Expert guide to Breast Reduction

Breast reduction surgery is one of the most popular cosmetic operations with over 6,000 procedures carried out per year in the UK.

As a procedure, I think it’s a little bit of a paradox. It’s technically classified as a ‘cosmetic’ procedure, but nearly all of my patients want breast reductions for reasons that concern practicality and comfort.

Many suffer from back ache, neck pain and soreness due to large breasts. They also find it uncomfortable to exercise and activities involving running and jumping prevent them from enjoying physical pastimes. Many suffer from weight issues too, as a result of avoiding exercise

Male patients may ask for breast reduction due to gynaecomastia, a condition that causes boys’ and men’s breasts to swell and become larger than normal. It is most common in teenage boys and older men. Changes in hormone levels as you grow older and weight gain can contribute to developing gynaecomastia.

What the procedure entails

Surgery primarily aims at reducing the size of the breast, which requires adjusting the shape to an acceptable appearance and involves repositioning of the nipple. The most critical part of breast surgery is repositioning the nipple with a good cosmetic outcome, but without risking cutting off its blood supply. For minor reductions, this is usually no problem but in larger reductions, the risk of losing the nipple increases.

Important time-frames to consider

• Breast reduction usually takes around 3 hours under a general anaesthetic and can be done as a day case or as an overnight stay
• Most patients can return to light activities after 2 weeks
• To moderate activities after 6 weeks
• To heavy work or extreme sports after 3 months.
• Driving a car is often possible 3 weeks after surgery
• There will initially be some bruising and swelling and it takes several weeks to months to see the final outcome.

Why do some patients choose to wait so long before getting a breast reduction?

Breast reduction used to be readily available on the NHS, so I had more patients referred to me in the past. Now the availability of breast reduction surgery varies greatly, depending on much stricter eligibility criteria. Often prospective patients are turned away by their GP, even if the issue is affecting their mental health. Most breast reduction surgeries are now self-funded.

For older patients, there tend to be some psychological reasons for taking so long to have surgery. In my experience, older individuals tend to feel a sense of guilt about having this type of surgery, as they are concerned they are being vain and extravagant spending money on such a procedure.

Lots of younger men who want a breast reduction are often not yet financially independent, which means possibly asking family members for financial support when it comes to surgery. Some men find this quite embarrassing and it takes them a while to overcome these feelings and to pluck up the courage to ask for help.

In your opinion who are the best candidates for surgery?

In general, the best patients are those who have realistic expectations and want the procedure for practicality reasons.

Patients who are unsuitable are those who think surgery is a ‘quick fix’ to help them lose weight. No amount of surgery will replace the benefits of exercise and it should not be considered as a weight loss management programme.

In general, I do not really like to operate on patients who are younger than 18 for purely cosmetic reasons. However, if the individual is experiencing lots of functional problems, or are psychologically affected and have parental support, I believe in these cases surgery can be a suitable option.

For example; I had a 17-year-old girl as a patient a while back who had JJ breasts and wanted a breast reduction. When explaining the potential risks and complications, I told her she could possibly lose her nipples during the procedure. She replied to this saying ‘I don’t care, you could cut my nipples off – as long as my breasts were smaller I would still be happy’.

For someone that young to say they were ok with something like that happening, made me realise how deeply troubled she was by the size of her breasts. In these cases, not operating could’ve unnecessarily prolonged her psychological suffering.

Concerns and risks

For younger women, a big concern is losing nipple sensation or the ability to breastfeed. This is less of a worry for older female patients, who may have already had children.

As with any surgery, complications can happen. Major complications are fortunately rare and most minor complications can be managed without affecting the final outcome significantly. Complications include bleeding, infection, scar problems, asymmetry, loss of nipple sensation, loss of breast feeding abilities and loss of nipple.

Enhancing recovery

Although complications can’t be avoided entirely, there are things that can be done to improve the chances of a good outcome. Factors which can negatively affect healing are smoking, alcohol or poorly controlled medical conditions such as diabetes.

A healthy lifestyle involving drinking lots of water and a diet rich in protein and vitamin C can help with wound healing.

By Hagen Schumacher