Breast reduction

Breast hypertrophy, or the development of excessively heavy breasts, can lead to various functional complaints such as neck pain, back pain, digging bra straps and irritation in the breast fold. Breast pain, postural problems and even tingling in the fingers can also result from breast hypertrophy.

Overweight breasts that are out of proportion to the rest of the body also often lead to feelings of shame, low self-esteem or depression. Professional breast reduction is the appropriate treatment for this. The goal of breast reduction is to:

• surgically reduce the size of the breasts
• improve breast shape
• if necessary, reduce and better position the areola
• restore harmony with the rest of the body

A breast reduction is performed under general anaesthesia and takes 2-3 hours on average. The excess breast tissue is removed for the breast reduction so that it leaves as few noticeable scars as possible (a scar around the areola and vertically downward, possibly with a horizontal seam in the fold). By using liposuction, the shape of the breast can be improved with minimal scarring, and excess fat under the armpits and in the flanks can be removed. Drains are placed and removed before you are discharged from the hospital. Most patients spend 1-2 nights in the hospital. A supportive sports bra can be provided upon request at the hospital before discharge.

The sports bra should be worn for about six weeks. Post-operative pain is well controlled with the classic post-operative painkillers prescribed by your physician. As soon as the wound sutures have healed, scar care instructions are provided during the first follow-up consult. The sutures dissolve on their own. Showering is allowed immediately after surgery. Light work is possible after approximately ten days. Two to three weeks off of work can be prescribed. Intensive sports practice is not recommended for the first six weeks after surgery. Follow-up consults are standardly scheduled at 1 week, 6 weeks, 3 months and 1 year.

Breast reduction is permanent if your weight remains more or less stable over the years. The breasts may sag slightly again after many years. This is often due to residual excess fatty tissue in the flanks next to the breast. Therefore, thorough liposuction in these regions is often indispensable to preserve the improved shape of the breast for as long as possible.

Although not always the case, that breastfeeding might no longer be possible after a breast reduction. If breastfeeding is essential to you, it is best to wait until you have fulfilled your desire to have children before undergoing the procedure. Very often the symptoms of breast hypertrophy are so detrimental to one’s quality of life that it is not possible to wait that long.

Sensation in the nipples (nipple sensitivity) may be reduced. Removing part of the breast also removes part of the nipple nerve. After a long period, this sensation may return, but the recovery is not always complete.

The possible complications of breast reduction include:

• Post-operative bleeding: fortunately quite rare. The drainage tubes remove the excess blood via the armpit. Very rarely, a haematoma (post-operative bleeding) may need to be removed surgically. It is recommended that you do not take aspirin derivatives after surgery to avoid post-operative bleeding.
• Wound infection: very rare, except in smokers and diabetics. Stopping smoking a few weeks before and after surgery is definitely recommended. Good glycaemic controls in diabetics are also indispensable. High fever and chest redness after the procedure may indicate an infection and should be reported to your attending surgeon immediately. Infections are treated with antibiotics.
• Delayed wound healing: The skin edges below the areola or at the seam in the breast fold may heal more slowly or show limited wound separation (dehiscence). These wounds heal spontaneously after a few weeks with proper wound care.
• Thromboembolisms: DVT or clot formation in the calves due to immobilisation during surgery and lung embolisms have become a rarity due to preventive measures (compression stockings for the calves and, in high-risk patients, the administration of a light blood thinner (heparin derivative) just before and immediately after the surgery.

The wound seams are red for the first few months but usually fade to a fine white line over the long term. Your physician may recommend massaging the scars with moisturising creams or scar ointments, or even applying specific silicone bandages. You can best assess scarring by asking your surgeon to show you some photos of post-operative results before you undergo the surgery.

Mammograms are perfectly possible after a breast reduction, and their interpretation is not affected by the procedure. Since the breasts needs time to heal after a breast reduction, it is best to wait three months before undergoing a mammogram.

Often, regardless of age, a mammogram is performed before the surgery (to exclude rare tumours) and one year after the surgery (as a baseline examination for comparison with later mammograms).

If the symptoms of breast hypertrophy are severe enough, you may be able to apply to your health insurance company for partial reimbursement of the operation costs. If the breasts are primarily ptotic (sagging) rather than excessively heavy, the correction is considered a breast lift (mastopexy) for purely aesthetic reasons and no reimbursement is possible.

A blood test (including clotting tests) and an electrocardiogram (for those over the age of 50) can be performed by the GP.

A bilateral mammogram (with breast ultrasound) is routinely prescribed.

The removed breast tissue is always weighed and examined by anatomopathologists to rule out the presence of breast cancer. Hospitalisation policies often require the report of this examination (including the weight of each breast) to assess the eligibility for potential reimbursement of additional hospital costs.

Latest publication date: 13/08/2024
Supervising author: Dr Vertriest Rudolf