Breast reduction surgery explained

‘Oversized breasts (pathological breast hypertrophy) can cause a variety of symptoms, including shoulder pain, muscle spasms of the shoulder girdle, headaches, skin rashes underneath the breasts, pins and needles in the arms and postural problems,’ says reconstructive and plastic surgeon at Mediclinic Hermanus, Dr Peet van Deventer.

‘Once a woman’s normal activities are hampered by the size of her breasts, a breast reduction can be considered. Most patients never look back.’

Oversized breasts not only cause health problems, they can also lead to lack of confidence, emotional issues,  inability to exercise or participate in sports and too much unwelcome attention.  Cape Town musician Juliet Harding underwent a breast reduction earlier this year. ‘It was a big decision for me because on the one hand a lot of people admired my big boobs and would tell me how lucky I was to have them, but then on the other I was living in so much pain, every day,’ she says of her choice to have the operation. ‘After many trips to the chiropractor and a few back specialists, we figured out that the best way to help my situation would be this surgery.’

As Dr Shane Barker, a plastic surgeon who operates at Mediclinic Constantiaberg and at a small private clinic explains, breast reduction usually involves a ‘lift’ at the same time. This is because reducing a breast that is generally large and has some degree of ptosis (drooping), the surgeon automatically lifts it in the process of reduction.

‘Breast reduction surgery can result in some scarring. This is usually a “fine-line” scar running around the nipple-areolar complex and extending in a vertical line down the lower part of the breast. There can also be a short horizontal scar in the inframammary fold [the natural lower boundary of the breast, the place where the breast and the chest meet], the length of which usually depends on the technique used and the size of the breast pre-operatively.’

For smaller breasts, a ‘short-scar’ technique is usually performed. This involves making a lollipop-shaped incision in the breast, with a ring around the nipple and a line extending part of the way down the underside of the breast. Some tissue is then removed from the sides and bottom of the breast, leaving tissue beneath the nipple and areola intact.

‘Sutures are usually “dissolving” sub-cuticular [underneath the skin] and scar treatment is initiated irrespective of the surgeon’s expectations of resultant scarring,’ says Dr Barker. ‘Keloid scars can, however, occur and patients need to be aware of this. There can be some sensory change in the breast, although this is true of only a small percentage of patients. In addition, breastfeeding after breast reduction surgery is generally unpredictable.’

Smaller breast reductions are done as day-case procedures, under local anaesthetic with conscious sedation, and patients go home the same day. Larger reductions may require overnight admission. Drains are often used in these cases and are usually removed the following morning.

Most patients are encouraged to be up and about as soon as possible, doing household chores. ‘After a week, I encourage them to resume their normal physical activities, provided these don’t involve any jarring motions, for example, no jogging, horse riding, mountain biking, etc. that would involve jarring of the upper torso,’ says Dr Barker. ‘Patients may, however, commence hiking, walking or doing exercises that work on areas other than the upper torso.’

Follow-up takes place a week after the operation, when dressings are changed, sutures are trimmed and all is checked.

Patients may usually return to all physical exercises about one month after the operation.  

Mediclinic hospitals, day clinics and staff are ready to welcome you. If you are interested in having breast reduction surgery, schedule an appointment with one of Mediclinic's expert plastic surgeons for an initial consultation.   Breast reduction surgery is one of the surgeries now offered to private paying customers as a Fixed Fees procedure. Find out more here: https://mediclinicprivatefixedfees.co.za/