Faq?

[sreekar]

1. How many techniques are there for breast reduction?
2. Is breast reduction permanent?
3. What does a typical breast reduction consultation entail?
4. How is breast reduction performed?
5. Where are the incisions made; are there any visible scars?
6. What should I expect post-operatively?
7. Is it quite painful? Is there much bruising?
8. When will I be able to return to work?
9. When will I be able to see the results?
10. What are the risks of breast reduction?
11. What is Arnica montana, I have heard that it reduces swelling and bruising? Which is the best kind to take?
12. What about Bromelain? Is this also good for swelling and bruising?

[nowornever]

How many techniques are there for breast reduction?

* There is a manual technique where surgeons remove tissue after having opened the breast along the tissue lines where surface tissue will be removed, as well as lifted.
* There is the tumescent technique that is in all actuality, liposuction in a lesser form.
* The liposuction technique can also be used with ultrasonic energy, but has an increased chance of injury due to burns. High frequency waves can excite the water molecules (or any fluid) causing them to boil beneath the skin as well as damaging superficial tissues as well. Unfortunately there is also the possibility that blind removal will accidentally disturb or remove milk ducts/glands in such a way that a patient's breast feeding chances are severely decreased.

[nowornever]

Is breast reduction permanent?

Yes, breast reduction is most often permanent. Although the remaining fat cells will swell and enlarge if you overeat and gain weight, as will the tissue swell or take on fluid and store milk in the event of a pregnancy. Breast tissue will still swell and be tender to the touch when affected by natural or synthetic hormones. If you take hormone supplements it is quite possible to gain small amounts of breast tissue back. Although it may not look the same or be as much.

The exception is in virginal hyperplasia/hypertrophy when the estrogen levels are high and the development of the breast is ongoing.

[nowornever]

What does a typical breast reduction consultation entail?

Firstly, your doctor will discuss your goals with you and he will explain what can realistically be achieved. A surgeon should take into account what your hip size is. Your breasts may be a hindrance to you but removing too much will make your hips look large and give you a pear shape. Obviously, you can request significant removal, although you may want to consider balance when determining your end size. Many women with large breasts just "want them out!" but may later regret having the majority of the breast volume removed. I am just suggesting thorough consideration before committal.

Your surgeon will then show you photos of his or her work, you may also wish to show him photos that you have brought to the consultation of what you like and do not like. He or she should discuss the risks at length and the details that are associated with breast reduction surgery There is no one size fits all technique when it comes to this procedure. It is all individual, just like you! But do realize that your surgeon may not be aware of newer or lesser scarring techniques, so do your research beforehand and get several opinions before scheduling your surgery.

Protocol for a pre-operative appointment if you should choose to undergo a breast reduction:
Prior to surgery, a complete medical history is taken in order to evaluate the general health of the patient. The breasts themselves are then examined thoroughly to determine the most effective surgical approach. The surgeon will go over the anesthesia to be used, the procedure, what results might realistically be expected and possible risks and complications.

Mammograms or x-rays may be taken as well as pre-operative photographs. Preoperative instructions often include the elimination of certain drugs containing aspirin for several weeks before surgery in order to minimize the possibility of excess bleeding. Birth control and other estrogen containing hormones may also be discontinued temporarily (depending upon the individual). Antibiotics, pain relievers and other medications prescribed a few days prior to your surgery for your convenience as we want you to be completely prepared for your surgery with no excess worry.

You may also be instructed to have blood tests performed which may include a Complete Blood Count (CBC), pregnancy test, clotting tests, a Chem-7, etc. This all depends upon the surgeon's requirements so these tests will vary.

[nowornever]

How is breast reduction performed?

For the liposuction technique, small incisions are made within the natural fold underneath the breast or perhaps on the outer side as well. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent ), Lidocaine (pain reliever) and epinephrine (prohibits excessive bleeding and excess absorption of Lidocaine) are injected into the targeted area. This technique's purpose is to engorge the tissues with the solution for a firmer working area and the fat cells (which are softer) are suctioned out. The epinephrine prohibits bleeding during the operation and less blood is lost during the procedure.

There is a liposuction technique which involves ultrasonic energy waves. These ultrasonic waves excite the fat molecules and literally melt the fat into a liquid for ease of removal by suction. Unfortunately, each patient's molecules may react differently or in the case of unskilled surgeons, may improperly handle the equipment resulting in severe burns.

There is the manual removal technique which is often similar to a breast lift operation but with more internal tissue removal. With this technique there will be scars associated with the breast lift more than likely anchor shaped as extensive tissue will more than likely be removed and proper re-positioning and re-contouring of the breast will be performed.

In any case, the targeted breast tissue and fat is removed, sutures are sometimes used in the closure of incisions for the smaller, liposuction-assisted breast reduction and most definitely for the traditional breast reduction techniques. Then, a support garment or surgical bra is worn for proper, compact healing. A surgical or soft bra will be worn for several weeks or months, both day and night.

[nowornever]

Where are the incisions made?

The incisions are made within the natural folds under the breasts, sometimes around the areolae and in a line from the crease to the areolae. Some procedures require only a keyhole incision (LeJour lift) in many cases. The breast reduction procedure is not a minor one and scars should be expected. Unnecessary scarring is generally avoided although in techniques not using only the liposuction-assisted method, scarring is more pronounced. Discuss with your doctor his or her incision placement of choice and why? And remember to get several opinions.

[nowornever]

What should I expect post-operatively?

The patient may be placed in two bras as well as an Ace bandage. In some cases, you may remove the top bra only and rewrap the breasts with the Ace bandage the day after surgery. Some patients are told not remove the Ace bandage or bra for at least 3 days. Patients may choose to wear the Ace bandage for up to 10 days if they find it to provide added comfort. Patients are usually instructed to wear their surgical bra for 21 days both day and night. However it is advised to wear a high quality support garment of any kind until the scar maturation, which may take up to a year. Please ask your own surgeon for specific instructions.

During recovery, the patient is carefully monitored and is allowed to be driven home a few hours later. In some instances, you are required to stay in the hospital. Although, in any case, a surgeon should insist that you remain near the vicinity in case you experience complications.

Some patients are instructed to ice continuously for the first 48 to 72 hours. If this is the case, you will put an ice bag (or bags bags of frozen peas) over a cloth or dishtowel which is laid over the breasts to maintain the coldness continuously without damaging the skin. This will reduce any discomfort and swelling significantly. The pain connected with the procedure is minimal to moderate and is controlled with oral pain medication. The antibiotics that were prescribed will be taken for several days post-operatively to prevent infection. Instructions for the day and night after surgery include bed rest with limited activities. Your surgeon will determine when normal activities can be presumed at your post operative visits -- normally at 3 weeks. Strenuous activities and heavy lifting must be avoided for several weeks.

You should notice a gradual reduction in discomfort. Sometimes swelling will increase over the first three days. Fever greater than 100.5 should be reported to your surgeon. Marked increases in tenderness after 48 hours along with redness may indicate an infection. This should be reported immediately.

You may only sponge bath for the first 3 days after surgery as you must not get the bandages wet. You can remove the bra after 8 days but only to put on a fresh one. Replace the bra quickly after washing. After 14 days a normal shower may be taken. Be sure to replace the bra immediately after showering or bathing. However, some surgeons require that you shower in a bra for several weeks.

There will be swelling and your doctor may recommend Arnica montana or Bromelain. There may also be some bruising but the Arnica montana & Bromelain may help alleviate some of this as well.

You should be wearing your bra 24 hours a day for at least the first 3 weeks. After the 21 day period, the bra should be worn at least during the day time for 6 months. The tapes that are over the suture lines should not be removed as your surgeon will remove them in approximately 10 to 15 days.

Complications and slow healing are rare, however there are certain inherent risks connected with reduction mammoplasty which will be thoroughly discussed at your consultation. The risks and instances of slow healing are more significant in smokers.

[nowornever]

Is it quite painful? Is there much bruising?

It takes about a week and a half for most of the swelling to subside. There may be bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. Some doctors suggest Arnica montana and a topical ointment as well. Some surgeons suggest Bromelain or drinking pineapple juice starting 3 days pre-operative. These products are thought to decrease both bruising and swelling in all procedures and in most cases have shown a significant decrease in both complaints. You should take your prescribed pain medication to alleviate any pain or discomfort that you may experience. Although if you feel as if your pain is severe do not hesitate to call your surgeon or the staff member on call.

[nowornever]

When will I be able to return to work?

Most patients return to work within 2 weeks. Although some patients have returned just after 5 days. It is highly individual. The discomfort is more than likely the main reason people tend to take off work. The bruising, may remain after 3 weeks. Still, you should not bend over, lift your arms over your head or exercise until well after 3 weeks post-op.

[nowornever]

When will I be able to see the results?

You should notice the difference in breast volume immediately. For some patients, if the procedure was due to back pain associated with very large breasts, the pain relief is usually immediate. After the swelling subsides you will begin to notice a difference in the compact appearance of your tissues.