CONSULTANT PLASTIC SURGEON
BREAST REDUCTION
What is breast reduction surgery?
Breast reduction surgery, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue, and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). This commonly requested, predictable procedure has the dual benefits of improving your appearance while relieving the physical and emotional burden of overly large breasts.
​
Disproportionately large breasts can cause both physical and emotional distress for patients. Patients with macromastia may experience physical discomfort resulting from the weight of their breasts. The resulting pain can make it challenging for some patients to perform common physical activities. Along with the physical ailments of macromastia, some patients may suffer from emotional distress or more significant mental health problems as a result of their large breasts.
​
Although breast reduction is often performed to address medical issues, patients who do not have the symptoms of macromastia but are unhappy with the size of their breasts can still pursue breast reduction as an aesthetic procedure. Patients choosing to undergo breast reduction surgery for cosmetic reasons may cite any number of factors, including social stigmas and wardrobe concerns. Breast reduction surgery is often part of a mommy makeover surgery.
“Breast reduction surgery is a highly individualized procedure. You should do it for yourself, not to fulfil someone else's desires or to try to fit any sort of ideal image, especially those coming from social media. Choosing a procedure based on “what’s new” is never a medically sound decision. Hearing about a procedure on television, through an advertisement or online does not necessarily mean it is the best procedure for you”.
Who is a good candidate for breast reduction surgery?
In general, you may be a good candidate for breast reduction surgery If your breasts are too large for your body frame and create back, shoulder, or neck pain, you have heavy breasts with nipples and areolas (pigmented skin surrounding the nipples) that point downward, you have shoulder indentations from bra straps, you have skin irritation beneath the breast creases, your breasts limit your physical activity, you find it nearly impossible to buy dresses and blouses and difficult to find tops and bras that fit, you are physically healthy and at a stable weight, nonsmoker or have stopped smoking recently and if you have realistic expectations of the outcome of your surgery.
What should I expect during a consultation for breast reduction surgery?
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Dr Ricardo will evaluate you as a candidate for breast reduction surgery and clarify what approach is best for you. Alternative and additional treatments may be considered, once he understands your goals and medical condition. It is important to be completely honest during the consultation and be prepared to discuss your medical conditions, drug allergies and medical treatments, current medications, vitamins, herbal supplements, alcohol, tobacco and drug use, previous surgeries, family history of breast cancer, and results of any mammograms or previous biopsies and why you want breast reduction surgery, your expectations, and desired outcome
​
Dr Ricardo will also evaluate your general health status and any pre-existing health conditions or risk factors, examine your breasts, take photographs, discuss the approach to your surgery, including the type of procedure or combination of procedures and tell you whether your expectations are in line with typical results, discuss any risks or potential complications and share before-and-after photos of cases similar to yours.
​
The success and safety of your breast reduction surgery depend very much on your complete candidness during your consultation. It's very important to understand all aspects of your procedure. It's natural to feel some anxiety, whether it's excitement about your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with Dr Ricardo.
How should I prepare for breast reduction surgery?
In preparing for breast reduction surgery, you may be asked to get lab testing or a medical evaluation, get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue (if you're over forty years of age), take certain medications or adjust your current medications, stop smoking in advance of surgery and avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding.
​
Your surgery will be performed in an accredited hospital and is usually performed on an outpatient basis unless you and Dr Ricardo have made other plans for your immediate postoperative recovery. You must arrange for a friend or family member to drive you to and from surgery and to stay with you the first night following surgery.
​
Dr Ricardo and the entire staff will provide thorough preoperative instructions and answer any questions you may have. The goal is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy, comfortable, and safe as possible.
What are the steps of a breast reduction procedure?
Step 1 – Anaesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anaesthesia. Dr Ricardo will recommend the best choice for you.
Step 2 – The incision
Incision options include a circular pattern around the areola, a keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease, L shape incision, or an inverted T or anchor-shaped incision pattern.
Step 3 – Reshaping the breasts
After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary. Underlying breast tissue is reduced, lifted, and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft). Liposuction may be used to improve the contour under the arm.
"Internal Bra Technique": What patients need to know?
The inner bra concept has been around since the early eighties. It refers to a myriad of different surgical techniques. “Internal bra” is actually an umbrella term including techniques intended to strengthen the lower pole of the breast. The idea of this technique is twofold. Firstly, to reinforce the inframammary fold. And secondly, to strengthen the lower portion of the breast. In tandem, this provides a more supportive foundation for a breast implant. The most common technique used for internal bra is additional suturing. Sutures create a more secure and stable breast fold and a stronger lower pole of the breast.
A rarer option used in more severe cases is the use of a surgical mesh that can be placed around the entire breast or around the lower pole of the breast to maintain shape and position. Recently, after good experience with human and animal dermal grafts in reconstructive breast surgery after cancer, plastic surgeons started using acellular grafts in the form of a support bra for cosmetic breast surgery. Known by the acronym ADM, Acellular Dermal Matrix eventually gets integrated into the body and may be completely replaced by the patient’s own collagen resulting in a thick and stronger layer of tissue.
​
Placing foreign materials in your body may increase the chance of infection, scarring and deformity and, although the "Internal Bra Lift technique" with a surgical mesh looks like a miracle procedure and maybe an appealing concept to the patient who wants breasts to stay perky, there is no evidence that this procedure actually works and what is its complication rate. It might be indicated for extreme cases of cosmetic breast deformities or for patients of breast reconstructions despite its use still remains controversial.
Step 4 – Closing the incisions
The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives (glues), or tapes close the skin incisions.
Step 4 – See the results
The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.
What results should I expect after my breast reduction surgery?
When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.
You will be given specific instructions on how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with Dr Ricardo. Remember to always follow his instructions to ensure the success of your surgery.
​
The surgical incisions mustn't be subjected to excessive force, swelling, abrasion, or motion during the time of healing. Sutures will be removed when it is appropriate. You should be ready to return to work and normal activity after 5-7 days. However, you must realize that the amount of time it takes for recovery varies based on what your surgery entails.
What results should I expect after my breast reduction surgery?
The results of your breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced before breast reduction. Your better-proportioned figure will likely enhance your self-image and boost your self-confidence.
​
Unless you gain or lose a significant amount of weight or become pregnant, your breasts will remain a consistent size. However, gravity and the effects of ageing will eventually cause your breasts to loosen and sag a bit over time.
​
Dr Ricardo makes every effort to hide and minimize scars, to achieve the desired results with the shortest possible scar.