BREAST REDUCTION
The best candidates for breast reduction are women troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. Breast reduction is typically performed for physical relief rather than just a cosmetic improvement. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. It's important the candidate is mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast feed.

The procedure will leave scars that are noticeable although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) It's also possible to end up with slightly mismatched breasts or unevenly positioned nipples. Some patients develop small sores around their nipples that can be treated with antibiotic cream. Breast feeding may not be possible after the procedure since many of the milk ducts leading to the nipples are removed. Other potential risks include the possibility of bleeding, infection, or reaction to the anesthesia. Rarely, the nipple and areola may lose their blood supply and the tissue will die. However, they can be rebuilt using skin grafts.

Planning your surgery
The initial consultation will allow you and your plastic surgeon to discuss specific goals and expected results from the procedure. Your surgeon will examine and measure your breasts and may take a photograph for your records and for processing insurance coverage. Your surgeon will discuss the procedure in detail as well as the variables that may affect it such as your age, skin condition, size and shape of your breasts. The type of anesthesia to be used for the surgery, the surgical facility and costs will also be discussed. Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require a certain amount of breast tissue be removed and may also require a "predetermination letter" from your surgeon.

Preparing for your surgery
You may be required to have a mammogram prior to the surgery. You may be required to follow some specific guidelines prior to surgery such as diet and/or smoking cessation. Breast reduction typically does not require a blood transfusion. However, if a large amount of breast tissue will be removed, your surgeon may advise you to have a unit of blood drawn ahead of time just in case it is needed. Be sure to arrange for somebody to drive you home following the surgery and to help you out the next couple of days.

Type of Anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll be asleep throughout the entire procedure.

The Surgery
The most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes the excess glandular tissue, fat, skin and then moves the nipple and areola into their new position. The skin on either side of the breast is brought down and around to create the new shape. Liposuction may be used from the armpit area to remove excess fat.

Typically the nipples are still attached to their blood vessels and nerves. However, if the breasts are very large, the nipples and areolas may have to be completely removed and grafted into a higher position. In this case the nipple and areola tissue will lose sensation.

In most cases stitches are located around the areola, in a vertical line extending downward and along the lower crease of the breast. In some cases, techniques can be used to eliminate the vertical portion of the scar. Occasionally liposuction will be used from the armpit to reduce breast size.

After your surgery
After surgery, you'll have a surgical bra over gauze dressings or elastic bandage wrapped around. A small tube may be inserted in each breast for the fluids to drain in the first day or two. In these first few days after surgery you may feel some pain, especially when moving around or coughing. Some mild discomfort may continue for a week or more following which your surgeon can prescribe some medication to relieve. The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. The stitches will be removed in one to three weeks. If the skin on and around your breast is exceptionally dry following surgery, moisturizer can be applied as long as the suture area is kept dry.

Your first menstruation cycle following surgery may cause your breasts to swell and ache. It's possible you may experience random shooting pains for a few months. Swelling may cause some loss of feeling in the nipples and the skin on your breast. This typically recedes over the course of six weeks or thereabouts. Sometimes the pain may last a year or longer, and in rare cases, the pain may be permanent.

Getting back to normal
You should feel able to get up and about in a day or two, but your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three to four weeks. You will receive detailed information for resuming your normal activities. Most women can return to non-strenuous work and social activities in a couple of weeks. You'll still have a little less energy so you should limit your exercises to stretching, bending, or swimming until you regain your full strength. You'll also want a good athletic bra for optimal support. You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to be as gentle as possible when coming into contact with your breasts for about six weeks. A small amount of fluid draining from your surgical wound or crusting is normal. Any other unusual symptoms such as bleeding or severe pain should be made known to your surgeon.

Your new look
Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll no longer have the physical discomfort of large breasts and your body will look more proportional, and clothes will flatter your figure more. However, you'll need time to adjust to your new image. Even after the swelling and bruising subside, it may still take up to six months for your breasts to conform to their new shape. As well, your breasts are still prone to normal fluctuations in shape due to hormonal shifts, weight changes and pregnancy. Every effort will be made to make the scars as inconspicuous as possible, but breast reduction scars are extensive and permanent. They sometimes remain lumpy and red for months, then gradually become less obvious. Be patient in the months following your procedure, remember why you had the surgery in the first place, and chances are, like most women, you will be very satisfied with the results.