The breast is the most important organ emphasizing the sexual identity of a woman. Small breasts may cause psycho-sexual issues. In the case of big breasts, health threatening problems are added to psychological ones. Especially in puberty, women experience embarrassment, difficulty moving or choosing clothes due to big breasts. Back and neck pain, hunchbacked posture, numbness in arms, eczema and skin rash under the breasts accompany these issues. A woman with excessively big breasts looks much larger and older than she is and has difficulty moving and choosing clothes.

Breasts can be big for many reasons. Genetic factors, hormonal changes or as a result of some illnesses, may cause large breasts disproportionate to the body measurements. Weight changes, breastfeeding or the gravity effect may accentuate the existing problem. Increase in breast tissue and related large breasts can also be observed in young women. Following the evaluation of patient’s condition, the operation may be planned after ages 17-18.

Good news is that today these surgeries yield considerably good results. Cosmetic breast reduction surgery is one of the most pleasing plastic surgery procedures. They do not only correct the aesthetic appearance, but also substantially improve the patient’s quality of life.

BEFORE THE OPERATION

If you are thinking of having a breast reduction surgery or want more information about the subject, you should first consult a plastic surgeon. During the first consultation, you should clearly explain your expectations to your surgeon. Your surgeon will first listen to you, learn more about your patient history and family history and examine you. At the end of the consultation, subjects such as the size of your breasts, their shape, the condition of your skin, your age, whether or not you are planning to get married and have children, the new placement of the nipple will be discussed with you. Do not hesitate to repeat your questions should you need clarification. Your surgeon will inform you about the details of the operation and will enlighten you on scarring, nipple sensitivity, breastfeeding, anesthesia type and possible risks of the surgery. Seeing pictures of patients who had undergone the surgery may help you make a decision.

Conditions such as high blood pressure, smoking, medication habits or diabetes should be discussed before the operation. Depending on the patient’s age, an ultrasound or mammogram may be requested.
Breast reduction surgery must be done in a hospital, staying at the hospital for one day will be sufficient. Blood tests necessary for the surgery will be done the same day in the hospital, before the operation. Skin markings of the breasts and planning should be done before the operation in line with the chosen and discussed technique. These markings are very important for a fast finalization of the surgery.

OPERATION

Breast reduction is one of the operations where the surgeon’s experience is crucial to obtain pleasing results and fast post-operative recovery. An experienced surgeon can complete the surgery in 2 – 2.5 hours, shortening the anesthesia duration and limiting blood loss.

In cosmetic breast reduction surgery, large breast tissue is reshaped in proportion with the patient’s body measurements. Excess tissue and surrounding skin is removed. The nipple is transferred where it is supposed to be. Regardless of the method used, when the nipple is transferred to its new placement, there will be a scar on the side of the areola. In addition, a sole incision line of 5-6 cm extending downwards from the middle of the lower portion of the breast. This is the recent, “Vertical” method and has been used by myself since its first days. Using this method, the shortest scars of breast reduction surgery are attained. This single vertical line technique can be used in cases where the breast tissue to be removed from each breast is up to 1000 gr. In the event the breast reduction concerns a higher volume, there will be a reverse T-shaped scar. The lower part of the T-shaped scar will be concealed in the breast fold. Apparent in the beginning, these scars may become barely noticeable over time. The degree of the scars following the operation depends on the size of the breast, used surgical technique and ultimately on the healing ability of patient’s skin. A group of patients state tanning topless. In some specific cases of excessively big breasts, it may not be possible to apply the abovementioned techniques. In these cases, techniques used consist of freely transferring the nipple. Same as the abovementioned surgeries, the scars of this surgery are in reverse T shape.

POST-OPERATIVE PERIOD

Post-operative period is generally comfortable. The pain is minimal. A compression garment (breast reduction bra) is put on at the end of the operation. Tubes called drains are usually placed on both breasts and they are taken out the next day, before the patient is discharged. Dissolving sutures are used, they will not be taken out. The compression garment will be worn for 3 weeks. Swelling may occur in early stages, loss of sensation in the nipple and violaceus color change of the skin may be observed, however they disappear quickly. The patient can go back to work 5-6 days later. Heavy exercise should be avoided for a month.

RISKS OF BREAST REDUCTION SURGERY

As in every operation, breast reduction surgery has some risks. Although surgery-related problems are not observed in most of the patients, it is important that you are aware of them.

Bleeding: It is a rare situation, may be observed during the operation or post-operative period. The drain placed in the breasts following the operation aims to track the bleeding and also to a certain point, avoid blood accumulation in the breast tissue. Aspirin and similar medication should be avoided during 10 days before the operation as they may increase tendency to bleed.

Infection: Highly unlikely, due to preventive use of antibiotics at the beginning of the operation.

Changes in nipple and skin sensitivity: Temporary reduction of sensation may occur in these areas.

Scars: Every surgical procedure heals through scarring, most of the time the characteristics of the scars cannot be predicted. While the scars are not visible in some cases, other patients may have scars in deep tissues. Moreover in rare cases, surgical correction or other treatments may be required.

Delayed scarring: May occur, although rarely. Complete healing of some areas of the breast or the nipple may take more time. Frequent dressing changes may be required. Scarring problems are observed more often in smokers.

Breast diseases: Independently from breast reduction surgery, in any period of the patient’s life, breast disease or breast cancer may occur. With or without surgery, she should have regular breast exams.

Breastfeeding: Some women who had undergone a breast reduction surgery can breastfeed, however this situation is hard to predict. Practically, I suggest my patients to prepare themselves to not being able to breastfeed. Nevertheless, this situation is not an obstacle for younger patients.

Cosmetic breast reduction is a surgery that generally yields good and permanent results, improving the mental health of the patient and her partner, making women’s clothing style easier, increasing their self-esteem and joy of life.