So one of the most common procedures that's requested
among patients who have symptomatic issues is actually breast reduction
and I would say that for my patients coming for breast reduction it's
most often not just because they want to aesthetically
reduce the size of their breasts for appearance sake, but really that they've had a lot of
symptomatic problems such as neck pain, upper back pain, shoulder pain
some patients have told me that
as they've had large breasts their whole life their shoulders are rotated forward, and they
hunched over, and those are all very common symptoms
see for patients for patients with heavy breasts
the range of
patients I've seen for breast reduction really varies. I mean I've seen
patients with really really large breasts and some who are just a little bit
heavy such that it's giving just not really severe symptoms but sort of
nagging, constant annoying symptoms. The goal of breast reduction surgery is really to
improve the symptoms
and so what I tell patients is we're really going to try
to reduce the size and make things better
and at the same time give a lift and make the breasts of course look
aesthetically appealing. After all it is plastic surgery, so we like to make people
look nice at the end, but the goal, as I tell my patients, is really to make them
feel better. Overall the procedure works very well
Patients really getting a very nice benefit with regard to their symptoms,
I can't remember the last breast reduction patient I've had where I've done the reduction and they didn't say
"I feel amazingly better, the symptoms are gone,
the pain is reduced, I'm very happy"
Best candidates for the procedure really are patients who
have had large breasts and really specifically can tell that it's the breasts that are causing
those problems
While we can usually tell
ahead of time that patients will be improved with the breast reduction
surgery
Occasionally we get the patient for whom it's not completely clear and so in that case, the
consultation
can really delineate whether that's a good idea or not.
For the procedure itself, there's a couple different ways
to do the breast reduction. There is what's called a
wise pattern or inverted T breast reduction, which is basically an incision
around the areola
down to the fold from the areola, and an incision down underneath the breast
the reason we make those incisions is because with breast reduction
in addition to the breast tissue being too big, the skin has been stretched out by
large breasts and so
in addition to taking out the breast tissue you do also want to also remove a lot
of the breast skin
very similar to what we do for a breast lift, and that's why for all my breast
reductions I will incorporate a breast lift technique into it
so that the breast is also lifted and gets a
nice rejuvenated appearance , sort of a bonus in addition to the reduction
In certain patients who have less extra skin
or who have less of a breast to reduce, there are other ways to do it. You can do what's
called a vertical breast reduction
which is incisions around the areola and downward
some people call it the lollipop incision, and it really again depends on the
degree of breast tissue that needs to be taken out and the degree of excess skin
so that's something that I would assess in the consultation with the patient
I usually am pretty carefully to make some very specific measurements that I like to make
because those measurements help tell me which method would work the best
and how I can individualize the plan for surgery. And as always, all these plans have to be
individualized because
people really do have a lot of differences. Very often as part of the
individualization
I do see that patients who need a breast reduction have
a pretty asymmetric type of breasts. One side is
significantly bigger than the other or for example one nipple may be significantly lower than the other
and of course the goal of surgery is to
make this closer as much as we can
The surgery itself, depending on the technique usually lasts about three hours
or so
it's done under general anesthesia, the patient's asleep the whole time
and it's more comfortable for them, and
again quite straightforward with procedure, the goal again to reduce the skin and
excess
breast tissue. After the procedure I have the patients
in some sterile dressings and a special surgical bra that I put on at the time of surgery
I have patients leave that on until the first post-operative visit when I see them
usually within that first week or so
then I'll take off the dressings, double check for signs of infection, and
things like that. Occasionally in some patients I will use drains
which are basically where you have some tubes that go into the tissue to
remove any excess fluid that remains. That really I do on a case by case basis
depending on how things go during the operation
after surgery, what
patients can expect is bruising and swlling, a lot of it to go away in the first two weeks or so
so, but really for the majority of swelling really to go away by six weeks
and the breast will continue to remodel and get better in terms of shape in a six weeks to six months
six months to a year really
and by that time a lot of scars have faded as well. Scars as always peak in terms of darkness
I'd say about four to six weeks after surgery, but afterwards it'll start this
slow lightening
process that goes on for the first 12 months. Overall breast reduction
works very well for patients and again the goal really is a symptomatic
improvement, usually in back pain, neck pain, and I find my patients are very happy with it