A newsletter from David J. Levens, MD, FACS
Board-certified plastic surgeon
Please contact me for a free consultation with Dr. Levens.
Case Study: Breast Reduction
“After pregnancy, my breasts went from a D cup to DD which caused lots of problems,” says Donna, 23, of Tamarac. “I had back pain and deep dents in my shoulders from bra straps. It was also difficult to buy well-fitting bras and shirts.”
Donna looked to her Mom for advice…and a referral to a plastic surgeon. Mom recommended Dr. Levens.
“I’m a C cup now and I feel wonderful,” Donna reports. “And I look 100% better in clothes. Having the surgery was definitely the right decision.”
The Procedure: Before making any incisions, Dr. Levens carefully marks and photographs the patient to plan the exact locations of the repositioned nipple/areola and the scars. These marks serve as a visual guide during the procedure. The first step is to surgically reduce the size of the lower skin envelope of the breast so the breast mound can be repositioned upward. Then the nipple and areola are repositioned upward on the newly shaped breast.
To remove excess tissue from the breasts and reposition the nipple and areola, incisions are made in the lower part of the breast. These incisions produce scars, which are visible, but improve significantly over 6-12 months. The scars are usually located around the nipple, from the lower center of the areola to the fold beneath the breast, and within the fold beneath the breast.
“During this procedure, we precisely weigh the amount of tissue removed, and bring the patient to an upright position on the operating table so we can carefully compare the two breasts to assure as much symmetry as possible before closing the incisions,” Dr. Levens says. “We also regularly refer to the patient’s pre-operative pictures to assure the best possible result. All incisions are then closed with sutures beneath the skin.”
After surgery, the patient wears a soft support bra for 2-3 weeks. A small plastic drainage tube may be used to lessen accumulation of fluid. We remove it a few days after surgery. The patient can shower 2-3 days after surgery.
Breast reduction surgery rates extremely high in terms of patient satisfaction, partly because there is a reduction in physical discomfort and partly because the patient has a much better proportioned figure afterwards.
But as with any surgery, there are risks. For example, to reposition the nipple upward onto the new breast mound, some surrounding breast tissue must be detached. The nipple is generally left attached to a stalk of tissue within the breast. This is done to maintain blood supply and nerve supply, but both may be decreased after reduction. Sensation usually returns over weeks to months, but some permanent sensation loss is possible. In very large breasts, or breasts with certain configurations, the nipple may have to be completely detached and replaced as a graft. Also, while many patients nurse successfully after reduction, the ability to nurse may be lost.
Most patients say they have minimal pain after breast reduction, but often experience tightness or fullness for 48-72 hours. This diminshes as swelling decreases.
The typical schedule of recovery is: Bruising and swelling, 10-14 days; return to work & social activity, 2-3 days; aerobic or strenuous activity, 14-21 days. For about three weeks after surgery, we ask our patients to avoid highly strenuous activity and excessive, exaggerated movements with the arms.