Breast Reduction Scotland

10-You will meet your consultant in the clinic. You will discuss your goals, expectations and any fears you may have. The surgeon will undertake a comprehensive assessment at the initial consultation by examining you and checking for any abnormality. Together you will decide the best approach to undertake reduction surgery.

There are 2 main surgical techniques: the anchor-scar (Wise-pattern) breast reduction, and the vertical-scar breast reduction. Vertical scar breast reduction tends to be more suited to patients who do not require a large volume of breast tissue to be removed. As well as removing unwanted excess breast tissue, both procedures also provide a tightening of the breast envelope. The nipples are moved to a higher, more youthful, position. In both cases, the scarring is well hidden beneath the fold of the breast and around the border of the areola.

Occasionally, breasts may be suitable for reduction either by liposuction (to remove tissue when the breasts are particularly soft, not dense) or a circumareolar (circle scar around the nipple). These are only possible in a small number of cases.

After a ‘cooling-off’ period of a minimum of 2 weeks (during which time you can cancel with no obligation to proceed), you will come in for surgery. On the day of surgery, you will be asked not to eat or drink anything from a certain time beforehand. You will meet the anaesthetist (doctor who puts you to sleep and keeps you healthy during the surgery) before going round for your operation. The procedure is performed under a general anaesthetic.

When you wake up you will be in a bed on a ward. You will have dressings over your wounds and there will be dissolving stitches, wound glue and paper stitches sealing your scar. Someone else will need to drive you home. If needed, take simple painkillers such as paracetamol or ibuprofen, but avoid aspirin.

Keep dressings in place for 10-14 days after the operation. Avoid getting the area wet for 48 hrs and then after that you should shower and pat the area dry until the dressing are removed.

You should wear a supportive (post-operative or sports-type) bra which isn’t too tight. You should avoid vigorous exercise for 4 weeks. Do not undertake contact sports or sleep on your front for 8 weeks.

As well as your appointment to have the dressing removed at 10-14 days you will receive a follow-up appointment at 6 months to check you are happy with everything.

Breast reduction is a common operation and most of these surgeries pass uneventfully. You will have swelling, bruising and pain after the surgery. This usually settles down within a few weeks but very occasionally you can be left with long-term pain related to your surgery.

There are some rarer but important early complications:

1. Bleeding – unexpected bleeding after surgery may require re-operation to evacuate blood and stop the bleeding. Rarely, you may require a blood transfusion or extra time in hospital. Bleeding affects 2-3 out of every 100 patients.

2. Infection – extensive precautions are taken both before and during the procedure to reduce the risk of infection. You will receive antibiotics at the time of surgery. Later infection may require further doses of antibiotics and in the worst cases may result in implants being removed. Infection happens in fewer than 2 out of every 100 patients undergoing implant augmentation.

3. Wound healing problems – for various reasons, including smoking, vaping, e-cigarette use or diabetes, the small blood vessels of the skin may not be working well. This increases the risk of wound breakdown (or necrosis), and the area particularly at risk is the T-junction at the bottom of an anchor-scar. If this breaks down you may require antibiotics, regular wound dressings and/or eventually additional surgery. You should not smoke for at least 6 weeks prior to and 2 weeks after your operation.

4. Nipple problems – the nipples are likely to be numb and less sensitive after surgery. Occasionally they can have increased sensitivity and this can cause pain. You will probably not be able to breastfeed following a breast reduction. If the nipple becomes swollen and blue, its blood supply may be at risk and you may need urgent surgery to correct this. There is a small risk of the nipple dying (nipple necrosis) and this may require the nipple to be removed and may be replaced with a graft of skin taken from elsewhere in your body, with the option to have a nipple tattoo or reconstruction in the future.

There are some later issues that it is important for you to know about:

1. Asymmetry – although care is taken to ensure that the breasts appear symmetrical following the procedure, there can be asymmetry between the two sides when you have healed. In the worst cases, this may require further reduction surgery on the side with too much tissue left behind. Differences between the scars can usually be corrected with a small procedure.

2. Unsatisfactory result – occasionally patients do not feel satisfied with the result of their surgery, and improvements in appearance and physical symptoms are not as good as they might have hoped. It is important that you are clear with your surgeon about the size and shape of breasts that you want, and realistic about what can be achieved. The outcome of your surgery can be expected to change with time, particularly as a result of ageing, pregnancy or weight loss or gain.