Breast Reduction

Breast reduction is one of the most popular plastic surgery procedures.

It is a very effective operation for treating the symptoms of large, heavy breasts. Patient satisfaction is therefore generally very high with this procedure. Many patients report that breast reduction surgery is life-changing.

Why do people have a breast reduction?

Patients with large breasts also experience other problems such as:

  • loss of confidence and embarrassment due to unwanted attention
  • problems getting bras to fit
  • difficulty getting clothes to fit
  • cosmetic concerns, for example excessive drooping, premature ageing of the breasts
  • asymmetry of size and shape
What does the consultation involve?

Mr Chester will take a full medical history and breast examination to determine your suitability for surgery. He will take measurements of your breasts and check you for breast lumps. Your height and weight will also be measured. Mr Chester will discuss whether surgery is appropriate for you and will go through the operation in detail. He will discuss the benefits, limitations and potential risks associated with breast reduction.

How long will I be in hospital ?

You will come into hospital on the day of surgery. Patients are normally in hospital 1 or 2 nights after breast reduction.

What happens during the operation?

Breast reduction is performed under general anaesthetic (put to sleep) and takes around 3-4 hours to perform. Excess breast tissue and skin are removed. Areolas (the pigmented areas around the nipples) are usually made smaller and the nipples are positioned higher on the breasts. Liposuction may be performed to reduce fatty tissue on the sides of the chest near the armpits. Mr Chester will explain the likely scarring but for most patients the scars are anchor-shaped. Mr Chester uses surgical drains which consist of narrow tubes coming out of the sides of the chest to take away excess blood or fluid following the surgery. Drains are usually removed before you go home.

What is the recovery period following breast reduction?

Breast reduction is a fairly big operation. In the first two weeks you will need to take it easy and will need help with activities such as shopping, housework, and looking after young children. You will not be able to drive for approximately 2 weeks.
You will require 2-3 weeks off work if your job is not physical. If you have a physical occupation then you may require around 6 weeks off work. You should be able to resume light exercise between 4-6 weeks following surgery. Strenuous upper body exercise can be resumed at around 3 months. Tiredness is common for around 3 months following this surgery.

You will need to wear a sports bra for 6 weeks after surgery to help support and shape your breasts.

Follow-up

Mr Chester normally sees patients following breast reduction surgery at around 1 week, 2 weeks, 6 weeks and 3-6 months post-operatively, although this is only a guide and sometimes patients can require additional appointments for dressings etc. Mr Chester provides most, if not all, of the aftercare himself to provide reassurance throughout the patient journey.

Before and after photographs

Here are some examples of patients who have breast reduction performed by Mr Chester in various stages of healing. Post-operative photographs taken approximately 6 months after surgery. Scars generally fade over 1-2 years.

Before surgery
After surgery

Reviews

“I had a breast reduction a year ago under the fantastic care of Mr Chester. I was very nervous about the procedure, but was instantly put at ease by the caring manner and professionalism shown. Mr Chester listened carefully and gave all the information needed to make an informed decision about going ahead with the surgery, and I am so glad I did. It has honestly been life changing for me. I waited a year before I wrote a review to allow me time to see results long term. No more back ache and Migraines are very very minimal now.The care I received from all staff at the hospital was great and Mr Chester went above and beyond to make sure I was comfortable and looked after in every way. The aftercare was also very good and I felt fully supported at all times right up until my discharge. I would highly recommend Me Chester to anyone contemplating a procedure.I would like to say a big thank you for improving my quality of life.”
“At the age of 55 I finally decided to look into a breast reduction.  After much research I decided to have a consultation with Mr Chester.  I cannot stress enough how at ease he made me feel.  He was extremely thorough in the initial consultation covering all areas of the procedure and ensuring I was totally aware of all the possible, if unlikely, things that could go wrong. I decided to go ahead with the procedure and am delighted with the results. I have gone from a 34G to a 34C.  The after care has been 100%.  I have had regular check ups to ensure breasts and scars are healing as expected. I would have no hesitation in recommending Mr Chester to anyone thinking of breast reduction.”
“Was very understanding of my daughter’s needs, sent us away to talk it through with her as she has learning disabilities and autism. Went through every possible scenario with us, still receiving fantastic aftercare 7 months after her breast reduction. Always has plenty of time for you and has done an amazing job of my daughter’s breasts. Her life is so much better now and she thinks that Mr Chester is just the best man in the world.”

Breast reduction – a guide for patients

Mr Darren Chester
Consultant Plastic Surgeon

The following information sheet is designed to supplement the consultation with Mr Chester. Breast reduction is a popular plastic surgical procedure, which Mr Chester performs regularly. Patients usually request this operation for physical symptoms, such as back pain, neck pain, and difficulty exercising and painful grooves from bra straps. In most patients these symptoms are significantly improved if not cured. Cosmetic concerns such as low nipple position, asymmetry and drooping can also be improved.

The operation is performed under general anaesthetic and usually takes 3-4 hours to perform. Patients are usually in hospital for one or two nights. Surgical drains (plastic tubes which take away fluid) are normally used. These come out through the skin just to the sides of the breast and leave small scars. The drains are usually removed before discharge home.

Benefit

Breast reduction surgery has high satisfaction rates based on the ability to significantly reduce physical symptoms. Reducing the weight of the breasts can have advantageous effects on exercising also. The cosmetic appearance of the breasts is usually improved.

Limitations

There are limitations as to what can be achieved with breast reduction. A bra size cannot be guaranteed after the operation, so you may find that you are smaller or larger than you would prefer. This is partly because there is no way of accurately measuring bra size during surgery and the surgeon therefore has to estimate the amount of tissue to remove. Bra sizes of course also vary from shop to shop. There is also a limit to how much tissue can be removed as some needs to remain to maintain the blood supply to the skin and nipples.

There is no guarantee that all symptoms related to large, heavy breasts will be improved.

Cosmetic imperfections

Although every effort will be made to make the result as good as possible, cosmetic imperfections can occur. There can be some degree of asymmetry of shape or size, which usually is small. Shape imperfections can sometimes occur. A small percentage of patients require further surgery to improve the cosmetic result, which may have cost implications.

Scars
Scars following breast reduction are usually anchor-shaped. for smaller breasts the horizontal scar may be avoided in certain circumstances. There will be scars running around the areola (which is usually reduced down in size), one running vertically and long scars running horizontally under the breasts. Most scars settle well and fade with time. Occasionally scars can become unsightly and may stretch or become thick, raised, red and lumpy (keloid).
Potential risks and complications
There are risks associated with all operations. Below is a list of potential complications that can occur after breast reduction surgery. Most complications are very treatable but if they occur the result can be compromised and recovery can be longer.

Infection
Infection can occur after any operation but this is relatively uncommon with breast reduction surgery. If infection does occur patients can require more frequent wound dressings and tablet antibiotics. Rarely admission to hospital for intravenous antibiotics and further surgery can be required.

Bleeding
Whilst every effort will be made during surgery to stop bleeding, occasionally this can occur in the early post-operative period leading to blood loss into the drains and a blood clot in the breast (haematoma) which results in swelling and bruising. Patients usually require surgery to remove the blood clot and stop the bleeding. A blood transfusion may be require if bleeding after surgery occurs.

Delayed healing
Wounds usually require dressings for 2-3 weeks after surgery. Sometimes though, wounds can open up in places and require dressings for longer. Rarely, further surgery can be required to get the wounds to heal.

Skin, nipple or areola loss
Whilst every effort will be made to preserve the blood supply to the skin of the breasts, nipples and areolas, in a small percentage of cases areas of skin can die. Normally the involved area scans over and eventually heals with dressings over a number of weeks. Rarely, further surgery is required to removed dead skin and apply new skin from another site on your body (skin grafting).
If skin loss occurs then unfortunately the cosmetic result can be compromised by scarring. The cosmetic appearance of the breast may also be affected if there is loss of the nipple and areola.

Bruising and swelling
Bruising and swelling is normal following breast reduction. Bruising usually settles in the first 2 weeks but swelling often persists for longer. The majority of the swelling resolves in the first 6 weeks. Occasionally, fluid can collect in the breast (seroma). If the seroma is small it may absorb itself. Sometimes though, drainage of fluid can be required using a needle and syringe, or even
with surgery.

Fat necrosis
Sometimes lumps can form in the breasts after breast reduction surgery due to areas of fatty tissue losing blood supply. This process is called fat necrosis. Whilst the lumps are not serious, they can be uncomfortable and may require tests to confirm the diagnosis.

Pain and tenderness
Most of the time, pain following this procedure settles over a couple of weeks and once at home, only tablet painkillers are required. Some patients can have more prolonged pain and tenderness although this is unusual.

Alteration or loss of sensation
There is often some degree of numbness of the breasts or nipples after breast reduction, which may be permanent. Some patients can develop hypersensitivity (excessively sensitive areas) within the breasts, which usually settles down with time.

Other effects on the breasts
It should be noted that breasts will still change with fluctuations in weight loss, pregnancy and
ageing. Breasts tend to age differently after breast reduction, with the lower poles of the breasts drooping and the areolas remaining higher on the breast mound; a process known as bottoming out or pseudoptosis. It should also be noted that patients who have had breast reduction are generally not able to breast feed.

Mammograms are still possible after a breast reduction operation. It is important that the person performing the mammogram is aware that you have had this operation.

Risks related to general anaesthetics
General anaesthetics are very safe. Mr Chester will assess your suitability for this operation. Some patients can require further tests and investigations before the operation can be recommended. For most patients, the risk of serious fatal reactions is very small indeed. There is a small risk of thromboembolism (clots in the veins of the legs which can go to the lungs), which will be
minimised by the use of special stockings and blood-thinning injections.

Dissatisfaction
Although most patient are very satisfied with the outcome of breast reduction, there is the
possibility of dissatisfaction if expectations exceed what can be delivered by surgery. Surgery should not be performed at times of psychological stress. Mr Chester advises that you only have surgery performed if you are absolutely certain it is right for you.

A special note on minimising risks
Breast reduction is a fairly big operation and your safety is of paramount importance. Some patients require modification of risk factors before becoming suitable fo this operation. Mr Chester will raise any potential concerns with you. Some of these risk factors are discuss below.

Body Mass Index (BMI)
It is a fairly big operation and to minimise risks patients must have a Body Mass Index (BMI) of less than 30. A BMI of higher than this is associated with increased risk of wound healing problems, deep vein thrombosis and poor cosmetic outcome. You may be asked to lose weight before having this procedure performed.

Smoking
An absolute requirement for this operation is for patients to completely abstain from all cigarettes and nicotine-containing products for for 6 weeks before surgery, this includes electronic cigarettes/Vaping and nicotine products (including electronic cigarettes) . Smoking compromises the blood supply to the parts of the breast and increases the risk of skin dying, fat necrosis and nipple loss. Smoking may therefore cause significant wound healing problems. Smoking should also not recommence until all the wounds have healed.

Medication
Some patients are not suitable for surgery due to medical problems or medication that they take. Suitability for surgery can only be decided following a consultation. Hormone-replacement therapy increases the risk of thromboembolism. If possible, this medication should be stopped 4weeks before the operation.

Recovery period
The recovery period is variable and will depend on the degree of discomfort and time to wound healing. Some patients are able to return to work in 2-4 weeks but for more physical jobs, 6 weeks off may be required. Patients frequently feel tired for a number of eels after the operation. Driving is usually possible after 2-3 weeks, although some patients find the seatbelt uncomfortable initially. Exercise will need to be restricted in the first 6 weeks also.

You will need to wear a post-surgical or sports bra for 6 weeks day and night following the operation. Mr Chester will advise you further on the choice of size you need to buy.

Final word
You should think very carefully before having this surgery. Whilst most patients are very satisfied following this operation, there is no guarantee that all symptoms are improved. Cosmetic results are subjective and if expectations exceed what can be achieved then dissatisfaction can occur.

Please contact Mr Chester if you have any queries or concerns.

Note regarding COVID-19
There are risks associated with carrying out surgery during the COVID-19 pandemic. There is a small risk (0.45%) of contracting the virus when coming into hospital. Should a patient develop COVID-19 whilst recovering from surgery under general anaesthetic, the mortality is high (in the region of 25%). The outcome of surgical procedures may be affected during periods of lockdown when clinic appointments may be cancelled. You will require a COVID swab and 3 days of strict social isolation prior to surgery. It should be noted that surgery may be cancelled at short notice during the pandemic.
For any enquiries or to book an appointment with Mr Chester please get in touch with his secretary
Contact