Reduction Mammaplasty (Breast Reduction)

Dr Georgina Konrat is a fully qualified and experienced female Cosmetic Doctor in Brisbane, Queensland. Her training and qualifications are specific to Cosmetic Surgery and her focus for many years has been on Cosmetic Breast surgery.

Dr Konrat uses the very latest techniques in breast reduction surgery to achieve the most natural and long lasting results.

The weight of large breasts can cause back, shoulder and neck pain, bra strap grooving, rash under the breasts, numbness in stretched tissues, unwanted attention and difficulty finding clothing that fits well.

Over-large breasts can make it difficult to exercise and enjoy regular physical activities; they limit what you can wear and can have a negative impact on the lives of women of all ages.

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. Dr Konrat will help you determine which is best for you:

The most common technique produces a scar completely around the nipple, and a scar that runs from the central point of the areola (the dark skin surrounding the nipple) to the fold beneath the breast.

Depending on 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 final scars depends on numerous factors, such as how well your skin generally heals, or whether you are prone to hypertrophic or keloid (thickening) scars.

Any unnecessary tension or pulling on the scars can widen and thicken the scars, so post-operative care is of the utmost importance in optimising 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 4 – 6 weeks. A well-fitted sports bra is recommended when you return to vigorous exercise.

Depending on the type of breast reduction surgery performed, breast-feeding may still be possible, but in general, breast-feeding may not be possible after breast reduction surgery. Mammograms, breast ultrasound and self-examination are advised as per normal screening post surgery.

Breast reduction surgery can take up to 12 months to reach its final shape when you can fully appreciate the permanent change in your appearance.

It is critical that you are fully informed about the procedure: the information on this website has been written and is regularly updated by Dr Konrat. It was designed to provide as complete an informative experience as possible, but it does not take the place of a personal consultation.

You should never make a decision by reading a web page alone, no matter how comprehensive the information is. We encourage you to book a personal consultation with Dr Konrat, where she will assess you, explain the procedure in detail and help you to understand all the options as well as the risks and complications of surgery in general and breast reduction surgery in particular.

Pre-Operation

An in-depth consultation (approximately one hour long) with Dr Georgina Konrat.

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 may be given or emailed an information brochure 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.

At least one week prior to surgery, blood tests will be taken, and pre-operative mammogram or breast ultrasound screening is recommended if not already performed.

In order to have the best healing result, Dr Konrat and the nursing team at Brisbane Cosmetic Clinic recommends that you:

Eat a diet rich in vegetables, fish, fruit and salads;

Commence taking Vitamin C and D, Zinc and Selenium as soon as possible to aid in preparation, recovery and healing after surgery.

Drugs

Do not take aspirin or anti-inflammatory drugs ten days before and ten days after your operation. These medicines can thin your blood and aggravate bruising or bleeding unless otherwise advised by your Doctor.

You must discuss your use of any ‘leisure drugs’ with Dr Konrat at the time of your consultation, as these could also have an impact on the success of the surgery.

If you are a smoker, you must cease smoking for at least 6 weeks before, and one month after your surgery.

Pre-operative and post-operative instructions are in the brochure provided and are sent to you once you have booked a date for your surgery.

Dr Georgina Konrat’s staff at Brisbane Cosmetic Clinic staff are pleased to answer any questions after your consultation, and you are encouraged to return for a second consultation any time you feel it would be useful.

Before making a decision to proceed with surgery, please review our Consent for Surgery form about this surgery.

Surgery Consent Form

The Operation

Breast Reduction surgery is performed in an accredited Day Surgery hospital under general anæsthetic. 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 the surgery, and what she is hoping to achieve.

Post-Operation

A complete list of instructions will be given to you prior to your surgery.

After a short recovery period, usually about two hours – 4 hours, you can go home. It is a legal requirement to arrange for a responsible adult to pick you up from Hospital and drive you home.  You will need someone to assist and support you in the first 24-48 hours post surgery.

Some patients will be wearing a special support garment.

You are likely to feel drowsy or even sleepy after the anaesthetic, and you should rest for at least two hours when you get home.

After waking, you should eat lightly and drink to replenish your body fluids. You may go to the bathroom with assistance as needed. Walking around the house every hour to exercise your legs is recommended to reduce the risks of DVT or blood clots in the legs.

If you feel fine, light activity will not harm you.

If you have some discomfort, you will find that placing well-padded ice bags over your breasts may relieve discomfort significantly.

You may have drains in place. If fluid accumulates during or after surgery, drains are used to promote fluid evacuation and healing. When the drains are inserted, the bulb at the end of each tube is compressed to create gentle suction. You will be given a demonstration of drain care in the recovery room if you have drains.

Day One Post-surgery:

If drains are in place, you will be required to attend Brisbane Cosmetic Clinic to see the clinic nurse and /or Dr Konrat for your first check- up.  The clinic nurse will educate you on how to continue using your drains and how to care for your dressings. Questions at this time are welcomed.

You may experience dizziness or light-headedness, shakes or tremors, breast tenderness, discomfort, or a feeling of bruising. You might feel nauseous (that should pass by the morning after the surgery), tired and very sleepy.

You should rest as much as you need and keep up fluids and healthy meals. Take the antibiotics that have been prescribed, along with the pain medication as prescribed and directed by Dr Konrat. Do not drive while taking pain medication that contains codeine. You can generally drive the car on day 3 post operatively depending on your progress.

You should not shower. Sponge bath only to freshen up each day, keeping your dressings and drains dry.

Day Two Post-surgery:

• You should expect some bruising, swelling, tenderness and soreness.
• You can sponge bath to freshen up, keeping your dressings and drains dry.
• Continue pain tablets and antibiotics as prescribed.
• You may feel quite well but rest and good nutrition are very important.
• Light activity is recommended to reduce the risk of leg vein clots (deep vein thrombosis).
• Wash your support garment if necessary and when dry put it back on.
• Medication:
• Antibiotics: (1 tablet 3 times per day). Appropriate antibiotic will be prescribed if you have any allergies.
• For pain: Take your anti-inflammatory and pain medications as prescribed.
• Vitamin C: 1000 mg per day.
• Zinc: 1 tablet per day.
• For bruising: Arnica: 4 tablets under the tongue, 3 times per day.
• You must avoid: Aspirin for 1 week, strong coffee, alcohol, smoking (for one month after the procedure) unless otherwise instructed by your Doctor.
• Most patients report mild to moderate discomfort that is well treated by your pain relief medications.
• Herbal Remedies: Some patients report that arnica contributes to a reduction in bruising and swelling, resulting in reduced discomfort and oedema, and improving healing. Take arnica orally according to the manufacturer’s instructions on the packaging.
• You must call at any time if you have:
• Severe pain not responding to pain medication;
• A lot more swelling and/or pain on one side than the other;
• Drains that fill rapidly and have to be emptied more frequently than twice a day.

Days Seven to Ten

A visit to Brisbane Cosmetic Clinic will be scheduled during this time.

If drains are present these will be removed and dressings applied to the drain exit wound.

The dressings over your nipples and down the center of the breasts will remain in place for three weeks or more. Waterproof dressings will be applied at this visit so you can shower normally again.

You do not need to sleep sitting up or lying on your back. Right from the first night, you are encouraged to sleep naturally, hugging a pillow, turning from side to side as normal. This helps the lymphatic system and veins drain away any swelling and bruising. However, you should not sleep on your stomach for at least 12 weeks.

Hygiene:

Sponge baths are recommended to keep your dressings dry for the first week while drains are in place. Once the drains have been removed, waterproof dressings will be applied and you can shower as per normal.

You can remove any support or surgical bra for showering.

You should not bath or swim (i.e. be submerged in water) for 6 weeks after surgery.

Activity Restriction:

You must not carry heavy weights, bags or packages for two weeks and you should refrain from any other physical activities that cause pain in the surgery area.

You may not be able to drive for about  3-5 days, although every patient recovers at a different pace. Dr Konrat’s recommendation to patients is that they 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. You must make sure you are recovered enough to drive safely before you get behind the wheel.

It is never safe to drive while taking oral pain medication containing codeine.

Week three:

All dressings are removed and any visible stitches are removed. You will be given dressings to take home and change once a week every week until week 6 post surgery.

You may commence wearing a supportive bra, and can change from the surgical bra to a normal bra provided it does not irritate your scars and is supportive.

Week Six:

Post-operative check-up. If you have questions or feel you need a consultation prior to this, you will be welcomed.

We want you to have a speedy and uncomplicated recovery. At this appointment Dr Georgina Konrat will examine you and assess progress. It is at this appointment that decisions are made about “dog ears”.

These are small puckers at the base of the vertical scar on your breasts. If they are obvious or significant a date will be made for excision of these puckers under local anaesthetic in the clinic.

If you are not sure about anything or have concerns, please contact us at the clinic sooner rather than later.

Do not hesitate to phone us at the clinic on 07 3391 5710 for advice at any time during your recovery.

Risks Specific To Breast Reduction Surgery

Infection

• Antibiotics are given at the time of surgery and for one week post-operatively to minimise the risk of infection;
• Further surgery may be required to improve scars if severe infection occurs;
• Tissue Necrosis or tissue breakdown has been reported following the use of steroid drugs, chemotherapy, radiation to breast tissue, smoking, and excessive heat or cold therapy. Occasionally, it can occur without any identifiable cause, but this is very rare.

Bleeding

• Bleeding with collection of blood and bruising (hæmatoma) can occur;
• Further surgery may be required to stop the bleeding. However, returning to the operating theatre for this is very rare.

Changes in Nipple and Skin Sensation

• Some change in, or loss of nipple sensation immediately after surgery is not unusual.
• It may take 9 to 12 months for full sensation to return.
• Occasionally, partial or permanent loss of nipple and skin sensation, or hypersensitivity may occur in one or both breasts.

Nipple Loss

• This is the worst complication of this type of surgery, 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 your initial consultation with Dr Konrat.

Poor Scarring and ‘Dog Ears’

• ‘Dog Ears’ are puckers or small ‘pleats’ at each end or one end of a scar. If these are bothersome or appear unattractive, they can be trimmed so their appearance is flatter and smoother.
• This is called a minor surgical revision and usually occurs after 3 – 6 months of the initial surgery.

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.
• The degree of scarring varies according to many factors. Dr Konrat will discuss this with you at your initial consultation.

Breast Asymmetry

• Your breasts may not be perfectly symmetric in size and shape after surgery. It is rare that both breasts are exactly the same size or shape prior to surgery.
• Nipple height may not be matched perfectly, as it is difficult to remove a considerable portion of breast tissue and match perfectly the nipple positions with the patient in a horizontal position.
• All care is taken to ensure that nipple position and breast size and shape is as symmetrical as possible.

GENERAL RISKS OF SURGERY

Because surgery is such a vital part of modern medicine, there is a tendency to forget that there are risks associated with every type of surgery. While these risks are small, every person undergoing surgery should be aware of the risks.

Wounds

All internal and external wounds need time to heal after surgery. Sutures or stitches and other material are used to hold wounds closed while they heal.

Infections

Despite taking precautions, infections can occur during and just after surgery. These may be general, such as pneumonia, or specific to breast surgery. Because of their generally good health, breast reduction patients usually have a lower risk of developing general infections such as pneumonia.

Pulmonary Risks

• All surgery patients have a risk of forming a blood clot in the leg (deep vein thrombosis) that breaks off and gets stuck in the lung circulation (pulmonary embolism). This is minimised by the wearing of surgical ‘stockings’ during the surgery, and by getting the patient out of bed as soon as possible.
• You will also be encouraged to breathe deeply when you wake up from the anaesthetic, as this expands your lungs and helps ensure your blood oxygen levels are good.

Risks of Anæsthesia

As a rule, these risks are very low in cosmetic surgery patients, because the patients are generally in good health. Dr Konrat will take a full medical history, and will order a number of tests prior to surgery. She will also make lifestyle recommendations to ensure your health is optimal before the surgery. This will minimise any general risks.

Mental Health Disorders and Elective Surgery

• It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement, rather than perfection.
• Complications or less than satisfactory results are sometimes unavoidable and may require additional surgery. This can be stressful.
• Please discuss openly with Dr Konrat in your consultation prior to surgery, any history of emotional depression or mental health disorders. If you are unsure whether a matter is relevant, please mention it anyway. Although many individuals may benefit psychologically from the results of elective cosmetic surgery, the effects on mental health can never be predicted, and could possibly have a negative influence on emotional stability.