What To Know About Getting A Breast Reduction
First – how common is breast reduction surgery?
“It’s more common than you might think. According to statistics from The British Association of Aesthetic Plastic Surgeons (BAAPS), 28,000 cosmetic procedures were carried out by BAAPS members in 2019. It’s therefore estimated that around 50,000 cosmetic procedures are performed each year in the UK, across all providers. The two most popular procedures for women are breast augmentation and breast reduction. In 2019, 6,888 women had a breast augmentation, down 11% on the previous year, while 3,949 had a breast reduction, down just 2% year-on-year. I see two major groups in terms of demographics. Firstly, the 18–25-year-olds with very large breasts that inhibit almost everything they do – they are keen to take action for their future life. Then there is the older demographic of women who are often peri menopausal. Their breasts often grow later in life out of proportion with the rest of their frame.”– Mr Paul Harris, specialist registered plastic surgeon
What are the main reasons why a woman would want to have a breast reduction?
“For starters, a breast reduction is appealing if you are the right candidate – it has the highest satisfaction rate of all plastic surgeries as it’s both functional and aesthetic. The most common reasons why a woman would want to pursue the surgery include back, neck and shoulder pain; an inability to exercise and wear certain clothes; social embarrassment; comments from strangers; and sometimes difficulty with work. One of my patients was a police officer who was unable to wear her stab vest comfortably, for example.” – Dr Dan Marsh, plastic and cosmetic surgeon
How many cup sizes can you do down – what’s realistic?
“This tends to be based on patient preference – it’s not possible to go from a GG cup to an A cup, but it’s usually possible to achieve what the patient wants. Most patients want to go down to a C or D cup. I usually remove around 500g of breast tissue per side but this can be up to 1.5kg per breast depending on how much needs to be removed.” – Dr Marsh
“Cup sizes form part of the pre-operative discussion but these are not accurate. Bra sizes also vary between manufacturers and many patients have never been formally measured. For this reason, no guarantee of an exact size can be given. Some recent advances in 3D imaging have now made it possible to simulate a certain weight reduction based on 3D photography of the patient. Such technology is used routinely in breast augmentation, but this hasn’t made its way into routine breast reduction practice yet. Ultimately, most women choose a final breast size that’s proportionate to their frame and one that maintains femininity.” – Mr Harris
How does the process work?
“Every doctor is different, but in my practice, the process starts with a patient consultation. This is an hour-long meeting where we discuss patient history, expectations, your options, and some information about the complications of surgery. After this appointment, you’ll be sent a letter with more information and quotes for the surgery. Around two to three weeks before the operation, you’ll have another 30-minute meeting with me to discuss the process further and answer any questions you may have. This is followed by a meeting with a specialist breast nurse – they will chat to you about admission to hospital, scarring, post-op wound care and bras. You will then have some pre-op tests and assessments. Three days before the operation, you’ll attend the hospital for a Covid swab and any other necessary pre-op investigations. You will then need to self-isolate between the Covid swab and admission.” – Mr Harris
What happens during the procedure?
“The operation involves first lifting the nipple into a new position, keeping it attached on a pedicle of tissue. Excess skin and breast tissue is then cut away, and the skin and tissue left is reshaped into a smaller, higher breast and the nipple is put back in place. Liposuction is then carried out on the chest wall to narrow the breast. There are two types of breast reduction. The most common is the anchor type, or inverted-T reduction. When this happens, the cut starts around the nipple, travels straight down and then along the crease under the breast. If only a small amount of tissue needs to be removed, however, something we call a peri-areolar reduction is carried out. With this type of reduction, the only scar is around the areola (the darker skin around the nipple). This option is often used when only one breast needs to be made smaller to match the other.” – Mr Harris
How long does the surgery take?
“The operation takes around two-and-a-half hours and is performed under general anaesthetic. Patients tend to stay in hospital for one night and are usually fit to leave hospital the following morning.” – Mr Harris
How long do the results last?
“The smaller the breasts, the longer lasting the results will be. All breasts will drop again over time due to gravity, and the bigger the breast the more they will drop. The nipple position tends to stay, although the breast shape will change and can become heavier at the bottom part. Breast shape will always change with weight gain and pregnancies.” – Dr Marsh
What’s the recovery like?
“You’ll need help at home for the initial 48 hours. After two weeks you can go back to non-physical employment (such as a desk-based job), and three weeks after the operation you can resume gentle exercise, but violent movements, such as upward stretching of the arms and physical employment are not recommended for six weeks. You can sleep on your back or side but not on your stomach for at least four weeks. You can expect to be back to normal by six weeks following the operation. However, it takes 12-18 months for scars and any numbness to settle.” – Mr Harris
What kind of scars are you left with?
“Scars are an individual response to surgery and vary between individuals and from one part of the body to another. In general, they fade and soften over a period of one year. However, they will never disappear entirely. Occasionally, in very young and/or darker skinned patients, the scars can thicken, become raised and itchy after surgery (scar hypertrophy) and in severe cases become keloidal. This is very rare and can be treated should it develop.” – Mr Harris
Can having a breast reduction affect your ability to breastfeed?
“Studies have shown patients with breast reduction have the same rate of breastfeeding as the general population who haven’t had surgery. However, I always warn my patients they may not be able to breastfeed and if this is a major concern they should wait until after having children before having a breast reduction.” – Dr Marsh
“The ability to produce breast milk depends on the breast gland being connected to the nipple by the breast ducts and these ducts are usually cut during surgery. Although some women are able to breastfeed after a breast reduction, this is the exception rather than the rule. It should be assumed that breastfeeding will not be possible after breast reduction surgery, unless it’s just a peri-areolar procedure.” – Mr Harris
Is there a risk of complications?
“All surgery comes with risks of complications – most commonly with a breast reduction it’s that there may be delayed healing at certain parts of the scar. Infection and haematoma (acute bleeding within one of the breasts) is always a possibility with surgery but isn’t common. At the same time, it’s important to remember that both breasts are usually different sizes so it’s impossible to guarantee absolute breast symmetry – breasts will often heal at different rates and some asymmetry can persist although it is usually minor. Total nipple loss is a potential complication but again is very rare.” – Dr Marsh
“Loss of feeling in the nipples is common in the first few months post-surgery, and in about 10% of patients this persists, more commonly in patients with very large breast reductions. Often such patients will have had poor sensation before surgery. More importantly, the nipple may not respond well to being elevated to its new position, which may result in scabbing of the surface of part of the nipple and subsequent discolouration. Very rarely the nipple may perish, either partially or completely. Fat necrosis, on the other hand, occurs more commonly. If the breast is very fatty, then when it is incised some areas of fat may lose their blood supply and die. This will become evident in the postoperative period with an area of hardness in the breast. In most cases, it resolves without treatment, over a three-to-six-month period.” – Mr Harris
Finally, what does it cost – and can you get a breast reduction on the NHS?
“It depends on both the surgeon and hospital. Central London tends to be more expensive, as are very specialised surgeons, but prices for the procedure tend to range from around £6,500 to £8,500.” – Mr Harris
“Getting it done on the NHS will depend on the Trust. For example, my local Trust guidelines are that patients must have at least an HH cup as well as a BMI of 28 or below. With the current Covid backlog, it’s unlikely the NHS will be doing breast reductions in the near future.” – Dr Marsh
For more information visit PaulHarrisPlasticSurgeon.co.uk and follow Dr Dan Marsh on Instagram @Dr_DanMarsh
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