DESCRIPTION
A bilateral reduction mammaplasty,
commonly referred to as a breast reduction, serves the
purpose of eliminating both volume and skin from the
breast; thereby reducing the weight of the breast and
“lifting” the entire breast tissue along
with the nipple/areola to tighten the breast. Most women
will present with the main complaint of back, shoulder
and neck pain. The symptoms have been present for a
number of years and are progressively getting worse.
The large volume of the breast affects the entire upper
torso and leads to the breast “falling”
downward, or becoming ptotic (pronounced totic). Women
present with these signs and symptoms as early as 16
years of age. The procedure is typically done on women
of varied ages from 18 to 70. Breast-feeding accentuates
the signs and symptoms. The degree to which the breast
falls will be unique to each patient. Various procedures
for breast reductions have been designed throughout
the years. In summary, the purpose of a breast reduction
is to attempt to alleviate the symptoms that the patient
is experiencing and to lift the breast.
PROCEDURE
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A breast reduction can be performed
under local anesthesia with intravenous sedation or
general anesthesia. We have found that our patients
are most comfortable undergoing general anesthesia.
The procedure is performed as an outpatient allowing
you to go home afterwards. Depending on your exact procedure,
the incisions will vary. However, most patient will
undergo their breast reduction through what is commonly
termed as an “anchor” or “inverted
T incision” This means that the incision will
be around the nipple/areolar complex then extend straight
down from the six o’clock position until it meets
the inframammary fold (the normal breast fold, inferiorly).
The incision then extends within the limits of the inframammary
fold, from the center of the chest to out laterally.
Every attempt will be made to make the scars less conspicuous.
However, you need to understand that every patient will
be different. Because the basic problem is that there
is too much glandular tissue and skin, the incisions
described above allow Dr. Perez-Gurri to remove the
necessary breast tissue and be able to tuck the breast
tissue, redistribute the glandular mass and reshape
the breast. The incisions are closed, a surgical bra
is placed and you are taken to the recovery room. After
allowing time for recuperation, you will be discharged
to go home.
POST-OP RECOVERY
You will be allowed to go home after your surgery. You
will need to wear the surgical bra for the first few
days. We then suggest that you wear a sports bra. Some
custom surgical bras are available from different manufacturers
and our office will be happy to assist you in this purchase.
You will experience some pain in the first 24-48 hours
and a feeling of tightness. This is normal. Pain medication
will be provided for you and we suggest that all your
post-operative medications be purchased prior to surgery.
You should not be the person controlling the meds to
avoid self-medication. At home, it is suggested that
you rest. You will be asked to come to the office the
next day. At this point, some bandages may be removed.
You will have “steri-strips” or small tapes
around all incisions that will come off by themselves
within the first 10-14 days post-op. If they need to
be changed, it will be done in the office.
We will need to see you within another week for possible
suture removal or to change the steri-strips. Frequently,
the sutures used are absorbable and will not require
suture removal. Check with us in your particular case.
Most patients require 7 days recovery before returning
to work and/or driving their car unless your work requires
strenuous activity in which case you may need 3 weeks.
Exercise may be continued after 6 weeks. Always check
with us. Household chores may be started within the
second post-operative week. Every patient is unique
and will recuperate differently. If you feel great,
don't over do it.
COMPLICATIONS OF BREAST REDUCTION
Although complications are not frequent and percentages
will vary, you need to be aware that the following complications
may occur:
PROMINENT VISIBLE SCARS, POSSIBLE LOSS OF TISSUE &/OR
NIPPLE, ALTERED NIPPLE/SKIN SENSATION (EITHER INCREASED
OR DECREASED), CONTOUR IRREGULARITIES, ASSYMETRY, INABILITY
TO BREAST FEED, INFECTION, HEMATOMA, FAT NECROSIS
Some of these complications if severe enough, may delay
recovery time, require further surgery for correction
at additional costs and may involve other specialists
within the medical field. Please be aware that smokers,
diabetics and overweight individuals have a higher incidence
of complications when compared to those who don’t
smoke, have diabetes and/or are overweight. You should
also note that patients undergoing combined procedures
(i.e. breast reduction and tummy tuck) also have a higher
complication rate than those undergoing a single procedure.
WHAT & WHAT NOT TO EXPECT
These procedures are considered
body contouring and enhancing in nature. It is more
probable than not that the breast reduction will alleviate
your symptoms. They are not meant as a substitute
for weight reduction. If you were overweight prior
to your surgery, you will be overweight following
your surgery.
Although Dr. Perez-Gurri will limit the extent of
your incisions, please understand that the incisions
are usually as wide as your breast. We have found
that one of the key factors in achieving patient satisfaction
is patient expectation. No guarantee implied or in
writing is given regarding the eventual bra cup size
that you will wear. A suggestion is made by Dr. Perez-Gurri
based on his professional experience as to the size.
Remember that many things are taken into consideration
but the one limiting factor is the skin and availability
of good tissue.
There seems to be an inverse relationship with expectation
and satisfaction. That is, the higher the expectation,
the lower the satisfaction. Body image is unique and
what the patient frequently sees may not be what is
seen by the surgeon. Therefore, it is important that
you become keenly aware of your expectations for the
procedure, know its limitations and fully discuss
any concerns that you may have regarding the procedure
with Dr. Perez-Gurri. We encourage questions and have
allowed ample time to answer them personally and with
our literature and videotapes. Please realize that
the results obtained through a breast reduction are
not permanent. Gravity continues to have an effect
on the tissues and the aging process and laxity of
tissues continue at the same rate as before. Every
patient is different and will have a unique experience.
OTHER QUESTIONS
What if I get pregnant?
Your breasts will grow under hormonal influence just
as they would without surgery. However, if you are
left with excess skin, the breast may sag once again.
Can I breast feed?
Probably not. You need to fully understand that some
women cannot breast feed regardless of surgery. However,
after undergoing a breast reduction many of the milk
duct connections are interrupted, therefore preventing
the normal flow of milk to the nipple.
Will the breast reduction increase the chances
of cancer?
No. There is no current scientific data that relates
a causal relationship between breast reduction surgery
and breast cancer.
Is mammography more difficult to interpret?
Yes. Frequently, your breasts heal with scar tissue
that may become calcified and mimic an abnormality.
It is important that you inform your mammogram technician
of your breast surgery so that the radiologist reading
the mammogram may take this into consideration.
Will I lose nipple sensation?
Maybe yes and maybe no. There are techniques that
have been developed to preserve nipple sensation.
However, even using these techniques it is possible
to lose sensation.
Are my results permanent?
No. The normal processes of aging & gravity that
cause continued laxity of the tissues eventually lead
the breast to sag again. There is no sure way of predicting
how long this process takes in any particular individual.
As you gain weight, your breast will enlarge.
Will my stretch marks go away?
No. There are no permanent cures for stretch marks.
Different creams and remedies exist that temporarily
hydrate the skin making the stretch marks less visible
but they do not remove stretch marks. Lasers have
been utilized to treat stretch marks but are only
effective in reducing the color intensity of red/bluish
ones. By stretching the skin as a result of the implants,
the stretch marks may become less visible.
The above information has been compiled as a benefit
to you. We hope that this document has served to better
inform you on the proposed procedure. We encourage
dialogue. Dr. Perez-Gurri and his staff at Imagos
Institute of Plastic Surgery, Inc welcome your questions.
It is our sincerest wish that your surgical experience
at IMAGOS INSTITUTE OF PLASTIC SURGERY, INC. be a
pleasant and informative one. We recognize that all
patients will experience pre-operative anxiety and
fear of elective surgical procedures is normal. Our
trained professional staff and doctors are here to
serve your needs and answer your questions.
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