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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