Breast reduction / Breast lift

1. General information about breast reduction and breast lift

Some women develop large, heavy and often hanging breasts. Few get used to having a bust like that, and for many people the situation will be limiting both physically and socially. Pain of the shoulders and neck is also common. Many of those who come to us for surgery have been to physical therapy numerous times. Skin rash underneath the breasts and painful grooves from the bra straps are also common.

The symptoms will be less noticeable once the breasts are smaller and lifted after the breast reduction operation. Over the last 30 years, it has become gradually more common to perform this procedure. We assume that over one thousand women undergo this operation every year. New techniques have made the procedure a lot safer. A breast reduction means that we reduce the size and weight of the breasts, the breasts are lifted and they become firmer. If wanted, the brown-pigmented area around the nipples can be made smaller. Sometimes there is only need to operate on one breast.

Some have large breasts without the physical problems. These women want an operation for practical or cosmetic reasons. Others again, have saggy breasts and only need a breast lift. A breast lift is performed in the same way as a breast reduction, but is a less comprehensive procedure. As you see, there is no requirement of physical problems in order to undergo an operation like this.

2. Who will benefit from a breast reduction/breast lift?

We recommend that women, who are bothered by large or saggy breasts, have the reduction done as soon as possible. The skin will become stretched over the years, and the saggier the breasts are, the harder it will be to operate them into their wanted shape and size. In addition to a better result, an early operation is also a way to prevent neck and shoulder problems.

All healthy, mature women with no allergies to anesthetics can be operated on. The skin around the breast must be clean, and without eczema, acne or sores. It is vital that you have realistic expectations as far as the result goes. Medications that contain acetylsalicylic acid (Dispril, Albyl, etc.) increase the bleeding tendencies. They must not be used for two weeks prior to the operation and one week after the operation. The same goes for smoking, snuff and nicotine gum, which contribute to delay wound healing.

You will need to rest for about two weeks after surgery. Women, who are physically troubled by large breast, will be on sick leave for about two weeks. Mothers of young children will be in need of assistance during the first week. Minors must be accompanied by one of their parents to a consultation before surgery.

3. Before the operation

The consultation
We recommend all patients to meet for a consultation before the operation. During that consultation, you will be examined by a surgeon with years of experience in breast reduction surgery. The gland tissue and the elasticity of the skin will be evaluated. We will also discuss how much tissue to remove. The client’s wishes will be taken into consideration and respected, as far as possible. During the consultation, we will answer any questions you may have. Unless any medical reasons speak against surgery, it is up to you to decide whether to undergo surgery or not.

If you live far from the clinic, you may submit photographs of your breasts by email (jpg-format) or by regular post. After we have reviewed the pictures, we will do a ”consultation” by phone or answer you by email. All patients need to fill inn a so-called personal statement of health, with information about your health; present or former diseases, allergies you may have, whether you are on medication, and so on. After a consultation, it is natural to take some time to consider whether you want to go ahead with the operation or not. If you decide that you want the operation, we will schedule you for surgery and you will be asked to pay a deposit. Since this is a private clinic, you will pay for the operation yourself. If your breasts are very heavy and you have serious health problems related to your heavy breasts, the operation may be performed free of costs in a hospital. This is an evaluation made by a surgeon in the hospital after a referral by your regular doctor.

4. The day of the operation

Your breasts need to be without sores or acne. About 24 hours prior to surgery, you will wash your breasts, upper body, neck and arm pits well with an antibacterial soap (for instance ”Hibiscrub”, which can be obtained in a pharmacy). The soap is rinsed off with water. On the day of the operation, the treatment is repeated.

On the day of surgery, you meet fasting in our clinic. Arrange to have someone pick you up after the operation, or for a taxi to take you where you are going afterwards. Out of town patients need to stay in the Oslo area for 1-2 days afterwards.

Some of the patients, who want the breast reduction treatment, are overweight. Losing a considerable amount of weight may decrease the size of the breasts, but a weight loss is not an efficient method to achieve the goal of smaller breasts. For instance, slimming will not lift the breasts. In addition, in young women, who are not particularly overweight, the breasts mainly consist of glandular tissue. Losing weight will not lead to a substantially smaller bust in these women.

If you are overweight, it will be beneficial for you if you manage to lose weight before the operation. It is no requirement, however. Heavy breasts often make physical activity difficult, which again make efficient weight loss difficult. Many have trouble getting started losing weight until their breasts have undergone a reduction. Should you lose weight, your breasts will decrease some in size. For overweight patients with large breasts who are unable to lose weight, we still recommend surgery. See 8. Complications.

5. The operation

Local anesthetics combined with a sedative are adequate. General anesthetics are usually not needed. The patient will mostly sleep during the operation, and she will feel no pain. See Pain Management.

Our clinic nurse will greet you, help you with practical details, such as recording the medical information, and receive payment. Then you will be given a sedative in the form of an injection or tablets, before your breasts are cleaned with alcohol and your upper body covered with sterile sheets. Now the anesthetics are administered. The surgeon will be performing the procedure with assistance from a surgical nurse, while an anesthetic nurse is positioned by the head of your bed, making sure you are safe and comfortable.

Breast reduction
During the operation, fat tissue, mammary gland tissue and excess skin are removed. The nipples are lifted up to normal height along with the gland. Sometimes liposuction is performed during the operation. Small plastic tubes (drainage) may be inserted into the operating wound. Blood and other fluids will come out of the incision through the drainage tubes and into a small bottle. Your stay in our clinic will last for 6 to 8 hours. The drainage tubes, if used, will be removed after one or two days. See illustration 1.

Breast lift
The operation is performed in much the same way as a breast reduction, but it is less extensive. In this procedure, only excess skin is removed, and the scars will be smaller. Especially the scar underneath the breast will be shorter or there will be no scar there at all. In rare cases, it is possible to make only an incision around the nipple – combined with decreasing the brown area around the nipple. After surgery, you will be in the clinic for about 4 to 6 hours. Often we place an implant at the same time or later. This can improve the shape of the breast. See Breast enlargement.

6. After the operation

After surgery, you will be given a special support bra which is to be worn at all times the first week. You will feel sore and tender for up to three days. Keep your activities at a minimum for the first week and be careful that no one bumps into your breasts. Also, be careful about lifting your arms over your head the first two weeks, as well as when you comb or wash your hair.

The drainage tubes, if used, will be removed two or three days after surgery. The bandage can be removed after five to seven days. It is normal that there are some fluids and blood coming out from the incision during the first week. Usually, we use self-dissolving stitches. After the bandage has been removed, the wounds are taped with a wound tape for one or two months more. Scabs come off more easily if you gently massage them with some cooking oil. After three to four weeks, you can start with physical exercise again. Keep your breasts away from the sun during the first months. The scars should not be exposed to sunbathing for the first 6 months after surgery.

7. What kind of results can I expect?

Most of the patients will have breasts that both look and feel natural after an operation like this. The larger and looser the breasts are before the operation, the more difficult it will be to make them ”perfect”. Even though the surgeon will evaluate and weigh the amounts that are removed, the breasts may become slightly different in size. In addition, the nipples may move a bit up or down in time – sometimes only on one side. The breasts may become smaller or larger than expected. Sometimes the shape of the nipples will not be completely round, and the shape may change in time. These, however, are all problems that can be solved by minor surgical corrections later.

It is impossible to perform surgery on the breasts and not leave a scar. See the Photo series Breast lift. At first, the scars are red and hard. As time goes by, they fade and soften, but they will seldom be invisible. Still, the scars will be hidden by a bra or a bathing suit, and they will not show in low-necked outfits. In a few rare cases, the scars will be wide and visible. It is hard to predict how the scars will look like, but you can get an idea by studying pictures of scars from former operations.

As the years go by, it is natural for the breasts to get a bit saggier, and a new operation may be needed again later.

8. Possible complications

Any type of operation has risks of complications – that is, that something unexpected occurs. The most common complication after a breast reduction is that there is a collection of clotted blood under the wound. The patient will notice this as an abnormal, pressing pain, and the skin will become bluish. In such cases, the wound needs to be opened and the blood removed.

The wound may have trouble healing. This means that the wound will be open and filled with matter for a few weeks, but normally it will heal normally by itself. In case of any complications, we have effective ways to deal with that.

Other complications, such as infections, hardly ever occur in private clinics. Patients who are overweight more often experience wound problems.

What about pregnancies and breast-feeding later in life? A breast reduction may reduce the ability to breast feed – often along with a reduced sensation of the nipples. The more of the breast that is removed, the higher the risk is that breast-feeding will fail later. If you have planned to have a baby in the near future, we recommend that you postpone the operation until after you have finished breast-feeding. The breasts may get looser and/or smaller after a pregnancy, whether you have been operated on or not.