Breast Reduction (Mammaplasty) Surgery

Is Breast Reduction Surgery for You?

If the size of your breasts causes you physical pain or discomfort, if you have back, shoulder or neck pain, if you avoid exercise because of problems with overly large breasts or you are self-conscious and embarrassed about them, you may be a candidate for Breast Reduction (Mammaplasty) Surgery.

The first step towards this surgery is your in-depth consultation with Dr Georgina Konrat, who performs this surgery regularly.

• Dr Konrat will ask important questions about you and your health (your medical history), examine your breasts, take photographs to aid in the diagnosis of your concerns and help plan the appropriate surgical procedure for you.
• You will be given an information kit to take home. We understand that you may not remember or understand everything you hear in the consultation, so we encourage you to make notes as soon as possible after the consultation, and call or email Dr Konrat with any concerns or questions you may have about the surgery.
• You should only book your breast reduction surgery when you are confident this is the right step for you and you understand fully what will happen.
• At least one week prior to surgery, blood tests will be taken and pre-operative mammogram screening is recommended if not already performed.

Before, During and After the Surgery

Before Surgery

• You need to re-read all of your instructions allowing enough time to call us for any clarification prior to your surgery. Phone: 07 3391 5710
• You must have nothing to eat or drink (no sips of water) from midnight before surgery. Anything by mouth could cancel or postpone your breast reduction procedure.
• Prescriptions: You will be given prescriptions of medication to take after the surgery. Have your scripts filled prior to surgery.
• Constipation: we recommend Guardian Flakes cereal, from Coles/Woolworths to ensure you are not constipated.
• YOU MUST NOT TAKE ANY ASPIRIN, IBUPROFEN OR MEDICATION CONTAINING Anti-inflammatories, as these can thin your blood and cause excessive bleeding.
• No vitamin E internally (pill) or externally (on the skin) should be used a minimum of seven days prior to mammaplasty surgery.
• Arnica tablets (homeopathic remedy that will help to minimise bruising and swelling) should be taken. Two tablets three times per day sucked or chewed (not swallowed) for seven days prior to surgery and seven days after surgery. Please purchase 84 tablets (6×14 days) from your chemist.
• Any tablets that you are taking should be reported to the doctor and then taken as instructed.
• No alcohol should be taken within 48 hours prior to surgery. Alcohol impairs clotting.
• If you smoke, we recommend that you stop. Nicotine markedly impairs the healing process by encouraging infection and poor circulation.
• The morning or evening prior to your breast reduction surgery you are requested to wash your hair and take a shower.
• Arrange for transportation to and from the hospital. Perhaps include a pillow and blanket in the car for your comfort post-operatively.
• Arrange for someone to stay with you at home for 24 hours after your surgery.
• If you experience any signs or symptoms of illness from this day until your operation, you need to call us. Early treatment could prevent postponing your surgery.
• Remove nail polish, contact lenses, jewellery and all make-up.
• Bring loose fitting, front opening and comfortable clothing to wear home.

The Operation

• Breast Reduction surgery is performed in an accredited Day Surgery hospital under general anaesthetic. Overnight admission is rarely necessary.
• Dr Konrat will make marks and drawings on your skin prior to the surgery to use as guides during the surgery.
• The procedure usually takes between two and three hours. The surgical technique is complicated: every woman’s procedure will be slightly different to the next depending on her breasts prior to breast reduction surgery and what she is hoping to achieve.
• Excess breast tissue, fat and skin will be removed, and the nipple/areola complex will be moved to the right position for the smaller breast. The breast tissue that remains is shaped appropriately.

After Surgery

• After breast reduction surgery, your breasts may feel bruised, swollen or tender. All of the bruising and swelling can take 4 weeks or more to resolve. DO NOT BE UNDULY WORRIED ABOUT THIS.
• NIPPLE CHECKS: For the first 24 hours post operatively, you must check your nipples regularly. There is a hole in your dressing for this purpose. Press lightly, if nipples are dark blue or purple, call our Office or After Hours Emergency numbers immediately.
  o You have had a surgical procedure and you MUST expect discomfort. Your first night at home and/or your second or third post-operative days are likely to be your most uncomfortable times.
• Panadol and Celebrex may be prescribed for post-operative pain. It is important to take the tablets with food and plenty of water.
• You will also be prescribed a course of antibiotics (e.g. Keflex – one tablet three times a day). Please ensure you finish the course.
• Sleep from side to side—not on your back—for the first two weeks following your surgery.
• A small water resistant dressing will cover your wounds. Please do not remove it until you see the nurse/doctor at your first post-operative checkup. You can get this wet and shower as normal the day after surgery but you may not swim, spa, bath or submerge for one month following the procedure.
• Please pat your dressings dry with a towel. Do not blow dry.
• On day 10-14, any remaining stitches will be removed if required. At this visit your dressings will be changed and you will be given special surgical tapes to be worn over your scars. You will change this surgical tape yourself once a week for 6 weeks, for healing purposes. Any questions in regards to when you can resume physical exercise, housework, etc., will be answered at your consultation.
• You may experience numbness in some areas of the breast. This may take several weeks or even up to 9 or 12 months to return to normal.
• If there is excessive bleeding, swelling or pain unrelieved by medication, or if there is extensive bruising or the nipples are dark blue or purple, please call the clinic on 07 3391 5710 or on the after hours mobile phone: 0468 476 451.
• If you have any questions pre or post surgery, we welcome the opportunity to assist and are available to support your needs every step of the way.
• REST: usually this procedure is day surgery, but requires at least 2 – 3 days of rest with mobilisation on the hour each hour during the day. On discharge, go home and rest. Have someone drive you and stay with you overnight. When resting, flex calves by pointing toes towards the ceiling then towards the ground. This will maintain leg circulation and avoid clots in the veins of the legs. Do this 10 times per hour. Start gentle mobilisation as soon as possible.

All surgery, including cosmetic surgery, carries risks. Although the vast majority of breast implant patients do not suffer complications, you should not undergo breast augmentation surgery without understanding the risks involved. There are two types of risk; those that apply to any kind of operation such as bleeding, anaesthetic risk and wound infection; and those that apply only to breast reduction surgery. Once you have read this information, you should discuss any concerns with Dr Konrat. The following explains some but not all of the risks specifically associated with breast reduction surgery.

There are general risks associated with ANY operation, including the following:

Infection in the wound with resultant redness, pain and possible discharge. In severe cases the wound could break open and need to be re-stitched. Usually after a wound infection, the scar is not as fine as it otherwise would have been.

Possible bleeding in the wound with swelling or bruising and possible blood stained discharge.

Secretions may accumulate in the lungs causing a chest infection.

Clotting may occur in the deep veins of the leg or pelvis, and rarely the clot may break off and go to the lungs.

Circulation problems to the heart or brain may occur and may result in a heart attack or stroke.

Death is possible during or after an operation due to severe complications.

There are also specific risks and potential complications associated with Breast Reduction surgery. They are rare, but you should be aware of them:

Infection: To minimise this risk, antibiotics are given at the time of surgery and for one week post-operatively. Further surgery may be required to improve scars if severe infection results.

Bleeding with collection of blood and bruising (haematoma) can occur. Further surgery to stop the bleeding may be required. Post-operative haematoma (unwanted blood collecting under the skin and breast tissue) and infection may occur. This can lead to delay or complete failure of the healing process. This may require an operation to drain either the infection or the collected blood. This may have an adverse outcome on the final quality of the result of the operation. Antibiotics may also be required.

Nerve sensation: There may be a loss of, or reduced sensation in the nipple and areola following this procedure. Although this is usually temporary, and sensation may take several months to return to normal or near normal. In some cases despite the nipple and areola remaining attached to their nerve supply throughout the procedure, the loss of sensation may be permanent. If the nipple and areola are removed and grafted into their new position, the loss of sensation is always permanent.

Nipple Loss: This is the worst complication and is more likely to occur 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 to you at the time of your initial consultation. The operation is planned in such a way as to try and ensure an adequate blood supply is maintained to all the remaining parts of the breast (skin, fat, breast tissue and nipple). On some rare occasions the circulation is inadequate and some of the tissues may die. Although this is uncommon, it is more likely to occur in patients with large breasts and patients with very poor circulation. This may mean that the surgeon may have to compromise and alter the size and shape from that which is desired in order to maintain an adequate circulation. In rare cases, the nipple and areola tissue can lose its blood supply and die. Reconstruction in the form of a skin graft from another part of the body will be required to rebuild the nipple and areola at a later stage.

Scars: There will be significant and obvious scars in the early months after breast reduction surgery. The prominence of these scars will gradually reduce with time. The shape of the scar will involve a circular scar around the nipple, a vertical scar passing below the nipple downwards, and, depending on the surgical technique, rarely there may be a curved horizontal scar which may be long, and passes near the mid-line in front to outside the breast near the armpit. The horizontal part of the scar is long following large reductions, and would normally be visible at each end but usually only on close inspection. The vertical scar usually fades and has a tendency to be slightly stretched. Sometimes the scars may be more thickened than normal and this may be associated with them becoming red, thick and itchy. This is called a keloid scar. The scars can usually be improved by a second operation if desired. The operation always leaves behind a scar in the pre-decided area. Very rarely, additional incisions or longer incisions may have to be used to achieve optimal results. Like all surgical scars, they may be initially noticeable. It may take up to 6 months for the scars to improve. Occasionally, the scars may be persistently red, itchy, lumpy or keloid-like for a long time and they may need some treatment for improvement. Generally speaking, taping the scar for the first 4-6 weeks after surgery and avoidance of over-activity and straining would allow the scars to mature early. Dog Ears describes a characteristic puckering of the skin that can occur after surgical wound closure. They are very common. If desired, these can be treated with revision surgery. A surgical fee and associated day surgery costs will be incurred.

Asymmetry: Some asymmetry of breast shape and size is likely to occur, and the position of the nipples may vary slightly. Every effort will be taken to keep this degree of difference to a minimum.
Despite careful planning, occasionally, there may be asymmetry in the scars, levels of the infra-mammary fold, levels of the nipples or breast shapes. Many times this is related to the pre-existing breast asymmetry, but not well appreciated before surgery. Frequently some of these may be corrected by judicious use of compression supporting bras or straps. Occasionally, if very obvious, they may need further surgery at a later date.

Breastfeeding: Breast reduction surgery is not recommended for women who intend to breastfeed. While some reduction techniques can preserve the nipple structure and milk ducts, others may lead to their removal.  During the procedure, damage may occur to some of the milk ducts, which may cause disturbance of milk secretion during pregnancy and prevent breastfeeding.

Seroma formation: Seroma is collection of ‘healing’ or ‘inflammatory’ fluid under the skin. It is not an uncommon complication after surgery. Use of drains is common after this surgery and these are normally removed in the first couple of days post operatively. Wearing a compression garment for breasts (special bra) reduces the risk of this complication but does not completely avoid it. When it occurs, it may need aspiration (with or without) ultrasonic guidance during follow up visits on a few occasions or rarely a surgical drainage if it is significant or if there is an infection.

Wound breakdown or dehiscence: Very occasionally there may be a breakdown in the wound edges, particularly near the junctions of the vertical and horizontal scars. This is a temporary nuisance and requires regular dressings, but rarely makes any difference to the overall final result. If the breakdown in wounds is larger then PICO or V.A.C. Therapy will be commenced to promote fast healing and to decrease the potential for infection. Revision Surgery:  Further operations may occasionally be required to improve the results.  This is particularly true if any of the above named complications develop.  You should not undertake breast lift surgery unless you accept the possibility that you may wish to have, or need to have, further surgery at some time in the future.  If further surgery is required due to complications you will be required to pay fees as quoted by Brisbane Cosmetic Clinic.

Revision Surgery: Further operations may occasionally be required to improve the results.  This is particularly true if any of the above named complications develop.  You should not undertake breast lift surgery unless you accept the possibility that you may wish to have, or need to have, further surgery at some time in the future.  If further surgery were required due to complications you will be required to pay fees as quoted by Brisbane Cosmetic Clinic.

CALL Brisbane Cosmetic Clinic IF YOU HAVE:

• Severe pain not responding to pain medication.
• Significant swelling, especially if much more one side than the other, fevers, shivers, feeling very unwell.
• Drains (if you have them) that fill rapidly and have to be emptied more frequently than twice a day.
• Nipples that are dark blue or purple.