Procedures - Breast Surgery

Dr. Weider's expertise encompasses both cosmetic and reconstructive breast surgery. His extensive training in both general and plastic surgery has provided him with a wealth of experience in all aspects of breast surgery. This includes breast reconstruction, breast reduction, breast augmentation and breast lift (mastopexy). In addition, he also treats gynecomastia (male breast disease).

Breast Reduction (Reduction Mammaplasty)

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. Unusually large breasts can make a woman or a teenage girl feel extremely self-conscious. Breast reduction, technically known as reduction mammaplasty, removes fat, breast tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple.

The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. The following paragraphs will give you a basic understanding of the procedure - when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. During your consultation Dr. Weider will make recommendations specifically for you. Please be sure to ask him to explain anything about the procedure that you don't understand.

The Best Candidates for Breast Reduction

The aim of breast reduction is usually physical relief rather than cosmetic improvement since very large, sagging breasts restrict activities and cause physical discomfort. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.

Some Risk

Breast reduction is not a simple operation but, performed by a highly qualified plastic surgeon, it is normally very safe. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Reduce the risks by following your physician's advice closely both before and after surgery. The procedure does leave permanent scars, but they will be covered by your bra or bathing suit. Poor healing and wider scars are more common in smokers.

The procedure may also leave you with slightly mismatched breasts or unevenly positioned nipples. Importantly, future breast-feeding may be impaired since the surgery involves removing many of the milk ducts that lead to the nipples. Some patients experience mild or even permanent loss of feeling in their nipples or breasts. Very rarely, the nipple and areola may lose their blood supply and the tissue will die. In such cases the nipple and areola can usually be rebuilt by using skin grafts from elsewhere on the body.

Planning Your Surgery

During your initial consultation, make sure to discuss your goals and expectations frankly with Dr. Weider. Every patient, and every physician, has a different view of what is a desirable size and shape for breasts. Dr. Weider will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He will discuss the variables that may affect the procedure such as your age, the size and shape of your breasts, and the condition of your skin.

He will also discuss with you where the nipple and areola will be positioned, since they will be moved higher during the procedure. Dr. Weider will describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He will also explain the anesthesia that will be used, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require that a certain amount of breast tissue be removed)

Preparing For Your Surgery

A breast X-ray (mammogram) may be required before surgery. You will also be given specific instructions on how to prepare for your surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Breast reduction very rarely requires a blood transfusion. Be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if necessary.

The Surgery

Breast reduction surgery may be performed in a hospital or an outpatient surgery center. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes three to four hours, but may take longer in some cases. Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation. The most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast.

Liposuction may be used to remove excess fat from the armpit area. In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.) Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the portion of the scar in the crease below the breasts.

After Your Surgery

After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two. Naturally you are likely to feel some pain for the first couple of days, especially when you move around or cough, and may feel some discomfort for a week or more. Dr. Weider will prescribe medication to lessen the pain. The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks until the swelling and bruising subside.

Almost all the stitches used will simply dissolve so very little removing of stitches is required. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry. Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting Back To Normal

Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. You will have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You'll also need a good athletic bra for support. You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks. A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don't hesitate to call your doctor.

Your New Look

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy. Dr. Weider will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, and then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better. However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be pleased with the results.

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