Breast Reduction
What is Breast Reduction surgery?
Many women feel that their breasts do not match their overall body physique. Extremely large or droopy breasts may be the result of excessive development or the aging process. Such changes most frequently occur during for hereditary reasons during menarche, pregnancy or following menopause; or at any time during a woman’s life as a result of weight gain.
Although the goals of breast reduction and breast uplift procedures are different, the procedures will be discussed together because the pre-operative preparation, external surgical incisions, and post-operative course are quite similar. In both procedures, incisions are designed to create a more youthful and natural shaped breast. In both procedures, this involves elevating the nipple/areola complex from a lower, droopier position, to a more natural position on the center of the breast mound.
Occasionally, the patient may desire breast implants at the time of an uplift procedure if the patient perceives that the breasts are not only too droopy, but too small as well. It is important to understand that no person is perfectly symmetrical from one side to the other, even before a surgical procedure. Every attempt will be made during surgery to minimize your side-to-side dissimilarities, but such differences are natural and always persist to some degree, even after the most successful operation.
There is no evidence that breast uplift or reduction surgery alters the possibility of developing breast cancer. It will still be necessary for you to examine yourself monthly for breast lumps and to undergo mammography as suggested by your personal physician. It is suggested that all females 35 years of age or older obtain a mammogram, and annually after the age of 40, whether or not you decide to proceed with elective breast surgery.
With the breast uplift procedure, few incisions are made within the substance of the breast. While reducing a breast, incisions will naturally course across breast ducts, but the ducts immediately beneath the nipple are left intact and usually such a patient would be able to breast feed, if this becomes desirable in the future. Although not all women are able to breast feed even before a breast operation, these procedures by themselves should not rule out the ability to breast feed at a later date.
Breast Reduction Overview Video
The following information has been prepared to familiarize you with facts about the surgical procedures known as breast reduction (reduction mammoplasty) and breast uplift (mastopexy). You are requested to read this information thoroughly and to discuss any questions, which might arise with your surgeon before proceeding with either a breast reduction or an uplift procedure. You are also requested to keep this form as a reference in the post-operative period.
Preoperative instructions
You may visit your surgeon as many times as you wish to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that is used before surgery, as well as pain pills, antibiotics and instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or laboratory (e.g. Kaiser Hospital, etc.) All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.
As with all other elective procedures, the patient should avoid ibuprofen (Advil®), all aspirin® products and excessive quantities of vitamin E (the small amount contained in most multi-vitamin preparations is not harmful) for two weeks before surgery, as these inhibit the clotting mechanism and increase your chances of unnecessary operative bleeding.
Patients will be given a prescription for Hibiclens® soap. It will be necessary to scrub the surgical site (from the neck to the belly button, and from one armpit to the other) for ten minutes the evening prior to surgery and for one final time on the morning of surgery before leaving for the surgical suite. Scrubbing the skin with Hibiclens® these two times will decrease the number of bacteria on your skin and lessen the small possibility of developing a surgical infection.
Usually, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Laguna Hills Surgery Center, prior to your procedure. As discussed in the general information sheets, it is imperative that the patient makes prior arrangements for transportation to and from the Surgery Center, and to have a responsible adult stay with you for the first 24 hours after the operation. If desired, the office can help find a nurse to look after you for the first night.
Details of the procedure
Mastopexy or breast reduction procedures are performed in an outpatient surgery center setting. In most cases, a light general anesthetic or deep sedative, along with local anesthetics, are employed to insure your comfort and safety.
In a breast reduction procedure, breast tissue is resected in addition to the excess skin, thus reducing the final volume of the breast, and elevating the nipple/areolar complex. Any tissue resected during a breast reduction procedure will be examined by a pathologist and you will receive separate bills from the laboratory and the pathologist for these services. Occasionally, liposuction is utilized to remove some or all of the excess breast tissue. In an uplift procedure, skin alone is resected and tissues are shifted to position the nipple/areolar complex in a more elevated location. Following the procedure, a brassiere-like dressing will be applied and you will be sent to the recovery room where you will be kept until you are awake and ready for discharge.
Post-operative care
Patients may choose in advance to spend the night after surgery with a nurse. Otherwise, after you have recovered to the point where you are awake and comfortable, you will be discharged home with a responsible adult. You are to leave the dressing dry and intact until your first post-operative visit to the office, which will generally be three to six days following the procedure. During these initial days, you will be requested to take an antibiotic tablet once daily and to limit your physical activity to avoid lifting or straining.
Following your first dressing change, you will be allowed to begin showering and to increase your activity as tolerated. Most patients find that within the three or four days, they can function comfortable around a home or office setting, but that at least three to six weeks must pass before increased physical activity can be tolerated without discomfort. The best rule of thumb is to avoid any activities that cause you discomfort and to enjoy those that do not.
Possible complications
Every activity in life, whether driving automobiles or having surgery is associated with risk. The following inherent risks must be understood and assumed by the patient if we are to proceed with this operation. Although most patients have a very satisfactory result, complications may occur following any surgical procedure. The patient must understand that asymmetry (differences in appearance from one side to the other) is perfectly natural and that some will persist following even the most successful procedure. Likewise, visible and occasionally unsightly scars are an expected outcome of such an operation.
Possible complications include infections, bleeding, alteration in sensation of the nipple/areolar area or elsewhere over the breast mound, breast tissue loss, skin loss (including the nipple/areolar area), which may delay healing, necessitate skin grafts or other subsequent surgical procedures or, if implants are employed, implant rejections.
It is not uncommon for the incisions to pull apart along the folds beneath the breasts or around the areolae; should this occur, the open area will be treated with a moist dressing and will frequently heal without the necessity for revision surgery. Such wound separations, however, will significantly prolong the healing process. On rare occasions, revisional surgery will be required, and will result in additional expense to the patients. It is not possible to advise you of every conceivable complication. The foregoing was not intended to frighten or upset you, but to insure that your decision to have this operation is made with your awareness of the possible risks. Most patients have a very satisfactory result following such surgery and complications actually occur rarely.
Fees and financing
All fees will be discussed freely in advance by the office staff. Assistance will be provided if you desire financing. Your insurance company may cover at least part of the fee if an excess of 500 grams of breast tissue is to be removed and you do not have an HMO. Payment of all fees, however, is the patient’s responsibility; all fees are due prior to surgery. If requested, the office staff will assist you with forms, but recovery of any insurance benefits is between you and your insurance company. Insurance companies never pay the entire fee for breast reductions or for any other procedures that are designed solely to improve your appearance. As such, you cannot expect the insurance carrier to cover the cost of a mastopexy procedure.
In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no later than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.
Pre and post-op photos will be taken of the treatment site for record purposes. I understand that these photos/videos will be the property of the attending physician. I do____, do not ___ agree to allow these pictures to be used for publication, teaching purposes or the practice web site. If I agree, I understand that my name will be kept confidential and protected.
IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL THE OFFICE DURING BUSINESS HOURS (949-888-9700) OR AFTER HOURS, CALL YOUR SURGEON – DR BUNKIS CELL PHONE NUMBER IS (949) 500-8856, OR REGISTERED NURSE, TRACEY PRESCOTT’S NUMBER IS (949) 338-6072.
WITH AN EMERGENCY THAT REQUIRES IMMEDIATE ATTENTION, CALL 911 BUT PLEASE HAVE YOUR FAMILY NOTIFY DR. BUNKIS OF ANY PROBLEMS YOU MAY HAVE!
I, _____________________________________________certify that I have read and understand the” Breast Reduction/Uplift” information sheets dated March 2008, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.
Witness_______________________________ Date__________________
I certify that I or a member of my staff has discussed all of the above with the patient and have offered to answer any questions regarding the procedure. We believe that the patient fully understands the explanation and answers.
Surgeon’s Signature_____________________ Date_________________
Initial if copy requested/given to patient____________________________
Copy placed in chart __________________________________________
Copyright 11/87 Last revised 03/08
Juris Bunkis, M.D., F.A.C.S.
