Large breasts can cause both physical discomfort and can affect emotional health and well-being. The weight of large breasts can cause back, shoulder and neck pain, bra strap grooving rash under breasts and numbness in stretched tissues, as well as the social challenges of teasing, unwanted attention, and difficulty finding clothing.

Symptoms such as these can make it difficult to exercise and enjoy regular physical activities.

Breast reduction is a surgical procedure that reduces, lifts and reshapes the breasts. It can also reduce the size of the areola (the dark skin surrounding the nipple).

Many different surgical procedures are possible to reduce the size of the breasts, and the scars vary according to the technique required. Your doctor will help you determine which is best for you. There is always a scar completely around the nipple. There will be a scar that runs from the central point of the areola (the dark skin surrounding the nipple) to the fold beneath the breast. Depending upon the surgical procedure needed, there may also be a scar in the fold beneath the breast. The scars are pink to start with and gradually fade over time. How well the scars heal and the quality of the scars depends on numerous factors, such as how well your skin heals and whether you are prone to hypertrophic or keloid scars (thickening). Any unnecessary tension or pulling on the scars can widen and thicken the scars, so post-operative care is of utmost importance in the quality of the scars long term.

You can expect to return to work and social activities about two weeks after your surgery. You should limit yourself to light exercise with no pushing, lifting or pulling anything heavy for 3 - 4 weeks. A well-fitted sports bra is recommended for exercise.

Depending on the type of surgery performed, breast feeding may still be possible, but in general, breastfeeding is not possible after breast reduction surgery. Normal mammograms and self-examination are advised.

Medications
Pain relief and appropriate antibiotics will be prescribed. Antibiotics are given at the time of surgery and for one week post-operatively. Please inform your Doctor of any known allergies or adverse reactions to any tablets known.

The Surgery

The surgery is performed at a Day Surgery. The operation is performed either under general anaesthesia or under twilight sedation and local anaesthesia. The operation takes between 3 -4 hours and in most cases you will not require an overnight stay in the hospital, unless complications arise, or you have an aggravating condition such as diabetes or other significant medical condition. Any drains required are removed within a day or two of the procedure.

Once you are awake you may be discharged home. You will be wearing your special support garment. It is advised to wear your garment day and night for 4 weeks, then during the day for another 2 weeks. You must arrange for a relative or friend to collect you following your procedure. You will not be permitted to leave unaccompanied. We recommend that somebody be with you for the first 24 hours at home.

You must not drive yourself home or use public transport.

After the Operation

Day 1
You will be dressed in your surgical bra over your dressings. A small tube (drain) may be placed in each breast to drain off excess blood and fluids for the first day or two.

The practice nurse will call the day after the surgery. If drains are in place they will be checked to determine if they are ready for removal.

You may feel some pain for the first couple of days, and then some discomfort for a week or more. Your doctor will prescribe medication to considerably relieve the pain and discomfort.

You will commence antibiotics prescribed by your doctor on the day of surgery.

Day 7
All dressings are left in place until this visit unless otherwise notified. Some sutures may be removed at this visit. Silicone patches will be applied to the scars to aid in their healing and improvement for the next 6 weeks to 6 months. (Silicone patches are to be cleaned daily with cold water only). You will continue to wear your surgical bra for up to 6 weeks. Swelling and bruising are expected but should begin to subside at two weeks post surgery.

A small amount of fluid may drain from your surgical wound, or some crusting is normal up to two or three weeks post operatively. Your breasts may ache occasionally for up to two weeks. Avoid lifting or pushing anything heavy for 3 - 4 weeks.

Week 6
Post Operative check -up
Continue wearing silicone patches
Normal fitting bra
Normal exercise routines

Month 3
Post-operative check-up

Month 6
Post-operative check-up. Small scar and dog-ear revision if required.

All enquiries and in-between consultations are welcome.

Possible Complications specific to Breast Reduction Surgery

Infection: antibiotics are given at the time of surgery and for one week post-operatively.

Bleeding: collection of blood and bruising (haematoma) can occur. Drains are sometimes placed to prevent this but further surgery to stop the bleeding may be required.

Nerve sensation: some numbness may occur, nipple sensation may be altered or lost, there may even be increased or decreased sensation to the nipple of breasts. It may take 9-12 months for full sensation to return.

Nipple Loss. This is the worst complication and is most common in very large breasts or in smokers or diabetics. If the nipple blood supply appears to be threatened at the time of surgery, conversion to free nipple graft may be necessary. This will be explained at the time of initial consultation.

Poor scarring and "dog ears". May need further surgery, usually after 3 months.

Permanent scarring: scars around the nipple, from the areola to the fold at the base of the breast and sometimes in the fold below the breast are permanent.

Breast Asymmetry: breasts may not be perfectly symmetric in size and shape after surgery. Nipple height may not be matched perfectly as it is difficult to remove a considerable portion of breast tissue and match the nipple postions with the patient in a horizontal position.

Main Risks of Any Surgery
Complications of General Anaesthesia, Death, Heart Attack, Stroke, Bleeding, Infection, Allergies, Clots in legs (DVT).

Pre-operative Instructions

For morning procedures

NOTHING TO EAT OR DRINK AFTER MIDNIGHT.

For afternoon procedures

If your breast lift surgery is in the afternoon, you may have a normal breakfast at 6 am then no food or liquids until your surgery.

For all procedures

• Avoid recreational drugs for 1 week before surgery
• Avoid coffee and alcohol for 24 hours before surgery
• Stop smoking 2 weeks before surgery

THE MORNING OF YOUR SURGERY:

Skin Preparation: Shower or bathe with anti-bacterial wash. Wash your breasts and under your arms thoroughly. You may want to wash your hair, as it may be uncomfortable to lift your arms for a few days after your surgery. Do not apply any moisturizers, deodorant, talcum powder or other products afterwards. Do not use hairspray or perfume.

What to Wear: Wear simple, comfortable, loose-fitting, dark colored clothing that does not go on over your head. Wear tops with easy to fasten front closures such as buttons or zippers, bottoms that are easy to pull on and comfortable, easy-fitting shoes and socks. Do not wear new clothes. Sweat pants are ideal. No high heels or pantyhose. Do not bring jewelry or valuables with you. Bring a case for contact lenses if you wear them, and bring glasses if you need them, as it may be awkward to put your contact lenses in immediately after your surgery.

Going Home: It is essential that a Carer/relative drive you from the surgery to home. We recommend somebody be with you for the first 24 hours after surgery.

BREAST REDUCTION: AFTER SURGERY

Day 1

• Immediately after your procedure you may experience
• Dizziness or light headed
• Shakes or tremors
• Nauseous
• Tired and very sleepy
• Breast tenderness/discomfort

• Keep up fluids and healthy meals
• Rest
• For pain take 2 Panadol or 2 Digesic every 6 - 8 hours (no more than 8 in a 24 hours period)
• Do not drive whilst taking pain medication
• Take your antibiotic tablets as prescribed
• Do not shower

Day 2

• Some bruising, swelling tenderness and soreness

• Have a shower (have a carer close by in case you become dizzy)
  
• Wash your support garment if necessary and when dry put garment back on
  
• Continue pain tablets and antibiotics as prescribed
  
• Light activity is recommended to reduce the risk of leg vein clots.

• Antibiotics: Keflex (1 tablet three times a day). If allergic to Penicillin, another antibiotic will be prescribed.
• For pain: Take Panadol or Digesic 2 tablets every 6 - 8 hours (maximum of 8 tablets in a 24 hour period)
• Vitamin C: 1000 mg daily
• Zinc: 1 tablet daily
• For bruising: Arnica: (4 tablets under the tongue, 3 times a day)

• Aspirin for one week
• Alcohol, strong coffee
• Smoking for one month after the procedure.

REST: When you arrive home, be prepared to rest in bed for 2 hours. If you feel nauseated, lie on your back with your head down and remain still. Any sensation of nausea should pass by the morning after your surgery. After you wake up from the short rest period, begin to eat lightly and drink to replenish your body fluids. You may go to the bathroom with assistance as needed. If you feel fine, light activity will not harm you. Placing well-padded ice bags over your breasts may relieve discomfort significantly. You may feel uncomfortable for several days.

1. severe pain not responding to pain medication;
2. more swelling and/or pain on one side than the other; or
3. drains that fill rapidly and have to be emptied more frequently than twice a day.

HYGIENE: Your doctor usually uses dressings that are waterproof so you can shower. You can remove the sports bra for showering. If you have drains, do not sit in a bathtub with the drains underwater.

DRAINS: One drain may be placed in each breast at the time of surgery. If fluid accumulates during or after surgery, drains are used to promote fluid evacuation and speed healing. When the drain is inserted, the bulb at the end of each tube is compressed to create gentle suction. As the fluid collects in the bulb, it expands. Empty the drains by opening the plug at the top and pouring out the contents, twice a day or when the bulb is half full. After you empty the drain, squeeze the bulb to recompress it. Do not remove the bulb from the tubing. If the bulb fills rapidly after emptying, or you have to empty it more than twice a day, call your doctor. You will be given a quick demonstration of drain care in the recovery room if you have drains.

• DO NOT CARRY ANY HEAVY WEIGHTS, BAGS OR PACKAGES for four weeks and refrain from any other physical activities that cause pain in the surgery area.
• Do not smoke for at least two weeks after your surgery for better healing.
• You may sleep on your back or on your side, but do not sleep on your stomach for four weeks.
• Do not sit in the sun or heat for four weeks. After that time, always avoid exposing your scars to the sun.

DRIVING: You may not be able to drive for about a week, although every patient recovers at a different pace. Our surgeons recommendation is that patients should not drive until they are recovered sufficiently that if they were driving and had a car accident they could truthfully state that they did not suffer diminished capacity due to recent breast surgery. Make sure you are recovered enough to drive safely before you get behind the wheel. It is not safe to drive while taking oral pain medication.

HERBAL REMEDIES: Some patients report that arnica contributes to a reduction in bruising or swelling, resulting in reduced discomfort and edema, and improved healing. Ask us if you wish assistance in locating a source of arnica. Take arnica orally according to manufacturer's instructions on the packaging.

POST-OPERATIVE APPOINTMENTS

• Day 2
• Day 7
• 2 weeks
• 6 weeks
• 6 months

Finally
It can take up to 3 months to appreciate and reach your final shape.

We want you to have a speedy and uncomplicated recovery. If you are not sure about anything or have concerns please contact us sooner rather than later. Do not hesitate to phone us for advice at any time during your recovery.