Breast Reduction

• A scar has to be placed on the breast to achieve a breast reduction. In general the scars can be of two different types:

Lollipop Scar (Vertical Breast Reduction Scar)

• This incision is placed around the nipple and areola, as well as vertically down from the areola to the fold of the breast

The advantage of this scar are:

• Allows excellent shaping of the breast, with the vertical scar allowing removal of excess skin on the breast, and allowing the breast to become more ‘perky’
• Allows resizing the areola to a more appropriate size
• The vertical scar takes tension off the nipple and areola reducing the chances of it widening over time

The disadvantages are few but include:

• There can also be some redundant loose skin left at the inferior part of the breast – this takes up over the first few months and rarely needs a small revision. If it needs to be excised the scar is often shorter than it would have been had it been removed at the time of the original operation.
• Suitable for small reductions only

Anchor scar (Wise pattern Breast Reduction Scar)

• This incision is placed around the nipple and areola, as well as vertically down from the areola to the fold of the breast, and a horizontal incision in the fold of the breast.

The advantage of this scar are:

• Allows excellent shaping of the breast, with the vertical and horizontal scars allowing removal of excess skin on the breast, and allowing the breast to become more ‘perky’
• Allows resizing the areola to a more appropriate size
• The vertical scar takes tension off the nipple and areola reducing the chances of it widening over time

The disadvantages are few but mainly that there are extra scars compared to the lollipop approaches. In general, we find that these scars heal well become more inconspicuous over time. Due to the T shaped scar, sometimes there is slower healing at the T junction.

• In general drains are avoided during a breast reduction procedure allowing patients to go home the same day
• The exceptions are patients:
  • Having very large reductions
  • Also having removal of old implants and capsulectomy (removal of the layer of tissue surrounding the implants)
  • On blood thinning medications
  • If unexpected bleeding or alternative situation that could increase the risk of seroma (fluid collection) is found during the operation.
• If a drain is inserted you may need to stay in hospital overnight

• Dr Aggarwal will place waterproof dressings over the incisions.
• You should wear a compressive sports bra or crop top for the first 6 weeks. This helps to reduce swelling, pain and discomfort in the early post-operative period as the area heals.
• You will be able to get the area wet after 48 hours and go back into your crop top or sports bra after your shower. You will not be allowed to swim in a pool or beach for at least 2 weeks after surgery. This could be a little longer is there are wounds that are slower to heal.
• You will be given a script for antibiotics by Dr Aggarwal which you must continue until the box runs out
• You will also be given pain relief medications although most patients only report minor amounts of post-operative pain that is responsive to simple oral analgesia.
• You will not be allowed to go back home on your own – you must have someone accompany you home, and it is best to have someone look after you for the first few days as you recover. You should not drive for at least 24 hours after having an anaesthetic nor operate heavy machinery.
• While most sedentary activities can be resumed in the first week, you must not do any exercise for the first few days after surgery that could raise your blood pressure. You will also not be allowed to do any heavy lifting or upper body exercises for the first 6 weeks.
• Dr Aggarwal will see you a week after your procedure to inspect how the wound is healing. You will be given instructions how to look after the wound as it continues to heal. You will be able to ask questions about what you can and cannot do. Generally we will see you at 1 week, 3 weeks, 6 weeks, 3 month, 6 months and 1 year post surgery.

• Nipple compromise – this is a rare but most significant complication in a breast reduction procedure. When the breast is reshaped the aim is to keep a block of breast tissue behind the nipple intact. This block of breast tissue contains the blood supply that keeps the nipple alive as well as the nerves that supply sensation to the nipple.
  • There can be problems with the blood supply of the nipple, and if there has been previous surgery to the breast.
  • Arterial problem – this is when there is a problem with the blood coming to the nipple and it therefore turns white. This may require the nipple to be removed and placed back as a nipple graft.
  • Venous problem – this is where there is a problem with the blood returning to the body from the nipple. It gets to the nipple, and pools there therefore turning the nipple blue. This may require manoeuvres to reduce the tension on the nipple, and sometimes other adjunctive techniques to increase the blood draining from the nipple.
  • The risk of these complications are much higher in patients who smoke or who are diabetic.
• Change in nipple sensation – a third of women preoperatively have reduced sensation to their nipples, a third have normal sensation and a third have more than normal sensation (hypersensitivity). Literature indicates that these ratios are unchanged following breast lift/reduction surgery.
  • However we believe that it is possible to reduce the sensation to the nipple following any breast surgery.
  • In most cases this should be transient and returns to normal, a process that takes up to 12 months.
• Change in the ability to lactate or breast feed: a third of normal women (who have not had surgery) have normal ability to breast feed, a third have reduced capacity (i.e. will need to supplement their feeds with formula to their infant), and a third have no capacity to breast feed. Literature indicates that these ratios are unchanged following breast lift/reduction surgery.
  • However we believe that it is possible to reduce the ability to breast feed following any breast surgery.
  • If this is of great significance to you, you should either not have breast lift/reduction surgery or postpone it to when you have completed having your family.
• Widening of the nipple-areola complex – this can be a problem with a periareolar mastopexy. The most effective way of preventing this complication is to place a vertical scar in addition to the scar around the nipple (lollipop) which takes the tension off the nipple and areola.
• Asymmetrical scars – There can be a difference in how each breast behaves to the underlying implant, and can produce an asymmetry to the scars, albeit the aim is to get them as symmetrical as possible.
• Hypertrophic or poor scars – How one’s body behaves to scarring is individual and largely genetic. Some types of skin are more prone to hypertrophic or keloid scarring, and some individuals and families are more prone to this. We will routinely advise you on how to improve the quality of scars over time. You should also discuss any history of abnormal scarring with Dr Aggarwal preoperatively.
• Asymmetrical nipple position and shape – due to scars on the breast, and native asymmetry of every woman’s breasts there can be a difference in how each breast behaves to the surgery, and this can produce an asymmetry to the nipple size and shape, albeit the aim is to get them as symmetrical as possible.
• Nipples too high or too low – in general at the end of a breast reduction procedure the aim will always be to have the nipples sit a little low. This is because as the breast settles, and scars relax the nipples will move up. The aim is to avoid the nipples looking too high as this can be an extremely difficult problem to correct. If long term nipples are too low this can be easily addressed though a crescenteric skin excision of skin just above the nipples, which can be performed under local in rooms.
• Unusual breast shape – it is common for the initial shape of the breast to be unusual as lower part of the breast gland and skin is tightened making the upper part look fuller and the lower part look tight. This settles as the scars relax and the breast settles. This can take approximately 3 to 6 months.
• Asymmetry
  • Most women’s breasts are asymmetrical
  • The aim during breast reduction is to get them more symmetrical – if required this may involve removing more tissue from one side than the other
  • However there can be small asymmetries in the final breast shape.

• You can see us at our main practice at Gordon, or at our other locations at Hornsby, Hunters Hill or Camperdown.
• Please scroll to the bottom of the page to find out more information about these locations.

• Any of the hospitals where Dr Aggarwal works – i.e. Sydney Adventist Hospital, SAN Day Surgery, Hunters Hill Private or Castlecrag Private hospitals

• Cease fish oil, and other supplements such as Ginkgo, Ginseng.
• Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.
• If you are smoking you need to cease this well in advance of surgery as the risks of nipple compromise and poor wound healing significantly increase in smokers.

• No but Dr Aggarwal recommends that you purchase a crop top or sports bra which you should wear for at least 6 weeks.
• You should not wear any bras with an underwire during this period

• You should not do any exercise that raises your blood pressure for at least 72 hours after surgery to avoid the risk of an unexpected bleed
• Heavy upper body exercise should be avoided for 6 weeks

• Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.

• Not usually.
• Occasionally we may undertake scar revision in a private hospital or under local anaesthesia in rooms. For instance this can be to remove loose skin that did not disappear completely after a vertical pattern breast lift.
• Most patients are extremely satisfied following breast reduction surgery and will not require any additional surgery.

• Yes
• However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.

• You may swim in a pool or beach after 2 weeks as this is the time it takes for the incision to heal.

• It is best to not drive for several days and up to 1 week after surgery.

• No
• You will require a general anaesthetic in an accredited private hospital.
• It is usually a day surgery procedure but you will need someone to pick you up and accompany you home after the procedure
• If a drain is used you may need to stay overnight

• A third of women preoperatively have reduced sensation to their nipples, a third have normal sensation and a third have more than normal sensation (hypersensitivity). Literature indicates that these ratios are unchanged following breast lift/reduction surgery.
• However we believe that it is possible to reduce the sensation to the nipple following any breast surgery. In most cases this should be transient and returns to normal, a process that takes up to 12 months.
• Permanent loss of sensation to the nipple is rare.
• If this is of significant concern to you, you should not have surgery on your breast.

• Even in the normal population (women who have not had breast surgery) up to a third of women cannot breast feed at all, and a third require additional supplementation for their infant. The remaining third of women can breast feed normally. These proportions of women are unchanged after breast lift/reduction surgery.
  • However we believe that it is possible to reduce the ability to breast feed following any breast surgery.
  • If this is of great significance to you, you should either not have breast lift/reduction surgery or postpone it to when you have completed having your family.

• Yes
• However the additional scarring within the breast can make breast mammogram and ultrasound more difficult to interpret by radiologists.
• It is therefore important that prior to undergoing surgery you have imaging of the breast – it makes sure there is nothing of concern in the breast tissue, and also forms a baseline against which a post-surgery mammogram can be compared.
• It is important for you to participate in regular screening as you would have otherwise done for breast cancer based on your age and family history, after having surgery

• No.
• However any tissue removed during surgery is sent for histopathological examination meaning it is examined by experts under a microscope. This is to ensure there is no evidence of suspicious pathology in that tissue.
• Despite having preoperative imaging, it is possible for an occult breast cancer to be detected by having surgery. The rate of this is much less than 1%.
• It is important for you to participate in regular screening as you would have otherwise done for breast cancer based on your age and family history, after having surgery
• In Australia it is recommended for women who reach the age of 50 to undergo 2^nd yearly mammography for breast cancer screening in the absence of other significant family history – if you have a strong family history you may be required to start breast cancer screening earlier

• Minor breast reduction can be performed with liposuction alone
• However this results in looser skin and makes the breast sag more
• It also means that the tissue removed cannot be sent for histopathological examination
• We therefore reserve liposuction alone for minor revisions where small adjustment of breast size may be needed to achieve symmetry.