AN breast reduction qxd

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      Tel: 020 8735 6060
                                                                                                                                      breast reduction
    One of the most satisfactory operations                                        Pathology                              How do we do a breast reduction?
    for patients and surgeons in the whole                                         ■ Large breasts in young girls just    There are many ways of doing
                                                                                     after puberty are caused by          this operation.
    field of cosmetic surgery.                                                       excessive hormone sensitivity        No procedure is suitable for every
                                                                          Before     to normal levels of oestrogen/       situation. Beware of the surgeon who
    Anaesthetic: general                                                             progesterone.                        does it only one way.
    Case time: 2.5 hours; 1 night stay                                             ■ Occasionally young girls can
    Recovery time: 2 weeks to heal, 6 weeks until full activity                      develop extremely large breasts:     ELEVATION
                                                                                     Called virginal gygantomastia.       All methods depend on the Nipple-Areolar
                                                                          After      In these cases the breasts           complex (NAC) being lifted to a new position
    Breast Reduction                                                                 may further regrow after             higher on the breast. A circular scar always
    Anatomy - Physiology                                                             breast reduction.                    surrounds the NAC. The nipple remains
                                                                                   ■ Most ladies’ breasts after breast    attached to the underlying breast tissue,
    ■ The female breast is a modified sweat gland of the                                                                  except in the free nipple graft procedure for
                                                                                     feeding undergo ‘involution’ (they
      skin whose function is to produce milk.                                                                             very large breasts, so nipple sensation is
                                                                                     get smaller), and droop because
    ■ It is present as a glandular bud at birth.                                     the supporting ligaments are         retained in 9 out of 10 cases and breast
    ■ It grows at puberty under the stimulation of hormones                          stretched.                           feeding can often follow breast reduction.
      oestrogen and progesterone.                                                  ■ 1 in 15 women in the UK develop      REDUCTION
    ■ Whether you have a large or small breast depends on the                        breast cancer. Studies have
      sensitivity of the breast bud to these hormones.                                                                    A variable part of the lower breast is
                                                                                     shown that Breast Reduction
                                                                                                                          removed to reduce the size of the breast.
    ■ The breast consists of breast tissue and fat. Their size will                  reduces your risk and it does not
      also be influenced by your overall degree of fattiness (obesity).              interfere with mammograms.           GLANDULOPLASTY
                                                                                     Ladies aged 50 and over should
                                                                                                                          The breast is re-shaped into a round ‘cone’
                                                                                     have a mammogram before
    Anatomy of the Breast                                                                                                 reducing the width of the breast.
                                                                                     breast surgery.
                                                            Pectoralis                                                    SKIN TAILORING
                                                            major                                                         The skin is then ‘tailored’ to the new size
                                                                                                                          and shape of the underlying breast.
                                                                                                                          This results in further scars:
                                                                                                                          - A vertical scar from the NAC to the
                                                                                                                             infra-mammary groove.
                                                                                                                           - And a further transverse scar under
                                                                                                                             the breast.
                                                                                                                          In many breasts we use only a vertical scar
                                                                                                                          with no transverse inframammary scar:
                                                                                                                          ‘A VERTICAL SCAR BREAST REDUCTION’

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                                                                                                                                 breast reduction
    Operation: How we do a breast reduction?                                         Examples of results of vertical scar breast reduction

                                                                                              Before Operation                   After 6 Months

                                                                                     Breast reduction

                    Before                 Nipple Areola Complex elevated to new
                                                normal position on a pedicle

                                                                                              Before Operation                   After 6 Months

       Excess breast tissue excised from   Scars of vertical scar breast reduction
               breast inferiorly
                                                                                              Before Operation                   After 6 Months

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                                                                                                                            breast reduction
    Examples of results of vertical and transverse scar breast reduction    Pre-Operative Instructions                ■ You will need to spend one
                                                                            ■ Mammogram if over 50 or strong            night in hospital so prepare
                                                                              family history of breast cancer.          an overnight bag and organize
                                                                                                                        somebody to escort you home
                                                                            ■ No aspirin, Nurofen or vitamin            the following day.
                                                                              supplements for 2 weeks prior
                                                                              to surgery.                             ■ Lose weight.
                                                                            ■ Stop smoking or aim to cut down         ■ Stop breast feeding at least
                                                                              smoking 1 week before and stop            3 months before surgery.
                                                                              completely three days prior to the      ■ Previous breast reduction is not
                                                                              operation. Complications are              a contra-indication.
        Before Operation        Three months after         After 6 Months     increased in smokers.                   ■ Organise someone to take you
                                                                            ■ Arnica, an homeopathic anti-bruising      and bring you back from
                                                                              agent: Take 7 days pre-op and 7 days      hospital.
    Examples of results of free nipple breast reduction                       post-op. Our personal experience is     ■ Leave plenty of time and allow
                                                                              that bruising is less.                    for traffic problems. Make sure
                                                                            ■ Bring a well fitting sports bra           you plan your route in advance.
                                                                              (not underwire) into hospital to        ■ Leave your jewellery, valuables
                                                                              wear immediately after the operation      at home.
                                                                              over dressings.                         ■ Bring a credit card with you to
                                                                            ■ If drains are used they will normally     cover any extras you may order.
                                                                              be removed the following day before
                                                                              leaving the hospital.
        Before Operation        Three months after

        Before Operation         Three months after

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                                                                                                                         breast reduction
    Early Complications                                             Operative Experience                         Teaching Experience
    Associated with General Anaesthesia - (rare):                   ■ Plastic Surgery Partners has a long        and Presentations
    ■ Chest infection.                                                experience in breast surgery both          ■ Publication of our own technique
    ■ DVT.                                                            reconstructive and aesthetic because         of breast reduction: Asplund OA,
                                                                      of our long association with the             Davies DM. Vertical scar breast
                                                                      breast surgery/plastic surgery unit at       reduction with medial flap or
    Associated with Breast Reduction                                  the Charing Cross Hospital offering          glandular transposition
    (early complications):                                            patients the very best in overall breast     of the nipple-areola.
    ■   Haematoma.                                                    care, diagnosis and treatment.               British Journal of Plastic Surgery
    ■   Infection.                                                  ■ With Dr. Asplund at the Charing Cross        1996 Dec;49(8):507-14.
    ■   Pain.
                                                                      Hospital we introduced the technique       ■ Institute of Cosmetic and
                                                                      of medial pedicle-vertical scar breast       Reconstructive Surgery. Stamford
    ■   Poor Wound Healing. Skin necrosis. (Rare).                    reduction which is now widely                Hospital. Masterclass in Breast
    ■   Nipple areola necrosis.                                       practiced in Europe and North                Reduction. May 2000.
    ■   Fat necrosis.                                                 America.                                   ■ ISAPS: Vertical scar breast reduction.
                                                                    ■ Last year we undertook 63 breast             Tokyo 2000.
                                                                      reduction procedures and our               ■ ISAPS: Vertical scar breast reduction.
    Longer Term Complications after
                                                                      partners with their experience of over       Beirut-Lebanon 2001.
    Breast Reduction                                                  30 years have undertaken over 1500
    ■ Breast Asymmetry.                                                                                          ■ ISAPS: Vertical scar breast reduction.
                                                                      breast reductions.
                                                                                                                   Istanbul 2002.
    ■ Poor shape.
                                                                                                                 ■ Hellenic Association of Plastic
    ■ Poor scarring.
                                                                                                                   Surgeons. Athens. Vertical scar breast
    ■ Change in nipple-areola sensation.                                                                           reduction. September 2003.
    ■ Fat necrosis leading to inflammation and longer lasting                                                    ■ West London Clinic Breast Surgery
      lumpiness/pain.                                                                                              Masterclass 2008.
    ■ So called ‘Dog ears’ at end of wounds. May require revision                                                ■ BOOKS: The ABC of Plastic Surgery
      under local anaesthetic.                                                                                     published by the BMJ, Safe Cosmetic
    ■ Adjustments.                                                                                                 Surgery and recently Plastic Fantastic.
    ■ Chest wall discomfort.

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                                                                                                                                                breast reduction
     Discharge Information                                                               Lumpiness: As the breast tissue is             Any problems, please contact
                                                                                         healing the breast may feel a little lumpy     Plastic Surgery Nurse Consultant,
     Dressing Clinic: You will be given a follow up
                                                                                         or hard in areas. This is because of the       Mon-Fri 8-5p.m. 020 8735 6060
     appointment to attend the dressing clinic 10 days
                                                                                         presence of scar tissue and will soften
     following surgery to have your dressing removed by                                                                                 Other contact information for all
                                                                                         over a period of a few months.
     the nurse. You will also be seen at 17 days post op for                                                                            hospitals including out of hours for our
     another wound check. Please try to keep the dressing                                Appearance of the Breast: It is not            Plastic Surgery Nurse Consultants will be
     intact and dry until then. Your stitches will dissolve on                           unusual for the skin to be bunched             provided at the time of booking surgery.
     their own and do not need to be removed.                                            and creased with a vertical scar after
                                                                                         reduction, like tummy skin after
     2 Sports Bras: Wear your own good fitting bra
                                                                                         pregnancy it will flatten after a few weeks.
     (not underwired) immediately after the operation.
     Bring it into hospital. It is preferable that you buy                               Out patient appointment: This will be
     2 bras prior to surgery in case you need to wash one.                               made for you to see the consultant 4-6
     The sports bra should be worn day and night for                                     week following surgery.
     approximately 6 weeks. An underwire bra may be                                      If you experience problems such as pain
     worn after the first month, but then only occasionally.                             or swelling particularly in one breast, if
     Swelling: Most of your swelling will be in the first week                           you feel unwell with a high temperature,
     following surgery, then it begins to slowly subside.                                please contact the practice as soon as
     Any swelling/bruising will take approximately 3-4 weeks                             possible for advice.
     to resolve or sometimes a little longer. Note that the swelling
     is slower to subside in warmer conditions.
     Try to sleep on 3-4 pillows for 1 week to reduce swelling, then you
     may start to reduce the pillows. The swelling may be more obvious
     in one breast than the other, this is due to more bruising within that
     particular breast.
     Exercise Arm movements: Try to avoid strenuous exercise or yoga
     for 4-6 weeks, and no swimming for 2-3 weeks following surgery.
     Try to limit arm movements for 2-3 weeks, then gradually
     increase movement.
     Bath/Shower: You may have a bath or shower, ensuring to dry the scars
     thoroughly with a towel, when instructed to do so. Please do not use talcum
     powder on the scars.
     Arnica/Creams: Continue to use arnica for 7 days after operation.
     When the scars have healed (approximately 10-14 days) apply minimal
     amounts of vitamin “E” oil to help the scars fade, and to soften any scar tissue.
     You can also use E45 cream or aqueous cream if preferred.

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              how to contact us
              Tel: 020 8735 6060



                 Cardiff       Windsor      Harley Street
                                          West London


    Plastic Surgery Partners
        55 Harley Street,
       London W1G 8QR
      Tel: 020 8735 6060

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