“Doctor, you don’t know what you have done for me…I can never thank you enough!!” These
were the words on a Thank you card sent to me by a young girl in her twenties who underwent
Breast reduction in spite of tremendous resistance from her parents. The change in breast size,
shape and contour following surgery gave her a more proportionate outward appearance but
what really made the difference was how she started perceiving her body. Suddenly there was a
spring in her step and all her previous loose-fitting clothes made way for a new and revamped
stylish wardrobe. Her self-confidence was very evident in the way she conducted and carried
herself. It made her more outgoing and sociable and suddenly this shy, diffident girl was
transformed into a lively, assertive and exuberant person with a newfound energy for life. That
then is precisely the power of this “life changing” surgery!!

Breast size and shape is an important feature in the overall appearance of a woman. If the breast
size is too large, it causes immense discomfort to the individual, both physical as well as
emotional. A simple solution for this problem is Reduction mammoplasty or Breast reduction
surgery.

Common problems of Abnormally large breasts (Macromastia):

* Constant pain or aching in the neck, back and shoulders
* Painful grooving and chafing in shoulders due to pressure of bra straps
* Poor posture leading to hunching of the spine and pain in knees
* Inability to perform high impact aerobics activities such as dancing and jogging due to the
excess weight on the chest
* Chronic rash or skin irritation beneath the breasts
* Difficulty in finding the rightsize bras and well-fitting clothes, which can make women ashamed
of going to malls and shopping for clothes and lingerie
* Difficulty in sleeping flat due to the weight of the breasts causing breathing issues in the supine
posture
* Immense social embarrassment in young girls
* A huge dent in the psyche and self-confidence of the person, even leading to depression in
extreme cases.

Surgery can help relieve a patient of all these symptoms and needless to say, this is an extremely
gratifying procedure.

Additionally, a recentstudy hasthrown up an interesting observation – that Breast cancerin large
breasted women is sometimes in an advanced stage at the time of detection. This could be
because it is difficult to detect the presence of lumps early in large breasts and hence the
diagnosis of breast cancer in such women may be delayed till it reaches a late stage. This is also
slowly emerging to be an important reason for undergoing surgical reduction of Macromastia.

What does the surgery involve?

There is no “one size fits all” ready-made formula in breast reduction. Every patient merits a
procedure that will be customized as per her body type in order to give her the best possible
overall result. Whatever the technique, thissurgery is always planned,such that the nipple areola
complex is safely transported, while attached to a strip of breast tissue known as the pedicle, to
a higher more youthful position and breast tissue is strategically reduced from different areas as
planned to provide a smaller better shaped and contoured breast. Hence in addition to a
reduction in size, the entire breast also gets lifted giving it a more youthful appearance. Only in
rare cases of extremely large and severely drooping breasts, a free nipple graft may be required.
Very select cases may be treated with liposuction alone.

The requirements of this surgery in a celebrity may be different from what an active athletic
sportswoman expects. So also a housewife and mother of two would have her own expectations
from this surgery depending on her lifestyle. Therefore it is imperative that the patient has a
detailed discussion with her surgeon regarding her priorities and expectations so that a
procedure can be planned which would suit HER body and meet HER expectations.

This brings us to…..
The first and the most important step:

If you are considering this surgery, first and foremost, you MUST choose your surgeon correctly.
Only a qualified Plastic Surgeon will be able to perform this delicate surgery with the finesse and
skill that it takes to reshape such an important part of your body, to give you a durable result of
shape, size and contour that you will be pleased with.

The next step:

Before embarking on surgery, you will need to have a panel of routine blood tests done to check
your fitness for anaesthesia and have a baseline mammography study done, to rule out any preexisting lumps or other pathologies in the breasts.
You will also be asked to stop blood thinners and herbalsupplements, if any, at least a week prior
to surgery.

Smoking is an absolute no-no, and you will need to completely quit smoking at least 2 weeks
before yoursurgery. Chronic smoking retards and delays healing,so doing thisisin your own best
interests.

Usually breast reduction is performed under GA (general anaesthesia) and it typically takes about
3-4 hours. Sometimes it can be performed as a day care procedure but more often you would
need to stay in hospital for 24 hours.

The planning:

Your surgeon will take pictures of your breasts, with your consent, and will assess them for any
asymmetries in size, shape and nipple position. Any breast asymmetries will also be noted and
brought to your notice at thistime. (You can rest assured that these pictures will not include your
face and your identity will remain confidential).
On the day of surgery, your surgeon will take a few measurements, carefully mark the incisions
and plan the type of procedure as dictated by your breast size, shape, quality of skin and nipple
position. This will be done with you standing or seated upright and this isjust as important as the
surgery itself because all the breast landmarks get distorted when you are lying down.
A written informed consent for the procedure will be taken from you and your kin prior to
surgery.

The surgery:

This is usually performed under full general anaesthesia. The technique used and the resultant
scars will be explained to you by the surgeon prior to surgery. In some cases, your surgeon may
need to put in drainage tubes at the end of the procedure to evacuate any fluid collections or
minor oozing. These are usually removed after 24-48 hours. You will be given a light supportive
dressing at the end of the procedure.

Postoperative Care:

You may be discharged either the same evening or after overnight stay.
*You will be encourage to ambulate yourself and walk around on the evening of the surgery; this
helps to reduce chances of blood clots in the leg veins and improves lung function.
*You will be advised to drink a lot of fluids for the first 48 hours after the surgery and have a
healthy nutritious diet to ensure good wound healing.
*It is mandatory to wear a surgical / sports bra in the immediate postoperative period 24/7 for
at least 4-6 weeks. This is important to support the newly remodelled breasts and to give you
optimum healing with good scars.
*You may gradually start moderate activity as per your pain tolerance by 3-4 days. You may
resume your job after a week to 10 days depending on your kind of work. You may resume driving
after 2 weeks or after you get full range of movement in your shoulders and arms. Avoid lifting
heavy weights for at least 4-6 weeks post-surgery.

Wound Care:

Your surgeon will want to check your stitches at regular intervals(usually every 4
th or 5
th day) for
the first 2 weeks. The patient is usually allowed to shower after the 2
nd dressing.
Stitches are usually self-absorbable. If any are to be removed, this is done after 8-10 days.
After 6 weeks you may start wearing a normal bra but you must avoid wearing any underwire
bras until it is allowed by your surgeon.

The recovery:

Typically it takes about 3 months for the breasts to settle to their final shape, size and contour.
You may have altered sensation or lack of sensation in your nipple areola complex, which
eventually settlesin 3-6 monthstime. The scars may be slightly itchy in the initial weeksfollowing
the surgery, this is part and parcel of the healing process and is absolutely normal. The scars will
fade gradually but will not completely vanish. They can be substantially reduced later with lasers
if you so wish.

Breast feeding after reduction mammoplasty:

Breast reduction surgery almost always leaves behind an adequate amount of breast tissue
connected to the ducts and the nipples without damaging them. So breast feeding will be
possible in most cases after the surgery but it will be proportional to the amount of reduction
done. This will of course become evident only once you actually start breast feeding.

Conclusion:

Breast reduction is a “life-changing surgery” for women with macromastia. This is really one
miracle cosmetic procedure, probably with the highest satisfaction rate in patients. It gives a
tremendous boost to the self-esteem and body image of the woman which in turn goes a long
way in improving her quality of life and allowing her the freedom to do activities she could only
dream of earlier ! So if you also dream of having wings, this is one surgery that promises to give
you a pair of them… and a smile too… Get ready to fly as high as your imagination takes you…with
fetters no more…

Dr.Anjali Saple
Consultant Plastic & Cosmetic Surgeon
Seven Hills Hospital, Visakhapatnam
Mail: sapleanjali@gmail.com

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