Mastopexy and Breast Reduction

A breast reduction is an operation designed to make large breasts smaller, perter and more in proportion with the rest of your body. The operation can also be performed to make each breast a similar size if one side is much larger than the other or asymmetrical. A mastopexy is a similar operation but maintains breast volume, so that there is no reduction in size.

Some mastopexy patients wish an increase in breast volume and it can be combined with a breast augmentation or fat transfer. Women with excessively large breasts may complain of having constant neck and back pain, painful grooves where bra straps have cut into the shoulders and skin irritation/rashes in the crease beneath the breast. Patients say that they cannot find clothes that fit, have poor posture and find many activities difficult due to the size of their breasts. In addition, large breasts can make a person feel extremely self conscious and embarrassed.

What does the surgery involve?

Incisions are made in order to sculpt the breasts into a smaller and perter shape. The incisions can be

Around the areola only (the dark skin surrounding the nipple) – this is used in a small mastopexy (uplift) only.
Around the areolar, vertically down from the areola to the breast crease and horizontally in the breast crease under the breast – this is used for most reductions and mastopexies where more skin needs to be tightened.

Excess breast tissue and skin is removed and the entire breast is reshaped with the nipples moved to a higher and more youthful position. The incisions are stitched up in a way that reduces scarring to a minimum. The surgery takes between two and three hours to complete.

A breast reduction / mastopexy is usually performed under a general anaesthetic (you will be asleep during the procedure). Providing all is well, you can expect to go home the day after surgery.

What are the risks and side effects of surgery?

Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of possible complications.

Scar – scars tend to settle remarkably well, however some patients heal with thick scars and this can make them more noticeable.

Bruising and swelling – swelling is very common and may take a couple of weeks to settle. Bruising is less common.

Haematoma – this can happen if a bleed occurs in the breast pocket, allowing a large blood clot to form. If this does occur, it is likely to happen within four to six hours of surgery. Any increase in swelling or pain should be reported immediately so that treatment can be given. Sometimes patients need to have this blood removed with another short operation.

Infection – this is rare but you may require antibiotics if there are any concerns.

Wound healing problems – this problem is rare but can happen around the nipple or at the T junction (where the horizontal and vertical scars meet). These healing difficulties can range from minor problems, such as small areas of wound separation, to major issues, such as skin or nipple loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery. Patients who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Numbness, reduced sensation or oversensitivity – this can occur in the nipple. This is usually temporary, but occasionally these changes can remain to some degree.

Fat necrosis – sometimes areas of fat within the breast scar and form hard lumps called fat necrosis. Usually, no specific treatment is required and the problem settles down over a 12 month month period.

Asymmetry – each breast is slightly different and will continue to be following surgery; they are ‘sisters’ and not ‘twins’.

Breastfeeding – not all patients will be able to breast feed after a breast reduction or mastopexy. If you have further family plans and wish to breast feed, then this procedure should be delayed.

DVT/PE – following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. In order to reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are immobile.

All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with me. Decisions about cosmetic surgery must never be rushed and requires personal research.

What happens after the operation?

Your incisions will be closed with dissolvable sutures that do not need to be removed. I use a glue and tape dressing (Prineo) which is waterproof and can be peeled off 3 weeks after surgery, when it starts to lift at the corners. You can shower as soon as you like after surgery and do not require any dressing changes. I recommend that you wear a support bra for 6 weeks. You will need to purchase this before your surgery and I will guide you in the clinic. Details can also be found in the compression garment guide below.

Before you leave the hospital, you will be given a follow up appointment to see the nurses at one week to check your incisions and an appointment to see me in 4-6 weeks. You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you.

What is the estimated time for recovery, absence from work and return to usual activities?

When you get home, you should take things easy for the first week or so. Most people take 2 weeks off from work. You should be able to drive from 2 weeks, return to the gym for lower body work at 4 weeks and begin upper body exercises at 6 weeks. You will need to wear your support bra for at least 6 weeks.