Hospital:

Breast Reduction Surgery: What to Expect Before, During & After

April 6, 2021

If you’re considering a breast reduction, there’s a lot to know about the process. We sat down with Jefferson Health – New Jersey’s Corinne L. Rieser, PA-C, board-certified in plastics and reconstruction, to get the facts.

First thing’s first: breast reduction is a common surgical intervention for many women who experience physical complications – such as chronic back, neck, and shoulder pain; deep shoulder grooves; and chronic rashes – and emotional distress (from these hindrances) secondary to the weight of larger breasts.

Anyone who has experienced such complications that haven’t been successfully managed through other efforts (i.e., OTC or RX medications for pain relief, chiropractic treatment, physical therapy or ointment), and is otherwise in good health, is eligible for breast reduction.

“We’ve seen patients at all ages, from 16 (with parental consent) to 70,” explained Rieser.

What to Know Before:

Your care team will work closely with your insurance company to gain approval and ensure they have all evidence needed to support breast reduction as a medical necessity.

“A multivitamin and vitamin C supplement should be taken for several weeks prior to surgery to enhance scar and wound healing,” said Rieser. “Plus, if you smoke, it is highly recommended that you stop – or at least cut back – prior to surgery to reduce surgical risks.”

In terms of pre-operative tests, a standard blood work-up will be ordered to ensure minimal surgical risk, as well as an EKG (if you have a history of cardiac issues) and a mammogram (if you’re 40+). Patients will continue to get mammograms following reduction, but it’s best to provide a baseline.

Maintenance medications are reviewed at your pre-operative visit and you will be instructed on which medications ma need to be stopped in anticipation of surgery OR which medications you may take the morning of surgery.

What to Know During:

Breast reduction surgery is an outpatient, same-day procedure. It typically takes around two-and-a-half to three hours, from start to finish. The surgeon will remove excess tissue, fat, and skin to achieve the patient’s desirable breast size.

There are a couple of different incision techniques, but at Jefferson Health – New Jersey, Dr. Brett Garber uses an inferior pedicle approach, resulting in an “anchor” scar: a circular incision around the nipple and areola; a vertical line connecting this circle to the bottom of the breast; and a semi-circular shaped incision along the crease where the breast meets the chest, explains Rieser.

The general anesthesia guidelines of no alcohol 24 hours prior and no food or liquid after midnight (before the day of surgery) are to be followed.

What to Know After:

Recovery can be split into two periods: short- and long-term.

Short-term (the first four weeks):

  • During this time, patients should avoid heavy lifting (anything greater than 10 pounds) and upper extremity movements (such as reaching, pushing, or pulling), says Rieser. This helps reduce stress to the incisions. Most patients feel back to “normal” after two weeks, so it takes a conscious effort to refrain from this kind of activity.
  • Patients are dressed in a surgical ace wrap, with a drain in each breast, until their first post-operative visit. This is typically one to three days after surgery. During this time, showering isn’t permitted.
  • At the first post-op visit, patients are given a special sports bra that fastens in the front and is gentle on the incisions. This bra is to be worn 24/7 – including in bed – for four weeks, says Rieser. Showering (with special precautions) is allowed after this.

Any complications – while incredibly rare – most commonly occur in this time period. Signs/symptoms to keep an eye on include high-grade fevers (greater than 101); redness or drainage at the incisions; and/or asymmetrical swelling of the breasts says Rieser. If you experience any of these, call your surgeon’s office right away.

Long-term (up to six months):

  • During this time, scars will fade, swelling will resolve, and sensation should return to the nipple and areola area (however, this is not guaranteed). Keep in mind, the most accurate results of your desired “cup size” – measured by the surgeon in grams – appear after all swelling has subsided.  
  • To promote healthy scar healing, patients can continue their vitamins, use a silicone-based gel to keep the skin hydrated, and use vitamin E (either orally or topically), says Rieser. If using both silicone and vitamin E, they should be alternated (i.e., one in the morning, one at night). 
  • After one month, patients can transition from a sports bra to a soft cup bra or bralette, if desired. However, it is recommended that patients maintain wearing one the previously mentioned supportive garments. Underwire should be avoided for at least six months.

Breastfeeding is one of the biggest concerns faced by women of child-bearing age after breast reduction surgery, notes Rieser. There is conflicting research on this, but many studies indicate that with the inferior pedicle approach, the milk ducts are less commonly affected, thus increasing the likelihood of preserved breastfeeding function. However, every case is different, and sometimes diminished nipple sensation can play a role in breastfeeding reflexes. (An OB/GYN and lactation expert can provide assistance with this.)

Overall, breast reduction can help give women their lives back. The greatest benefits are often relief from physical limitations, a new-found sense of confidence, happiness, and comfort, says Rieser. What are you waiting for?

To learn more about breast reduction surgery and other Plastic & Reconstructive services offered at Jefferson Health – New Jersey, click HERE.