.

Will my health insurance cover the costs for the surgery?

Sometimes. If the reason for surgery is primarily to treat symptoms your health or in case of severe asymmetry or breast malformation your health insurance may cover some or sometimes all of the costs for the procedure.

Most insurance companies will expect the following requirements to be met:

• Planned reduction of at least 500g of breast tissue on each side
• Normal body weight (BMI <25kg/m2)
• Proof of failed conservative treatments of symptoms such as back pain or skin problems (e.g. physiotherapy, dermatological treatments)

Written confirmation of approval to cover the costs by your insurer will need to be obtained by your doctor prior to the procedure.

Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?

Yes, provided the complication is purely medical, e.g. an infection. Corrections of aesthetic complications (e.g. unsatisfactory shape, size etc. ) are not covered.