The size of women's breasts may be determined by several factors, such as inherited genes, body weight and hormonal influences. They can, therefore, be a problem to some women early in adolescence or may not become uncomfortable until middle age following the menopause or the use of HRT. The problem of large breasts, however, may cause similar problems at all ages and these are chiefly backache, neck pain, grooves in the shoulders from bra straps, rashes under the breasts and the feeling of self consciousness. Because of the sexual nature of breasts, the undue prominence may attract unwanted attention from the opposite sex, comments and sexual innuendos. These can cause psychological distress to many women. One of the commonest complaints of women with large breasts is that it is very difficult to wear fashionable clothes and indulge in active sports, particularly in the summer months.
  What can be done?
Reduction mammaplasty is an operation which removes the excess fat and skin from the breasts, which are then reshaped and the nipples repositioned to form newer, smaller breasts. This should result in more attractive breasts and reduce many of the problems outlined above. There are several different surgical designs to reshape the breasts and are illustrated here. All of them will involve a scar around the areola of the breast. Each method will use different scars and will have advantages and disadvantages and your surgeon may select, with your approval, the best technique in your particular case.

Will the improvement last?
Unless your operation is done at an age when your breasts are still growing they should not re grow afterwards. They will, however, increase in size if you either put on weight or become pregnant and decrease in size if you lose weight. Even normal breasts have a tendency to droop with time and you can expect some change in shape to occur after a reduction mammaplasty. You can delay this tendency by supporting your breasts in well fitting bras.
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  What you should do before the operation?
Your surgeon is likely to recommend that you reduce weight if you are overweight and to make alternative arrangements if you are on the contraceptive pill.

What can you expect at the time of the operation?
This procedure is carried out under general anaesthetic and when you wake at the end of the operation there will be some discomfort which will last for two or three days. You will be given suitable pain killing injections or tablets. Drainage tubes are frequently used and will be removed within next few days of time. You may need to remain in hospital for three to four days. The stitches will normally be removed between ten to fourteen days and you will be tired and require help at home for a period of time, from two to six weeks depending on your age and general fitness. A well-fitting bra will need to be worn following surgery but because of the post-operative swelling the final size of your breasts may not be obvious for several weeks. There is likely to be some tenderness and lumpiness of the breasts for several weeks or even months following surgery.
  Risks and Limitations
  What Are The Consequences?
Apart from the change of shape and reduction in size, the most obvious consequences are the scars. These are designed to be invisible whilst wearing normal clothing and as far as possible are designed to lie under the average bra or bikini top. Over the months following surgery the scars will fade from being red, possibly thick, and uncomfortable, to become much paler and less obvious. However, they will always be present and visible when clothing is not worn and the scars will vary from one woman to another. In some they may be very thin; in others they may stretch and become quite red and possibly ugly. In the vast majority of women, however, the scars are acceptable and a small trade-off for the benefits of dealing with the problems of large breasts. Very few women are able to breast feed after breast reduction surgery as the nipples are separated from the underlying milk ducts and at the time of pregnancy the milk supply will gradually dry up, sometimes with the assistance of hormone treatment. Breast reduction is no contra indication to pregnancy but young women may well wish to take the fact that they are unable to breast feed into account before embarking on the procedure. The nipples are likely to be much less sensitive following surgery due to the nature of the cuts and the nerve supply and it is quite possible that numbness will extend over part of the breast as well.

What Are The Limitations?
It is very important that you discuss thoroughly with your surgeon beforehand the size of breasts you wish to achieve. Many women wish for a very radical reduction but in order to achieve this shape and aesthetic quality of the breasts may be compromised. It is also possible that there may be a degree of asymmetry. This is often less than existed before surgery. In women with very large breasts the benefits of a significant reduction may outweigh the potential imperfections of poor shape and loss of nipple function and sensitivity. However, in women with breasts which are only slightly larger than normal very careful thought must be given to the scarring and the potential shape and size as the outcome of the surgery may not be as aesthetically pleasing as a normal breast appearance.

What Are The Risks?
Any major operation with a general anaesthetic carries a small risk of chest infection particularly among people who smoke and there is also a risk of thrombosis in the veins of the leg, particularly for patients who are taking the contraceptive pill.
Occasionally, heavy bleeding can occur after the operation is finished which may need a further operation and a blood transfusion. Occasionally, infection from germs harbouring in the ducts of the breast can be troublesome. Infection can be treated with antibiotics bit it will delay the healing process, scars are likely to be worse to start with and there may be a need to re-stitch them at a later date. If you have a discharge from your nipple it is most important to tell your surgeon about it before your operation.

Occasionally, skin can become sloughy and for a scab which gradually separates to leave a broad scar. The nipple disc and the skin where the scar meets underneath the breast are parts most likely to be affected. People who smoke are at greater risk of this happening. Usually the scars settle well to end up as thin lines but they will always be noticeable. However, some people have an inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time.
When reducing large breasts it may occasionally be necessary to adjust the folds of skin at the end of the scar, both between the breasts and at the sides. This can simply be carried out under local anaesthetic several months later.

There is no evidence to suggest that reduction mammaplasty causes breast cancer. Nor does it prevent your breast from being examined for cancer in the usual way.
  Care & Aftercare
  The stitches you have need removing. Occasionally a small piece of stitch may remain and needs removal at subsequent visit.
You must keep your dressing as dry as possible until your follow up appointment.
Swelling and bruising may be severe. Excess swelling will decrease over the next 6 – 12 weeks.

You should have been measured for bra size preoperatively. Although it is difficult to be precise about your size after surgery, you should have an indication of the size of the SPORTS BRA you will need. As a general rule expect to keep your chest measurement (36, 38 etc) but you should reduce your cup size.

Please bear in mind that we will endeavor to give you the breast reduction you desire, but it may be that to obtain the desired reduction in size, this may compromise wound healing as well as shape of the breast. This will have been discussed with you at your initial consultation and in your pre operative discussion a few days prior to surgery. The operation we have performed is to ensure a SAFE and NATURAL result.

Scarring is always an issue and hopefully your scarring will be reasonable. If scarring is an issue we will advise you to correct this with scar reducing creams, silicone gels and silicone sheet applications as well as with lasers. We have IPL VL as well as CO2 Fractional lasers with us and our experience over last 10 years has shown that all freshly formed scars if exposed to IPL VL periodically every three weeks become finer and merge nicely with surrounding skin. Any corrective surgery if required will only be undertaken when post operative swelling settles which may be after 9 - 12 months.
At your follow up appointment you will be given further advice regarding scar massage.
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