A breast reduction (reduction mammaplasty) is a cosmetic surgical procedure that involves the removal of excess breast fat, glandular tissue, and skin with the goal of achieving a breast size that is proportional to the rest of your body and alleviating the discomfort associated with overly large breasts. Breast reduction surgery, in certain cases, can be covered by the provincial Health Insurance Plan (Régie de l’assurance maladie du Québec, RAMQ).
Before & After photographs shown on this site are actual patients of Dr. James Lee who have given their permission to have their photos published online. They are for illustrative purposes only; individual results vary. We do not guarantee outcomes and no prediction of outcome is implied. Individual healing characteristics and unexpected complications can affect the outcome of any surgery.
2. IDEAL CANDIDATES
Breast reduction surgery is a safe and effective treatment option to help alleviate the physical and/or emotional discomfort experienced by women with overly large breasts. The surgery will not only enhance your body image, but it will help improve your quality of life by eliminating the pain and physical repercussions associated with having large breasts, while also allowing for a more active lifestyle.
In general, ideal candidates for breast reduction surgery are healthy, non-smoking females who:
- Are emotionally bothered by the fact that their breasts are too large
- Are unable to lead an active lifestyle as a result of their large breasts
- Experience physical discomfort (i.e. back, neck, and/or shoulder pain), poor posture, or shoulder indentations from bra straps, owing to the weight of their breasts
- Have skin irritation at or beneath the breast crease
- Have realistic expectations
Breast reduction surgery can be performed at any age; but preferably after the breasts have fully developed. You should also know that future pregnancies and/or significant weight fluctuations can alter the outcomes of your breast reduction surgery.
3. THE PROCEDURE
The procedure is performed under general anesthesia.
Breast reduction can be performed through a variety of incision patterns and excision techniques. The two most commonly used breast reduction techniques are the vertical mammaplasty and the inverted-T (Wise) pattern breast reduction. These techniques use slightly different incision patterns to remove excess skin, fat, and glandular tissue from the breasts. Consequently, the location of the scars on your breast will depend on the breast reduction technique that is used (See section on “Incisions/Scar pattern and location” below).
Generally speaking, the best candidates for a vertical mammaplasty are women who only require a small to moderate reduction in breast size whereas an inverted-T pattern breast reduction is more appropriate for women requiring a moderate to large reduction.
3.2.1. INCISIONS/SCAR PATTERN AND LOCATION
A. VERTICAL MAMMAPLASTY
- The incisions used to perform a vertical mammaplasty will result in a “keyhole” (or “racquet-shaped”) scar that circles the areola and extends vertically down to the breast crease.
B. WISE PATTERN BREAST REDUCTION
- The incisions used to perform an inverted-T pattern breast reduction will result in an “ìnverted-T” (or “anchor-shaped”) scar that circles the areola, extends vertically down the middle of breast, and horizontally along the breast crease.
Although scars are permanent and visible on the breast, they are well concealed when wearing a swimsuit or bra.
3.2.2. TISSUE REMOVAL
- If necessary, the size of the areola is reduced by excising excess skin from its periphery.
- Excess skin, fat, and glandular tissue are subsequently removed to reduce the size of your breasts.
3.2.3. NIPPLE REPOSITIONING AND CLOSURE OF INCISIONS
- The nipple is positioned into its new location.
- The remaining breast tissue rearranged in order to lift and reshape the new, smaller breasts.
- The skin incisions are brought together and closed in multiple layers with absorbable sutures.
- Excess fat (or “fat rolls”), that extends from the lateral aspect of the breast and onto the chest wall, becomes more apparent once the breasts have been reduced in size. For this reason, liposuction is commonly performed as an adjunct to breast reduction surgery to remove excess fat from the lateral chest wall which can be quite unappealing if left behind after the breasts have been reduced in size.
NOTE: Liposuction is not covered by provincial health insurance plan (RAMQ).
4. PREOPERATIVE CONSULTATION
Dr. Lee will perform a thorough medical evaluation during your consultation to ensure that you are medically fit for surgery. He will also revise your medication list, as certain medications may need to be temporarily stopped before your surgery.
After carefully evaluating your breast anatomy and assessing your aesthetic goals, Dr. Lee will review your available surgical options and help you choose a breast reduction technique that will allow to achieve your desired results. The following factors will be taken into consideration by Dr. Lee throughout the decision-making process: your body weight and height; the size, symmetry, and composition of your breasts; as well as your desired final breast size.
Since smoking is known to be associated with poor/delayed wound healing, wound dehiscence, wound infections, and increased scarring postoperatively, smokers will be asked to stop smoking 4 weeks prior to surgery, and for at least 2 weeks postoperatively1.
Patients will also be scheduled for routine pre-operative blood testing and an electrocardiogram 1-2 weeks before surgery. Dr. Lee may also recommend that you undergo a pre-operative baseline mammogram, as this helps detect future changes in your breast tissue. If necessary, further recommendations will be made once the results of these tests have been reviewed.
The operation is performed on an outpatient basis and most patients are permitted to go home a few hours after surgery.
There will be dressings over your breasts after surgery. You will also be given a surgical support bra to wear for the first 4 to 6 weeks. Before leaving our facilities, you will be given specific instructions on how to care for your breasts and surgical wounds throughout your recovery. It is imperative that you follow these recommendations in order to minimize the appearance of your scars and to optimize your final results. Dressings should be left in place until your first post-operative visit with Dr. Lee, at which point he will assess your wounds and if necessary, apply new dressings.
You may experience some discomfort following surgery; however, this can be controlled with the pain medications which will be prescribed for you. Some swelling and bruising are expected for the first 3-4 weeks after surgery. Although the results of your breast reduction surgery will be immediately apparent, it may take up to 6-12 months for you to completely heal and achieve your final look.
Most patients are able to return to work or school after about a week of convalescence. For the first 4-6 weeks, patients are asked to sleep on their backs, and to avoid bending over, lifting their arms above their shoulders, or lifting anything over 5 pounds. Light exercises are permitted at 2 weeks, while regular exercise and activities can be resumed at 4-6 weeks.
6. RISK AND COMPLICATIONS
As with any surgery, there are risks associated with breast reduction surgery. Smoking, diabetes, peripheral artery disease (poor circulation), as well as heart, lung, or liver disease may increase your risk of perioperative and/or post-operative complications.
- Risks associated with anesthesia
- Bleeding (hematoma)
- Changes in nipple or breast sensation, which may be temporary or permanent
- Fluid accumulation (seroma)
- Poor wound healing
- Breast asymmetry
- Breast contour and shape irregularities
- Excessive firmness of the breast
- Potential inability to breastfeed
- Potential partial loss of skin/breast tissue where incisions meet each other
- Potential partial or total loss of nipple and areola
- Skin discoloration and/or prolonged swelling
- Potential of fat tissue deep to the skin dying (fat necrosis)
- Deep vein thrombosis
- Cardiac and pulmonary complications
- Possible need for revision surgery
Scars form as the body’s natural response heal tissues. As with any scar, the extent of post-surgical scarring depends on a number of modifiable factors (i.e. avoidance of UV light exposure, tension-free wound closure, appropriate wound care, etc.) and non-modifiable factors (i.e. patient age, comorbidities, skin type, genetics, etc.). While it is not possible to perform scar-free surgery, Dr. Lee makes every effort to minimize the appearance of your post-surgical scars through careful pre-operative planning, the use of meticulous surgical technique, and by ensuring appropriate wound care and follow-up post-operatively.
It is not unusual for scars to appear red and be slightly raised/firm for the first 4-6 weeks following surgery. Scars will flatten and become more pale over time, and can take up to 12 months before achieving their final appearance.
Dr. Lee will thoroughly discuss these risks (and possibly others) with you and answer any questions you might have prior to obtaining your consent for surgery.