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Information

Editors

PauliinaHomsy
CatarinaSvarvar
TiinaJahkola

Breast Reduction Surgery

Essentials

  • Breast reduction surgery, or reduction mammoplasty, is used to reduce the total weight of the breasts.
  • The aim of such surgery is to decrease pain or skin symptoms in the neck-shoulder region and to improve body balance.
  • The patient's body mass index (BMI) should be < 28.
  • For overweight patients, the primary treatment is weight loss, since it will also reduce breast size.

Indications

  • Breast reduction surgery should be considered if a normal-weight or slightly overweight woman (BMI < 28) has breasts that are heavy in relation to the rest of her body and significantly affect her health-related quality of life.
  • Symptoms
    • Long-term pain and tension in the neck-shoulder region
    • Tension-type headache
    • Numbness of the upper extremities
    • Back pain and postural problems
    • Body balance problems
    • Skin problems such as rash, maceration or ringworm on the skin under the breasts
    • Difficulty doing physical exercise
    • Breathing and sleeping problems
  • When considering surgery, the probability of achieving significant positive effects on the patient's symptoms should be assessed.
    • In Finnish studies, the financial costs of breast reduction surgery have been relatively low considering the benefits to health-related quality of life.
  • In the case of overweight women, it should be noted that breasts will also become lighter with weight loss because fat forms a significant part of breast tissue. Therefore, surgical treatment is not recommended for overweight women.
    • The BMI should be < 28.
    • Optimally, the woman should be of normal weight (BMI < 25).
  • For stable aesthetic results, the patient should preferably be in her target weight at the time of surgery.
  • Unilateral reduction mammoplasty can be performed to treat significant breast asymmetry. Causes of asymmetry may include congenital developmental disorder or a history of chest injury or surgery or breast cancer surgery.
  • In some cases, the breasts may not be significantly heavy but problems may be due to abundant excess breast skin or the location of descended breast mass on the abdomen.
    • This may be due to significant weight loss or to a developmental disorder of the breasts, for example.
    • In such cases, breast lift surgery, or mastopexy, can be considered, mostly involving reduction of breast skin, along with reshaping the breast tissue.
    • Breast lift surgery for normal, age-related descending breasts is not done in public health care.

Contraindications

  • Breast reduction surgery is done under general anaesthesia, and the related risks should be assessed individually for each patient.
    • No particular underlying disease or factors such as increased risk of thrombosis prevent the operation as such.
  • There is no upper age limit for breast reduction surgery.
  • In the case of very young patients, it is recommended to wait until the end of puberty.
    • Breast reduction surgery for juvenile gigantomastia can be carried out for minors, too, but normally no earlier than at the age of 16 years.
    • It should be noted that breast growth will not halt after reduction surgery, and some patients may end up wishing for repeat surgery after several years.
  • Breast reduction surgery increases the risk of unsuccessful breast feeding.
    • The timing of surgery should be considered individually.
    • Surgery is not performed during pregnancy or breast feeding. Breast feeding should have been stopped no less than 6 months before surgery.
  • Smoking increases problems with wound healing significantly and should be stopped well before surgery Preoperative Smoking Cessation and Postoperative Complications. In many public units, non-smoking is a prerequisite for placing the patient on the surgical waiting list.

Before surgery

  • A plastic surgeon or breast surgeon will always assess the indication for breast reduction surgery case by case.
  • The treatment of any underlying diseases, such as diabetes or hypertension, should be optimized.
  • The skin in the breast area should be in the best possible condition.
  • After making the decision to perform surgery, imaging of the breasts should be done by mammography, ultrasound scan, or both, depending on the patient's age and imaging findings.
    • The aim is to detect any undiagnosed breast cancer or precancerous lesion. Any further examinations required must be done before surgery.

Procedure

  • The aim is for breasts that are well-proportioned with the person's body and that will tolerate changes due to ageing.
  • There are many surgical techniques available. All of these involve removing skin and tissue from various parts of the breast and reconstructing the breast from the remaining tissue.
    • The type of breast surgery done cannot be inferred exactly from scars seen on the skin. There will be a scar around and vertically down from the areola and, depending on the technique applied, also in the inframammary fold.
    • Breast reconstruction involves reducing the areola and raising the nipple into a new place suitable for a smaller breast. Nipple sensation is often reduced or increased after surgery but usually only transiently.
  • Removed breast tissue should be sent to a pathologist for examination.
  • Breast reduction surgery is done under general anaesthesia, most often as day surgery.
  • Recovery normally takes 1 month. During the period of convalescence
    • compression garments should be worn night and day
    • physical activity with strong, tearing movement of the breasts should be avoided
    • the surgical scars should be taped for several months unless the tape irritates the skin.
    • A combination of paracetamol and ibuprofen is usually sufficient as analgesic treatment.
  • The breasts will appear lifted immediately after surgery, and the final results can only be assessed after healing of tissues, about one year after surgery.

Surgical complications

  • Breast reduction surgery is common. In most cases, surgery and recovery proceed uneventfully.
    • Serious, life-threatening complications are extremely rare.
  • Haemorrhage in an operated breast requiring emergency reoperation occurs in less than 5% of patients.
  • Inflammation requiring hospital treatment is rare.
  • Wound healing problems are more common, the risk of such problems increasing with the amount of tissue removed, certain underlying diseases and smoking, in particular.
  • Necrotic areas may develop in the mammary gland, nipple or breast skin due to insufficient circulation.
  • In breasts previously treated with radiotherapy, there is a significant risk of complications. The treatment of such complications may require repeat surgery.
  • In some patients, breast scars widen or cheloids form over a longer period of time.
  • Women may be dissatisfied with the size or shape of their breasts after surgery.
    • Open and direct communication between the surgeon performing the operation and the patient before surgery is of primary importance.
    • The indication for surgery must be confirmed and understood.
    • Surgery always changes the look of the breasts, and not necessarily as desired.
    • Unrealistic expectations may cause long-term mental stress after surgery. The need for repeat surgery to improve the shape or size of the breasts can usually be assessed one year after surgery.

Information to be included in the referral

  • Age, any underlying diseases, medication, allergies
  • Any history of breast surgery or radiotherapy of the breast or chest area
  • Smoking history
  • Height, weight, BMI, distance between the jugular fossa and the nipple
  • Breast palpation findings, and the most recent imaging of breasts
  • Accurate description of any problems the patient experiences from her breasts.

    References

    • Merkkola-von Schantz PA, Kauhanen SMC, Jahkola TA, et al. Breast Cancer Detection by Preoperative Imaging in Reduction Mammaplasty Patients: A Single Center Study of 918 Patients. World J Surg 2017;41(8):2013-2019 [PubMed]
    • Shestak KC, Davidson EH. Assessing Risk and Avoiding Complications in Breast Reduction. Clin Plast Surg 2016;43(2):323-31 [PubMed]
    • Valtonen JP, Setälä LP, Mustonen PK, et al. Can the efficacy of reduction mammoplasty be predicted? The applicability and predictive value of breast-related symptoms questionnaire in measuring breast-related symptoms pre- and postoperatively. J Plast Reconstr Aesthet Surg 2014;67(5):676-81 [PubMed]
    • Saariniemi KM, Kuokkanen HO, Räsänen P, et al. The cost utility of reduction mammaplasty at medium-term follow-up: a prospective study. J Plast Reconstr Aesthet Surg 2012;65(1):17-21 [PubMed]