Extremely large and pendulous breasts can be as disturbing to a woman as very small breasts. In addition, breast pain, shoulder discomfort and back pain are prevalent. The need for special supportive undergarments and difficulty in finding suitable clothing in readily available sizes contribute to the problem. Overly large breasts limit participation in various athletic activities. Surgical correction of this condition is possible and long in use. There are many different operations, some conceived fifty to seventy-five years ago, that are still performed today with very little modification.

The basic breast reduction surgery involves reducing breast volume and restoration of normal contour. Enlargement of the breast is associated with varying degrees of sagging and in most cases gradual displacement of the nipple to a lower position. Restoration of normal contour therefore includes replacement or shifting of the nipple to a new level consistent with the remaining breast. Surgical procedures to relocate the nipple more effectively are extremely varied. Functional and aesthetic considerations also figure in the selection of a specific procedure; among them are the location and degree of postoperative scar tissue which will be present at the site of each separate incision. The scars are sited around the areola, beneath the breast (in the infra-mammary fold), and a short vertical scar joining the above two scars. Scars notable in the first six to twelve months following the breast reduction surgery will gradually fade and improve with time, but will never completely disappear.

What To Expect

The procedure can be performed under general anaesthetic at a hospital, or at a day clinic. In the latter case, the patient will be transferred to an overnight facility. The drainage tubes will usually be removed the next day before the patient is discharged. Before discharge, the patient will put on her new surgical bra, the size as discussed with Dr Efraim pre-operatively. The bra will be worn for six weeks post-operatively, day and night. The operation is usually not very painful; however, patients’ experience of pain do differ. Pain medication will be prescribed.

The dressings are waterproof and the patient is allowed to shower. Dressings will be removed after one week at Dr Efraim’s rooms. Driving will be allowed one week after the operation, but a full exercising routine is only possible after six weeks. A supportive bra should always be worn when exercising.

Local risks in this type of surgery are essentially associated with loss of soft tissue and replacement by scar tissue-largely the result of compromised blood circulation. Shifting, partial excision, and manipulation to achieve proper contour necessarily involve partial separation of tissues from their normal blood supply. While every case shows great adaptability, some types of deformities can require large reductions in volume and so extreme change in position that the tissue’s natural limits may be exceeded. When this occurs, the tissues so affected undergo destruction and are replaced by scar tissue. Minor tissue losses may take place. Since the nipple area always requires the greatest displacement, partial or even complete loss is possible. With present techniques, however, the possibility of loss has become extremely rare.

Partial or complete loss of nipple sensitivity may occur depending upon the type of operation selected, and the pre-operative size of the breasts. While the loss is a significant consideration, it should be recognized that the over enlarged pendulous breast is less sensitive to begin with.

Breast-feeding after the usual breast reduction mammoplasty generally may be possible. Great care is taken at the pre-operative consultation to decide on the specific size the patient prefers to be.

Meticulous attention to the healing scar with taping and recovery serum during the maturation process will usually culminate in very acceptable scarring.