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Breast Reduction/
Mammaplasty
If you're considering breast reduction...
Women with very large, pendulous breasts may experience a variety of medical
problems. These include back and neck pain, skin irritation, skeletal
deformities, and breathing problems. Bra straps may leave indentations in the
shoulders. Unusually large breasts can make a woman-or a teenage girl-feel
extremely self-conscious.
Breast reduction is designed for such women. The procedure removes fat,
glandular tissue, and skin from the breasts. The breasts are made smaller,
lighter, firmer, and perkier. The procedure can also reduce the size of the
areola, the darker skin surrounding the nipple. The goal is to give the woman
smaller, better-shaped breasts in proportion with the rest of her body. If
you're considering breast reduction, Dr. Karp will try to give you a basic
understanding of the procedure- when it can help, how it's performed, and
what results you can expect. It will not answer all of your questions. A
consultation is required to deal with each individual women's situation. Be
sure to ask Dr. Karp if there is anything about the procedure you don't
understand.
The best candidates for breast reduction
Breast reduction is usually performed for physical relief and cosmetic
improvement. Most women who have the surgery are troubled by very large,
sagging breasts that restrict their activities and cause physical discomfort.
In most cases, breast reduction isn't performed until a woman's breasts are
fully developed. The best candidates are those women who are mature enough to
fully understand the procedure and have realistic expectations about the
results. Breast reduction will decrease the ability to breast-feed.
All surgery carries some uncertainty and risk
Breast reduction is not a simple operation, but it's normally safe when
performed by a qualified (Board Certified) plastic surgeon. Nevertheless, as
with any surgery, there is always a possibility of complications, including
bleeding, infection, or reaction to the anesthesia. Some patients develop
small sores around their nipples after surgery; these can be treated with
antibiotic creams. You can reduce your risks by closely following Dr. Karp's
advice both before and after surgery. The procedure does leave noticeable,
permanent scars, although they'll be covered by your bra or bathing suit.
(Poor healing and wider scars are more common in smokers.) The procedure can
also leave you with slightly mismatched breasts or unevenly positioned
nipples. Future breast-feeding may not be possible, since the surgery removes
some of the milk ducts leading to the nipples. Some patients may experience a
permanent loss of feeling in their nipples or breasts. Though in Dr. Karp's
experience about 95% of patients retain normal or near normal nipple
sensation six months after surgery. Rarely (less than 1% of the time), the
nipple and areola may lose their blood supply and the tissue will die. (The
nipple and areola can usually be rebuilt)
Planning your surgery
In the initial consultation, it's important to discuss your expectations
frankly with Dr. Karp, and to listen to his opinion. Every patient and every
physician has a different view of what is a desirable size and shape for
breasts. Dr. Karp will examine and measure your breasts. He will probably
photograph them for reference during surgery and afterwards. (The photographs
may also be used in the processing of your insurance coverage.) He will
discuss the variables that may affect the procedure-such as your age, the
size and shape of your breasts, and the condition of your skin. He will also
discuss where the nipple and areola will be positioned. Usually they are
moved higher during the procedure, and should be approximately even with the
crease beneath your breasts. Dr. Karp will describe the procedure in detail,
explaining its risks and limitations and making sure you understand the
scarring that will result. He will also explain the anesthesia used, the
facility where the surgery will be performed, and the costs. (Some insurance
companies will pay for breast reduction if it's medically necessary; however,
they may require that a certain amount of breast tissue be removed. Dr. Karp
will write a "predetermination letter" if required.)
Preparing for your surgery
Dr. Karp may require you to have a mammogram (breast x-ray) before surgery.
You'll also get specific instructions on how to prepare for surgery,
including guidelines on eating and drinking, smoking, and taking or avoiding
certain vitamins and medications.
Breast reduction almost never requires a blood transfusion.
While you're making preparations for surgery, be sure to arrange for someone
to drive you home after your surgery and to help you out for a few days if
needed.
Where your surgery will be performed
Breast reduction is generally done in a hospital, either as an inpatient or
outpatient procedure. The surgery itself usually takes three to four hours.
If your surgery is inpatient, expect to stay in the hospital for one day.
Type of anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll
be asleep through the entire operation.
The surgery
Techniques for breast reduction vary, but the most common procedures involves
an incision that circles the areola and extends downward. In cases of small
to moderate sized breast reductions these are the only incisions. This is the
short scar breast reduction that has been developed by Dr. Karp. In very large breast reductions an
additional incision is added underneath the breast that follows the natural
curve of the crease of the breast.
Dr. Karp removes excess glandular tissue, fat, and skin, and
moves the nipple and areola into their new position. He then brings the skin
from both sides of the breast down and around the areola, shaping the new
contour of the breast. Liposuction may be used to remove excess fat from the
armpit area or in area that Dr. Karp feels extra contouring to achieve the
absolute best result. In most cases, the nipples remain attached to their
blood vessels and nerves. However, if the breasts are very large or
pendulous, the nipples and areolas may have to be completely removed and
grafted into a higher position. Stitches are located in the incisions. Dr.
Karp uses almost all absorbable sutures. Very few, if any sutures need to be
removed after surgery. The wounds are dressed with tape strips that stay on
for several weeks after surgery.
After your surgery
After surgery, you will have loose dressings in place. A small drainage tube
may be placed in each breast to drain off blood and fluids for the first day
or two. Dr. Karp does not use surgical bras right after surgery. He feels
that the bra irritates the incisions in the early postoperative period. After the drain is out,
Dr. Karp does use bras in all short scar breast reductions. Bras are optional
in all other patients.
You may feel some pain for the first couple of days after
surgery. This is worse when you move around or cough. Some discomfort for a
week or more is not unusual. Dr. Karp will prescribe medication to lessen the
pain. The bandages will be removed a day or two after surgery. Your stitches
will be removed in one to two weeks. Dr. Karp uses mostly absorbable
stitches, and there are never many stitches to remove. If your breast skin is
very dry following surgery, you can apply a moisturizer several times a day,
but be sure to keep the suture area dry. Your first menstruation following
surgery may cause your breasts to swell and hurt. You may also experience
random, shooting pains for a few months. You can expect some loss of feeling
in your nipples and breast skin, caused by the swelling after surgery. This
usually fades over the next six weeks or so. In some patients, however, it
may last a year or more, and occasionally it may be permanent.
Getting back to normal
Although you may be up and about in a day or two, your breasts may still ache
occasionally for a couple of weeks. You should avoid lifting or pushing
anything heavy for three or four weeks. Dr. Karp will give you detailed
instructions for resuming your normal activities. Most women can return to
work (if it's not too strenuous) and social activities in about one to two
weeks. But you'll have much less stamina for several weeks. No exercise is
allowed for about one month after surgery. When you begin exercise you should
limit your exercises to stretching, bending, and swimming until your energy
level returns. You'll also need a good athletic bra for support when
exercising. You will be instructed to avoid sex for a week or more. Sexual
arousal can cause your incisions to swell. You should avoid anything but
gentle contact with your breasts for about six weeks. A small amount of fluid
draining from your surgical wound, or some crusting, is normal. If you have any
unusual symptoms, such as bleeding or severe pain, don't hesitate to call Dr.
Karp.
Your new look
Although much of the swelling and bruising will disappear in the first few
weeks, it may be six months to a year before your breasts settle into their new
shape. Even then, their shape may fluctuate in response to your hormonal
shifts, weight changes, and pregnancy. Dr. Karp will make every effort to
make your scars as inconspicuous as possible. Still, it's important to
remember that breast reduction scars are permanent. They often remain lumpy
and red for months, then gradually become less obvious, sometimes eventually
fading to thin lines. Fortunately, the scars can usually be placed so that
you can wear low-cut tops and bikini bathing suits. Of all plastic surgery
procedures, breast reduction results in the quickest body-image change.
You'll be rid of the physical discomfort of large breasts, your body will
look better proportioned, and clothes will fit you better. However, as much
as you may have desired these changes, you'll need time to adjust to your new
image-as will your family and friends. Be patient with yourself, and with
them. Keep in mind why you had this surgery, and chances are that, like most
women, you'll be very pleased with the results.
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