Breast reduction surgery is performed for both aesthetic and health reasons in most cases, such as nose surgeries. Excessive growth and/or sagging of the breasts cause visual, social and medical problems. This condition can occur with puberty, it can also occur after birth and breastfeeding. This situation, which is often not very disturbing, can become unbearable in advanced ages, especially after menopause. There are treatments that can be applied in any case, depending on the age, condition and expectation of the patient. The operation performed is not a standard procedure and can actually be defined as the sequential application of several different operations at different degrees according to the need. Basically, in this surgery, both the breast volume and mass are reduced and the shape, posture, and characteristics of the breasts are changed. Which component will be applied to what degree is decided according to the patient’s condition and expectation.
For example, in a patient who does not have a large breast volume, therefore does not have neck and back complaints, complains of excess skin, but has other aesthetic and health problems due to severe sagging, there is no need to perform a breast mass reduction component in this surgery. The surgery to be performed is called breast lift (recovery – mastopexy, mastopexy) surgery and includes almost the same steps as breast reduction surgery. Both breast reduction and breast lift surgeries are the same in principle, only the surgical steps are applied to different degrees.
Why do breasts grow and sag outside of normal?
It can be answered as internal and external causes.
Internal causes are personal factors, that is, racial, hereditary causes. Your relatives, such as your mother, grandmother, aunt, and aunt, have similar problems. It is not possible to change or prevent them. This structural difference depends on the hormone levels and the sensitivity of the breast tissue to the hormone. Hormonal changes occur during puberty, and although hormone levels are normal, the breasts grow outside of normal due to the sensitivity of the breast tissue. Even boys may have breast enlargement (gynecomastia) during this period. At a young age, the skin covering the breast is tense, similarly, the suspensory ligaments and ligaments in the breast are tighter. For this reason, sagging is rare even with advanced breast enlargement at young ages. However, the extremely large breast tissue causes loosening in the skin tissue and ligaments after a while, causing sagging.
External causes depend on many factors. The biggest factor is time. At young ages, the mammary glands and adipose tissue that make up the mammary tissue are at a certain rate, and the mammary glands are more than the adipose tissue. With aging, there is a decrease in the mammary glands, but the adipose tissue increases. With breastfeeding, milk tissues increase, breast skin expands, but at the end of breastfeeding, the milk glands decrease and there is no obvious shrinkage in the skin. External effects such as the effect of gravity with aging, the decrease in the mammary glands that make up the breast tissue and the increase of less resistant adipose tissue, and the enlargement of the breast skin cause sagging of the breasts and deformation of the breast shape. If the nipple is lower than the lower fold of the breast while standing, it can be said that there is breast sagging. The degree of this and other deformities of the breast and the surgery to be applied are decided.
What kinds of problems arise?
In abnormally large breasts (mammary hypertrophy, macromamma, gigantomasti) problems arise in the early and late periods. The problems in the early period are mostly social and psychological problems. In adolescence and young adulthood, fear of being teased, not being able to wear the desired clothes (eg, not being able to enter the sea or pool), avoidance of sports activities and lack of self-confidence, hunching to hide the breasts, back pain and rash are also important complaints. In advanced age, mechanical problems and complaints come to the fore together with accompanying medical disorders. Neck-back pain, grooves created by bras on the collarbone and shoulder, rashes and skin disorders, difficulties in sitting and standing up or while doing work (eg tying shoes) are often openly expressed, but there are also problems such as physical dissatisfaction and aging depression.
The points that need to be corrected in breasts that are larger than normal and drooping are weight and sagging. In other words, it is the proper removal of excess breast tissue (mammary gland and fat), excess skin that causes sagging, and providing a new breast. Techniques such as sports, massage and regional tightening will help a little, but surgery is not recommended for people who will be satisfied with this difference. Therefore, there is no treatment that can perform them without surgery.
What kind of surgery?
The surgery is performed under general anesthesia in all cases. Depending on the amount of tissue to be removed, the duration of the operation may take between 2.5 and 4 hours.
Regardless of the technique and in any way, in all surgeries where excess skin is removed, an incision is made and a scar remains. While removing the excess breast tissue and skin, this procedure is not performed on only one part of the breast. In order for the newly formed shape to be a breast shape again, the appropriate amount of tissue and skin must be removed from almost everywhere, which means that there will be a long incision. In other words, it can be said that it is a surgery that gives good results in terms of breast volume, shape and posture, but requires sacrifices for scars.
In all techniques applied, a circular scar around the dark area (areola) on the nipple and a vertical (5-10 cm) scar extending from there to the lower crease of the breast is inevitable, but it can also continue as a horizontal scar in the lower crease of the breast (inverted T shape). The more breast tissue and skin to be removed, the longer the scars will be. When the wound healing is completed normally, the scar around the nipple is not very obvious due to the transition. The scar on the lower fold of the breast is also less obvious because it is both a fold and remains under the breast when standing. However, the perpendicular trace will be the most conspicuous. In some techniques, the horizontal scar can either be left at all or shorter (vertical scar, short-scar). However, it should be accepted that all techniques will leave a vertical scar.
In all techniques, the remaining traces do not go out of decollete clothes, underwear or bikini. Although the scars that will remain at first are the biggest concerns of the patients, the size and shape of the breast becomes more important in the future.
What other risks are there?
Risks related to anesthesia, bleeding, infection, etc. that may occur in all surgeries. Apart from this, another risk is the risk of circulatory disorder and loss of sensation in the nipple. One of the reasons why the techniques applied in this surgery are different is that the blood supply of the nipple and its sensation-taking structures can be protected in different ways (pedicle). Apart from the wrong choice of the appropriate technique, the factors belonging to the patient play a more important role in this regard. Underlying reasons such as the breast being too large or sagging, wanting to reduce more than the safe reduction range, smoking, circulatory problems, infection, diabetes, and heart diseases increase the risk of loss of circulation and sensation of the nipple. There may be complete or partial nipple loss. Loss of sensation, which occurs without loss of circulation, usually returns to normal within months.
Another risk is the loss of breastfeeding. After this surgery, the ability to give milk may be lost. For this reason, it would be useful to talk to your doctor about such situations and explain your expectations in advance. Breast reduction surgery is not a standard surgery and many points will need to be taken into account when choosing a technique. However, if the lactation (lactation) protective technique is chosen, there is no problem in lactation, in summary, there is as much risk as women who have not had surgery.
Other risks are wound problems and related bad scars, asymmetries and aesthetic dissatisfaction found in all aesthetic surgeries. Some of them can be predicted. Communication between you and your doctor and reasonable expectations prevent disappointments. Scars that are more than normal can be reduced with minor procedures after months.
What to do before surgery?
Before the operation, breast examination should be performed and the presence of a mass should be investigated. Hormonal tests are performed when necessary. All women before the age of 37 should have a breast ultrasound, and after the age of 37 they should have a mammogram. Thus, it may be possible to prevent the misfortunes that may occur during the surgery in advance.
Quit smoking at least 2 months before surgery. Do not start after surgery if possible, but you must not drink for at least 2 weeks to make sure your stitches have healed.
It is not considered as the most painful post-operative period among aesthetic surgeries. However, it is still beneficial to stay in the hospital for at least 1 night. There will be closed or open drains in order to drain the collected blood in the operation area. These drains are removed in 2-3 days. There is not much difference in pain between the drain removal process and the stitch removal process.
It is recommended to rest for about 1 week after the surgery. It is recommended that you lie upright, do not lean forward as much as possible, and do not raise your arms too much. You can take a bath after 5 days. It will be useful to use the special bra applied immediately after the operation for at least 1 month.
In general, stitches that do not need to be removed later are used. You can return to your normal daily activities within 3 days, but you must wait at least one week for active working life.
In summary, breast reduction surgery is a permanent and reliable surgery that provides a high satisfaction rate when applied in the right hands and in the right situations, and provides solutions to both psychological and social problems of the person, such as neck-back pain.
Is there a risk of breast cancer after surgery?
Every woman has a risk of breast cancer. This risk is also related to the amount of breast tissue. Since the amount of breast tissue will be reduced in this surgery, the risk of subsequent breast cancer is also reduced, but the risk of breast cancer is not completely removed. The tissues taken in breast reduction surgery are sent for pathological examination, so that non-cancerous diseases of the breast (cyst, fibroma, fibrocyst, etc.) are also diagnosed and treated. You have to have breast follow-up like women who have not had surgery. However, there is no increased risk associated with surgery.
Who can have surgery?
Anyone who has completed the age of 18, who is not medically prevented from undergoing surgery, whose breast growth has stopped in the last 6 months, and who is in line with the expected results of the surgery can have this surgery.
Can the resulting scars be reduced after surgery?
When necessary, scars can be thinned, straightened, brought to the same level and color as the skin, but not shortened, but lengthened.
Will the ability to breastfeed disappear after the operation?
After this surgery, the ability to give milk may be lost. For this reason, it would be useful to talk about such situations with your doctor and explain your expectations in advance. Breast reduction surgery is not a standard surgery and many points will need to be taken into account when choosing a technique. However, if the lactation (lactation) protective technique is chosen, there is no problem in lactation, in summary, there is as much risk as women who have not had surgery.
Why does loss of sensation occur in the nipple?
One of the reasons why the techniques applied in this surgery are different is that the blood supply of the nipple and its sensation-taking structures can be protected in different ways (pedicle). Apart from making the wrong choice of the appropriate technique, the factors belonging to the patient play a more important role in this regard. Underlying reasons such as the breast being too large or sagging, wanting to reduce more than the safe reduction range, smoking, circulatory problems, infection, diabetes, and heart diseases increase the risk of loss of circulation and sensation of the nipple. There may be complete or partial nipple loss. Loss of sensation, which occurs without loss of circulation, usually returns to normal within months.
Will there be regrowth and sagging after the surgery?
Growth and sagging that may occur in someone who has not been operated on is also present, although less in someone who has had surgery. In other words, if you gain weight, you will naturally gain weight from your breast area. Over time, sagging will occur again, so a little more lifting / recovery is performed in the surgery than normal.
When will the breasts take their final shape and shape?
Wound healing takes 6 months in all surgeries. In general, we can say that it takes its final form roughly after 3-4 months, no change is expected after 1 year.