BREAST HYPERTROPHY SURGERY
or REDUCTION MAMMOPLASTY
Aesthetic surgery:
This document has been conceived under the authority of the French Society of plastic Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIMS AND PRINCIPLES
Mammary hypertrophy is defined by a breast size too large, particularly in relation to the morphology of the patient.
This excess volume is generally associated to sagging breasts (ptosis) and sometimes to a certain degree of asymmetry.
The breast enlargement almost always involves a physical and functional impact (pain in the neck, shoulder and back discomfort for sports, clothing difficulties). There is also a frequent significant psychological impact. These disorders justify the assumption by health insurance under certain conditions.
The surgery aims to reduce breast size, correction of ptosis and a possible asymmetry in order to get both breasts harmonious in themselves and in relation to the morphology of the patient (both breasts reduced and lifted, symmetrised and remodelled).
The procedure performs the removal of excess glandular tissue. It preserves a volume consistent with the silhouette of the patient and with their desires. This residual glandular volume is lifted, concentrated and redesigned.
Then the skin envelope must be adjusted, which requires removing the excess skin to ensure a good retention and a good shaped curve to the new breasts. The edges of the skin are then sutured: these sutures are in the origin of scars.
Often these scars are shaped like an inverted T with three components: the periareolar, around the areola between the white and brown skin; vertical, between the lower pole of the areola and the inframammary fold; and horizontal, concealed in the inframammary crease.
The length of the horizontal scar is proportional to the importance of hypertrophy and ptosis.
Sometimes, particularly when the hypertrophy and ptosis are moderate, a method called "vertical", that removes the transverse scar in the inframammary fold and reduce scarring to their periareolar and vertical components, could be used.
A mammoplasty for hypertrophy can be performed from the end of growth and beyond, throughout the duration of life.
A subsequent pregnancy is of course possible as well as breastfeeding, but we recommend waiting at least six months after the intervention.
The risk of developing breast cancer is not increased by this intervention.
BEFORE THE OPERATION
A preoperative assessment is normally conducted as required.
The anaesthesiologist will be seen in consultation at least 48 hours before surgery.
In addition to the usual pre-operative examinations, a radiological breast study is prescribed (mammography, ultrasound).
Smoking cessation is strongly recommended, at least one month before and one month after the intervention (smoking can cause delayed healing).
Stopping a possible oral contraceptive may be required, particularly when associated risk factor are present (obesity, venous disease, bleeding disorder).
No medication containing aspirin should only be taken within 10 days prior to surgery.
TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia:
This is general anaesthesia, during which you sleep completely.
Hospital stay:
Usually is required a hospitalization of one to three day.
THE PROCEDURE
Each surgeon adopts his/her own technique that adapts to each case to obtain the best results. However, some common basic principles apply:
The tissues removed are systematically sent to a specialized laboratory for examination under a microscope (histology).
At the end of surgery, a modelling bandage, with elastic bands, shaped like a bra, is made.
Depending on the surgeon and the importance of hypertrophy, the procedure can last from two to four hours.
AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
The postoperative course is usually less painful, requiring only simple analgesics.
Swelling (edema) and ecchymosis (bruises) in the breasts, and a slight pain on elevation of the arms are frequently observed.
The first dressing is removed after 48 hours and replaced with a lighter one, making a sort of elastic bra fashioned custom.
The discharge takes place one to three days after the intervention, then the patient is reviewed in the clinic two to three days later.
We then set up a bra ensuring good retention.
Wearing this bra is advised for about a month, day and night, during the recovery period of the operation.
The sutures, if they are not absorbable, are removed between the eighth and twentieth day after the intervention.
Should be considered a recovery and work leave for a period of 8 to 15 days.
It is advisable to wait one to two months to resume sport activities.
THE RESULT
It cannot be judged until one year after surgery: then the breasts have usually a smooth curve, are symmetric or very close to the symmetry, and natural looking. Beyond the local improvement, this procedure generally has a positive impact on the balance of weight, sportswear, clothing options and psychological state.
It just needed to have the patience to wait the time required for the improvement of scars and to observe during this period a good surveillance, attending the clinic about every three to six months for a year.
The operated breast is natural and sensitive, especially to hormonal changes and weight.
The goal of this surgery is to bring improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction.
DISAPPOINTING RESULTS
The essential problems are the scars, which should be carefully monitored: they frequently take a pink and swollen aspect during the second and third months after surgery; subsequently, they usually fade and become, over time, barely visible. They may however remain wide, white or instead brown.
Regarding the scars, you should know that although they fade, in general, over time, they do not disappear completely. In this regard, we must not forget that if it is the surgeon who performs the sutures, it is the patient who does the scar.
Sometimes some asymmetry of the breasts may persist, whether of the volume, height, size or orientation of the areolas.
In all cases, a secondary surgical correction may be made, but should wait at least a year or two.
POSSIBLE COMPLICATIONS
A reduction mammoplasty, although done in part for aesthetic reasons, none the less is a real surgery, which involves the risks associated with any medical procedure, however small it may be.
The surgical suites are generally simple after a mammoplasty. However, complications can occur, some general, inherent in any surgery, other locoregional that are observed mostly in cases of significant hypertrophy.
We must distinguish here between risks related to the anaesthesia and those related to the surgery.
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For the anaesthesia, the anaesthesiologist will explain the risks during the preoperative consultation. You must be aware that anaesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anaesthesiologist, in a surgical context, means that the risks are statistically practically negligible.
In fact techniques, products and monitoring methods have progressed considerably over the last twenty years, giving optimal safety, especially when the operation is not an emergency and the patient is in good general health.
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Concerning surgery: by choosing a competent, qualified Plastic Surgeon, used to performing this procedure, you limit the risks, without however eliminating them completely.
Fortunately, the real complications are uncommon following a reduction mammoplasty performed under the rules. In practice, the vast majority of interventions go without any problem and the patients are fully satisfied with their result.
However, despite their low frequency, you must still know the possible complications:
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Thrombo-embolic accidents (blood clots, pulmonary embolism), although generally very rare after this type of intervention, are among the most fearsome. Preventive measures should minimize their incidence: wearing of anti-thrombotic stockings, early deambulation, and possible use of anti-coagulant drugs.
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The occurrence of an infection requires antibiotic treatment and sometimes surgical drainage.
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A hematoma may require evacuation.
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Delayed healing can sometimes be observed, which prolongs the postoperative course.
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Necrosis of the skin or gland, in fact rarely seen with modern techniques, may be responsible for delayed healing (the risk is increased by smoking).
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Alterations in sensitivity, including the nipple, can be observed, but normal sensitivity usually returns within 6 to 18 months.
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Especially, the evolution of scars may be unfavourable, due to the occurrence of hypertrophic scars or keloids, of unpredictable onset and evolution, which can compromise the aesthetic outcome and require specific local treatment, often of long duration.
Thus, in the vast majority of cases this procedure, if well studied previously and properly performed, gives a very pleasant result in terms of comfort, even if the scarring is inevitable and the main drawback.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.