What is a Breast Reduction?
A Breast Reduction surgically reshapes exceptionally large or heavy breasts in order to make the patient more comfortable and satisfied.
The excessive weight of very large, pendulous breasts may cause a variety of medical problems such as back and neck pain, skin irritation, breathing problems, even skeletal deformities. Bra straps may leave indentations in your shoulders – and unusually large breasts can make a woman or a teenage girl feel extremely self-conscious. Breast reduction, can help such women by removing fat, glandular tissue, and skin from the breasts. This will make your breasts smaller, lighter, and firmer. It can also reduce the size of your areola – that is the area of darker skin surrounding the nipple. The goal with this surgery is to give you smaller, more shapely breasts that are more in proportion to the rest of your body. What can and should be done in your case will depend on a consultation with Dr. Fred Coville. However the following introductory paragraphs will, we hope, be helpful. Please be sure to ask us at Cornerstone Plastic Surgery & Aesthetic Medicine if there is anything about the procedure you don’t understand.
Is a breast reduction right for me?
Our breast reduction is generally carried out for women who feel their breasts are too big. This may be simply a question of feeling self-conscious about their size, or it may be that your breasts are causing other problems such as back or shoulder strain. The procedure involves removing some of the breast tissue, and also lifting the tissue that is left, to give a firm, natural result.
The aim of breast reduction is usually physical relief rather than cosmetic improvement since very large, sagging breasts restrict activities and cause physical discomfort. That said, Dr. Fred Coville believes that reconstructive plastic surgery, such as a breast reduction, and cosmetic plastic surgery are one and the same. He strongly believes that every procedure deserves meticulous attention to detail and that his patients should always expect the most aesthetically pleasing result – regardless of the procedure requested. It is for this reason that he routinely keeps his scars to a minimum and very rarely leaves the classic “anchor scar” behind. Breast reduction is not normally performed until the breasts are fully developed but it can be done earlier if large breasts are causing serious physical discomfort. Ideal patients are mature enough to understand the procedure and risks fully and to have realistic expectations about the results. Some women would rather postpone breast reduction surgery if they intend to breast-feed down the road.
Are there any risks?
Breast reduction is not a simple operation but, when you choose a well-qualified surgeon such as Dr. Coville, any complications are likely to be minor and the operation is normally very safe. Nevertheless – as with any surgery—there are possible complications, including bleeding, infection, and reaction to the anesthesia. Reduce the risks by following the advice we give you at Cornerstone Plastic Surgery closely both before and after surgery. The procedure does leave permanent scars but they will be covered by your bra or bathing suit – and, as stated Dr. Coville keeps your scarring to a minimum if possible. Poor healing and wider scars are more common in smokers. This procedure may also leave you with slightly mismatched breasts or unevenly positioned nipples. Importantly, future breast-feeding may be impaired since the surgery sometimes involves removing many of the milk ducts that lead to the nipples. Some patients experience mild or even permanent loss of feeling in their nipples or breasts. Very rarely, the nipple and areola may lose their blood supply and the tissue will die. In such cases the nipple and areola can usually be rebuilt by using skin grafts from elsewhere on the body. Dr. Coville will discuss these and other potential difficulties with you in detail during your consultation and will give you as much time as you need to feel comfortable in your understanding of the procedure.
In your initial consultation, Dr. Fred will evaluate your health and explain which surgical techniques may be the most appropriate for you, based on the condition of your breasts and skin tone. Every patient and every physician will have a different view on what is a desirable size and shape for breasts. It is very important, therefore, to discuss your expectations fully and frankly with Dr. Frederick Coville. He will examine your breasts and will most likely photograph them – as well as take some key measurements to assist him in planning the procedure. These photographs and measurements also serve as reference during surgery and afterwards. He will explain the variables that may affect the techniques to be used, such as your age, the size and shape of your breasts, and the condition of your skin. Dr. Fred will describe the procedures he feels will work for you in detail as well as explain any risks or limitations. Be sure you understand the scarring that will result. He will also describe the anesthesia that will be used, the facility where the surgery will be performed, and the costs involved. Most insurance companies will pay for breast reduction if it’s medically necessary. However, they may require that a certain amount of breast tissue be removed. Most companies will also require that the procedure be “pre-authorized” by them. If that is the case, our office will send any information needed to secure this authorization. Please be certain what your policy covers before agreeing to surgery.
Dr. Coville will also ask you about any medical conditions that could cause problems during or after surgery, such as high blood pressure, blood-clotting problems, or any tendency to form excessive scars. Be open, particularly about smoking and any drugs, medications, or vitamins you are taking – aspirin for example can affect clotting. Be sure to discuss your expectations frankly with him and our staff. He will be equally frank with you, describing your alternatives and the risks and limitations of each of your options. This is your best time to ask any questions you may have about discomfort, healing time and so on.
How do I prepare for a breast Reduction?
Our staff at Cornerstone Plastic Surgery & Aesthetic Medicine will give you detailed instructions to prepare you for your surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain medications. Dr. Coville may require you to have a breast x-ray (mammogram) before he agrees to operate; if your age and family history suggest this would be wise. While making preparations, be sure to arrange for someone to drive you home afterwards. Someone should also be available to help you out for a day or two if needed. If you would like, we can arrange a health aide to stay with you to assist you during this period. If you are visiting us from out of town or abroad for your surgery, we will facilitate all the arrangements to make your recovery as comfortable as possible. Be sure to ask about our Seaside Recovery options.
Where will my surgery take place?
Dr. Coville will review your options with you during your consultation. The surgery is typically performed on an outpatient basis at one of the fully accredited surgery centers on the beautiful Southern Shore of New Jersey with which Dr. Coville is affiliated.
Breast Reductions are almost always done under a general anesthetic – you sleep through the entire operation. The operation usually takes from two to three hours for both breasts. Many techniques are available but Dr. Coville almost routinely eliminates the traditional anchor-shaped incision that many surgeons still use. Dr. Fred feels very strongly about the need to limit scarring on the breast. In his experience, these limited scar techniques also provide a better-shaped breast with a stronger and longer-lasting lift. During the breast reduction, Dr. Coville will also move the nipple and areola up to a higher, more youthful position. The skin around the areola is then brought down and drawn together to re-drape the breast. Stitches go around the areola and in a line extending downwards from the nipple and towards the lower crease of the breast. He may also make use of liposuction to remove excess fat from the armpit area, the brassiere line or upper back to further refine the shape your breasts.
You will wake up wearing a surgical bra over gauze dressings. A small tube may be in placed in each breast to drain off blood and fluids for the first day or two. Naturally you are likely to feel some pain for the first couple of days, especially when you move around or cough, and may feel some discomfort for a week or more. Most of your discomfort can be controlled by medication that Dr. Fred will prescribe for you before surgery so that you have them with you when you need them.
The bandages can be removed a day or two after surgery, but you will probably have to continue wearing a surgical bra around the clock for several weeks while the swelling and bruising subside. Almost all the stitches used will simply dissolve so very little removing of stitches is required. If your breast skin is left very dry, you can apply a moisturizer several times a day, but you must carefully avoid the stitched areas unless Dr. Coville instructs you differently. Your first menstruation following surgery may cause your breasts to swell and hurt. You might experience some pains at times during the first few months. Some loss of feeling in your nipples and breast skin is natural, caused by the post-surgical swelling but this usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and rarely, it may be permanent.
You should be up and about in a day or two but your breasts may still ache occasionally for a couple of weeks. Avoid lifting or pushing anything heavy for three or four weeks. Our staff will give you detailed instructions about resuming your normal activities. After about two weeks most patients can return to work, provided it is not too strenuous, and enjoy social activities. Nevertheless, you will have much less stamina for several weeks, and should limit your exercises to stretching, bending, and gentle swimming. For this you will need a good athletic bra for support. You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks. A small amount of fluid drainage from your surgical wounds, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don’t hesitate to call our office at once.
Any scars will be firm and pink or red for at least six weeks. Then they may remain the same size for several months, before they tighten up. After several months, your scars will begin to fade, although they will never disappear completely. Dr. Coville will want to see you during this period to see if there is any need for him to treat your scars so that they heal as inconspicuously as possible.
Will I Be Happy?
Dr. Fred Coville will make every effort to make your scars inconspicuous and create a very pleasing breast shape for you. The procedure he utilizes most often will leave your breasts looking a bit flattened on the under-surface. This is both temporary and a necessary part of keeping your scarring to a minimum. Over the next several weeks and months, your breasts will settle into a very pleasing and natural shape. Much of the swelling and bruising will disappear in the first few weeks, but it may be six months to a year before your breasts settle into the new shape that you expect. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.
Breast reduction causes the most immediate and profound body-image changes. You will be freed from the physical discomfort of large breasts, your body will look better proportioned and clothes will fit you better. However, it will take you time to adjust to your new image. Your family and friends will also need time to adjust. Be patient with yourself and with them. Keep in mind why you had this surgery and, the chances are, that, like most women, you will be extremely pleased with the results.
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