Large breasts or “macromastia” can be quite disabling Patients tend to suffer upper back, neck and shoulder pain, bra strap indentations, skin irritation under the breast (intertrigo) and other symptoms such as headaches and migraine. Posture changes tend to occur especially if the breasts are asymmetric and can lead even to lower back symptoms. Clothing tends to be a significant issue and the size of the breasts can even affect daily activities including exercise. Breast reduction patients are some of the happiest patients seen in plastic surgery practices after their surgery. The instant relief or weight lifted often camouflages the pain from the surgical incisions made and post-op recovery tends to be faster than other breast procedures. Before and after images Magnifying Glass Patient 1 Magnifying Glass Patient 2 Magnifying Glass Patient 3 Magnifying Glass Patient 4 Magnifying Glass Patient 5 Magnifying Glass Patient 6 Magnifying Glass Patient 7 Magnifying Glass Patient 8 Magnifying Glass Patient 9 Magnifying Glass Patient 10 Magnifying Glass Patient 11 How can I have my breasts reduced? Breasts can become significantly large early in life and plastic surgeons try to allow complete breast development before considering breast reduction surgery. Dr Raja Sawhney prefers not to perform this surgery on patients under the age of 18. In the young, liposuction alone may alleviate some of the problems but usually the skin has stretched and needs reduction for shaping and lifting the nipple and areola. Macromastia can recur after breast reduction surgery, especially in patients under 18. The risk remains high in the early 20’s. Normal breast enlargement during pregnancy can be a cause in some patients who do not shrink after their pregnancy. Should you wait until you have had children before having a breast reduction? This is something to consider but if you are having significant problems it is reasonable to want to have it treated prior to childbirth. Pregnancy will certainly cause your breasts to regrow and they may not shrink back to where they were before the pregnancy. This may mean you need a further reduction if your symptoms or pain recurs. It is a matter of weighing up the symptoms you have with your plans for childbirth. Breast reduction surgery aims to reduce the volume and size of breasts, leaving good shape and symmetry. There are many procedures described to achieve this depending on how much reduction is required and how low the nipples are sitting on the chest wall. The amount of excess skin and breast tissue, as well as difference between each side needs to be assessed before choosing the best option on an individual basis. Will I have any scars? Small to moderate reductions can be performed with scars around the nipple and running vertically down below the areola. Removing larger volumes tends to leave behind more skin laxity so the scars need to be extended as a curve towards the outer part of the fold beneath the breast. This scar may even need to be extended in that fold towards the midline, giving a full anchor incision. If you need a full anchor scar, the junction of the vertical scar and the scar in the fold under the breast can take some time to heal, as it scars joining together at what is called a T-junction. When the distance that the nipples need to be moved exceeds 12-15cm the blood supply to the nipples can get compromised by the reduction in breast tissue and it may mean that the areola needs to be taken off the breast tissue and grafted to their new position to take like a skin graft. This is quite uncommon, and Dr Raja will discuss this with you if he thinks the need may arise during your surgery. Breastfeeding Not all women can breastfeed, even without surgery and of those who can a significant proportion need to supplement it with commercial formulas. After breast reduction surgery, approximately one-third of patients can breastfeed sufficiently and one-third can breast feed but only partially and need to supplement this with formula. The remaining one-third cannot breastfeed at all. The size of reduction and residual breast volume may have some effect on your chance of being able to sufficiently breastfeed. Nipple Sensation With regards to nipple sensation, a significant proportion of patients with large breasts have reduced sensation due to the weight pulling on the nerves. Some even have no sensation at all. It’s not unusual in these patients for the sensation to improve after reduction surgery and can even become hypersensitive after surgery (requiring desensitisation with massage). This, however, tends to settle with time. Those with normal sensation may have transient or less often permanent reduction or loss in sensation. The loss of sensation can be in general sensation, erotic sensation or both. The amount of reduction required, and residual tissue left in the area of the nerves does have a bearing on potential nipple sensation after this surgery. If you have significant excess in the armpit areas you may benefit from liposuction to this area as surgically removing tissue in this area can be hazardous because important nerves and lymphatic channels traverse here including the nerves that supply the nipples. Dr Raja Sawhney will assess your individual situation, desires and risk factors. He will then explain the options, relative risks and benefits of each before coming to a decision with you on a plan for your chosen procedure. It is imperative that smoking is avoided completely for six weeks before and after your surgery. Smoking causes a much higher rate of wound breakdown, nipple and fat necrosis/death and other complications. Don’t forget to share this via Twitter, Google+, Pinterest and LinkedIn.