BREAST REDUCTION AND RESHAPING
Breast reduction has one of the highest satisfaction rates of all plastic surgery operations performed around the world.
Women put up with pain in the shoulders and neck, skin problems and difficulty finding fitting clothing for years, often decades before finding a solution in this operation.
The reason this is such a loved operation by patients isn’t just because it improves their functional symptoms. The shape of the new breast is improved, the nipple no longer points downward and, having a breast lift without implants, the resultant scar heals well.
What is involved in Breast Reduction?
The nipple and areolar complex are moved upwards into a better position and excess breast tissue is removed to solve the functional problem.
A more youthful breast is created by rearranging the tissue to improve the shape. Everyone is different so it depends on the desired amounting to resizing that is wanted.
The resulting scar around the nipple areolar complex is usually well hidden. There will be a vertical scar down to the breast fold below and usually a scar along that fold under the breast.
The operation takes between 2-4 hours depending on the amount of reduction required, and you would stay in hospital overnight. You need to wear a wireless bra for 6 weeks and should anticipate around two weeks off work while you are healing.
If you have private health insurance and can confirm coverage for this operation your hospital operating theatre fee and overnight bed will be covered by the insurance company which will save you a few thousand dollars in costs.
Some times for this reason people sign up for private health insurance but be mindful that there is usually a 12 month waiting list before you can claim so it is useful weigh up the benefits and costs versus your situation.
What Are The Risks in Breast Reduction?
Apart from the standard risk of surgery (infection, bleeding and risk of anaesthetics) some specific risks are:
Excessive Bleeding This collection of blood in the wound is called a Haematoma and is the commonest complication and this can happen for many reasons including inherited bleeding disorders. If it happens it rarely causes major problems except the need to go back to the operating theatre to stop the offending vessel bleeding
Fluid Collection in the wound (Seroma) – can happen and may need an ultrasound guided drainage until the wound heals.
All breast reduction procedures will experience have some fluid retention but it only becomes a problem when it becomes excessive.
Poor Scar Healing Even in darker skin individuals this is rarely complained about, perhaps because of such a large functional component in breast reduction. It also depends on each person’s genetic makeup and generally how well they heal wounds. In all cases we implement a very aggressive scar management programme to ensure the best outcome possible.
Asymmetry As with eyes and ears, differences between right and left breast are usual so although we do our best to match both sides there may be still be some difference after the operation especially if the difference was noticeable before we start.
Change in Sensation of the nipple.
The risk of this is very low and interestingly some claim the sensation is better particularly in women who have had very large volume reductions, perhaps because the weight is gone.
Viability of the nipple. This can occur if there is a blood supply problem, however the chance of this happening is less than 1% unless you are a smoker. Dr Kim will not perform breast reduction on people who have not stopped smoking for at least 6 weeks prior to the operation. Our priority is setting your surgery up for success and smoking creates an unacceptably increases this risk for breast reduction. (And all other operations for that matter!)
Will I Be Able to Breast Feed After Breast Reduction?
The short answer is yes. While the breast reduction itself is very unlikely to affect your ability to breast feed, you need to know the statistics.
In the general population- a third of women can breast feed and will do so, a third of women can but don’t and a third can’t because of various issues.
Breast reduction doesn’t change this, we just don’t know which group an individual belongs under yet.
There may be a need to supplement breast milk because logically, you have less breast tissue and glands to produce milk from.
A positive aspect of this reduction in breast tissue is that according to a number of studies done, breast reduction also reduces the risk of breast cancer.
In Dr Kim’s practice anyone without a notable risk of breast cancer and 35 years of age and above will have a base line mammogram. Breast reduction involves rearranging breast tissue so it is wise to be sure before we start this journey.
Breast augmentation is one of the most popular operations in plastic surgery. The operating time is about two hours and usually done as a day surgery procedure.
It involves using implants to enhance the aesthetics of the breast and you already know what that can do so it won’t be covered here.
Because of the strong emotional involvement with the idea of changings one’s body and self-image through breast augmentation it is easy to overlook the potential risks. We want to make sure you are full informed when making these important decisions.
What Are The Risks Associated With Breast Augmentation?
Apart from the standard risks of any operation (infection, bleeding, anaesthetic risk) the risks specific to breast augmentations are as follows.
Risk of bleedingand haematoma (collection of blood) in the pocket created for the implant- if this happens there is a need to return to operating theatre to stop the bleeding and washout the pocket. There is also a higher risk of capsular contracture (more on this below) if there has been a haematoma but thankfully this risk is low.
Risk of infection around the implant. Although this is very rare it can happen either immediately after the operation or, even more rarely, quite a long time after the operation.
In this rare event is usually following another procedure, say dental procedure or any other invasive procedure that may introduce the infection into the system. If this happens there may be a need for admission for intravenous antibiotics and or a need to remove the implant to resolve the infection.
For this reason you should be on prophylactic antibiotics after a procedure in the future to be covered.
Implant related problems – Historically the types of problems stemming directly from the implant include a rupture in the implant causing a silicone leak and sometimes an implant can rotate.
However, the implants these days are designed very much better and Dr Kim only uses implants from Mentor and Motiva, who provide highest of standard of implants available.
Capsular contractures– all breast implants get surrounded by scar tissue, this is a natural response to an implant anywhere in the body.
When this scar tissue begins to tighten and contact this constriction can change the shape of the breast and can even cause pain. This is often the reason why patients present with implants they have had many years previously.
These revision cases can sometimes happen earlier early and the treatment requires removal of implant and if desired replacement with new implants.
Breast Lift - Mastopexy
None of us can defy gravity which is why our eyelids, our faces, our tummy and our breasts migrate south.
A breast lift is designed to reverse this inevitable slide south. The aim is to restore the position of the nipple, re-inflate the breast tissue and restore a more youthful appearance.
Customised Breast Lift. Although not a must a breast lift usually involves the use of breast implants however there is an alternative. It is a hybrid of breast reduction and breast augmentation.
This procedure is a marriage of the two- a lift of the nipple areolar complex and rearranging of the breast tissue like a breast reduction and increasing the volume of the breast, if desired, like a breast augmentation. Not using implants does remove the risks associated with implant surgery.
Since you don’t have to have implants this operation can be staged. We do the lift first and if after that heals you would like fuller volume, you can always have an implant later. Initially you avoid all risks associated with implants and you have not lost any future options.
This customised approach will be discussed with you when we meet and understand your goals.
What is Breast Implant Associated Anaplastic Large Cell Lymphoma. BAI-ALCL
There has been widely publicised association of breast implant with ALCL. So what are the facts?
Let’s start with what lymphoma is and is not: Lymphoma is cancer that begins in infection-fighting cells of the immune system. It is not breast cancer,
ALCL is a rare form of lymphoma and BIA-ALCL (breast implant associated ALCL) is a subset of this type of lymphoma. In another words ALCL can occur in people who have never had breast implants. It can can also occur in those who have breast implants.
Studies suggest that women with breast implant associated ALCL usually have a much more benign for compared to those with other types of ALCL. Cases of BIA-ALCL are so rare that there was an international collaboration to study it.
There are between five and ten million women around the world with breast implants yet the occurrence is very low but does vary depending upon the type of implant used.
Please refer to media release by Australian Society of Plastic Surgeons for the detailed facts here.
There are many reasons for surgery on the nipples.
Nipple and areolar reconstruction– This is routine practice after breast cancer operation and often done under local anaesthesia. This is by far the commonest reason for operation around the nipple and can involve tattooing to get the colour just right.
Retracted nipple (Inverted nipple)– this is the commonest cause outside of cancer surgery. The severity of nipple that doesn’t protrude past the breast mound is varied from ones you can pull out easily to ones that are “stuck” permanently. It can cause problem with infection because of difficulty with hygiene but it can be purely an aesthetic concern. The treatment is tailored to your situation but if not so severe there are non-surgical options for trial to avoid surgery.
Nipple height reduction– Some women have what some perceive as “excess” length and shape and surgery can be considered to refashion both the shape and the height.
Breast Balancing Surgery
Asymetrical Breasts Many patients come to us with the complaint that their breasts are not even is a very common complaint. The reality is no two breast are the same, it’s a matter of just how different they are.
When the difference is significant it can cause one to be embarrassed and avoid social and intimate contact- this is a good reason to seek a remedy in the way of surgery.
In Australia, our Medicare system recognises this as a need which means a portion of the surgery cost is covered by your health insurance.
For many women this has been a long standing problem that they have suffered in silence. Reconstructive surgery to correct this can be very worthwhile both physically and mentally.
A Combination of all techniques described here need to be considered in creating the desired outcome. A breast lift, reduction and implants will all be considered to bring about an improvement and a better symmetry.
This individualised surgical solution will be discussed with you at length to ensure that we can align our goals.
Why Are My Breasts Uneven
No two breasts, eyes and ears are the same. But in breast surgery many other factors are at play.
Your skeletal structure, your shoulders, back and chest wall are all carefully looked at because sometimes there are conditions such as constricted or “tuberous” breasts or other genetic conditions such as Poland Syndrome that predispose you to the difference obetween one side and the other.
There are many options available so Ask us today about options to to improve the symmetry of your breasts.
Breast Cancer Reconstruction
You will be looked after by the breast cancer surgeon for the treatment of your cancer and the reconstruction can be performed either at the time as your cancer surgery or some time later.
The surgical procedure needs to be tailored to your body and the treatment you have had. Difference in anatomy, difference in treatment such as chemotherapy and radiotherapy and also your preference about what would you like to have done all have a bearing on how we proceed.
Breast reconstruction after cancer surgery generally falls into three categories.
Using breast implantsand or other adjuncts to improve the soft tissue coverage of the implant.
Using your own body tissue, usually either your tummy (Yes, you get a bonus tummy tuck) or your back muscles and in some cases excess tissue in your thigh or buttocks.
Using a combinationof implants and your own body tissue.
Nipple reconstruction is done as described above in the nipple surgery section.
Ask us about the best options available for you.
Breast Revision Surgery
Breast revision, the replacement or fixing of existing implants, needs careful assessment of what has been done in the past, and what has not gone to plan.
A customised approach can then be developed to address the issues at hand.
The most common reason for revision surgery is capsular contracture, this is an immune system response that causes the formation of capsules of tightly-woven collagen fibers which can deform the breast.
Implant related problems are also a common cause frequently experienced with implants put in overseas.
These complications including silicone leaks and capsular contracture can lead to changes in shape in your breasts. Hard contractures may be seen, felt and even painful.
Targeted imaging and a customised plan will be discussed with you as we explore the best ways to address the problem.
Ask us to explore options.
The Standard of Care in Breast Surgery
In Australia, the incidence of breast cancer over a life time is one in eight, so we can never be too vigilant about continually monitoring for it.
A breast examination is undertaken as a baseline in our practice and a detailed history is taken to assess your level of risk for breast pathology.
Make sure you keep up the regular breast check with your doctor and make self- examination of your breasts a regular a habit as well. Watch out for any lumps that appear, any discharge from your nipples, and change in the colour and tethering of breast tissue that wasn’t there before.
Like most health conditions, the outcome is better when detected early.
If in doubt feel free to contact us.
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British Medical Association House
Level 6 Suite 603
135-137 Macquarie St
7 Ashley Lane
Westmead NSW 2145
Phone 1300 911 151
Fax (02) 9475-1370
© 2019 Dr Leo Kim firstname.lastname@example.org