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Breast Reduction with Breast Lift
Overview
One of the most satisfied patients in
plastic surgery is the one who has had a breast reduction. People who don't have large breasts don't understand the tremendous
inconvenience and pain associated with them. The average
person thinks that large breasts are a blessing; something
that most women want. Little do they know that large breasts
can actually be a significant handicap. Often, they prevent
the woman from wearing normal clothing, cause back and neck
pain, make it difficult or impossible to exercise, and a whole
host of other problems.
After a breast reduction, the patient
feels as if a burden has literally been lifted off of her
shoulders. Gone are the bra strap marks across the shoulder,
the rashes, and the burden of carrying around all that extra
weight. It is a tremendous relief.
Not uncommonly, the patient with large
breasts can also be overweight. It is best for these patients
to try to lose as much weight as possible for several reasons. Not only because losing weight is healthy but because it makes
the operation technically easier. Another reason is that
an insurance company may not pay for a breast reduction in
a patient who is significantly overweight. Often, an insurance
company will refuse to pay anyway and the patient is forced
to pay for it herself. The only way to find out is to have
the procedure pre approved prior to the operation. It is
safe to say, though, that if the procedure is mostly cosmetic,
insurance will not pay for it.
There are several ways to perform a breast
reduction. Dr. Cruise is a big advocate of what is called
the "short scar " breast reduction. This type of
breast reduction is somewhat more technically difficult but
has the huge advantage of leaving a shorter scar and it also
creates more breast projection and cleavage. Dr. Cruise will
elaborate more in the section "Dr. Cruise's philosophy. "
It is important to point out that this procedure is not just
a reduction procedure but it is a cosmetic procedure as well,
or at least it should be. Breasts are very important to most
women and it is important to add an artistic quality to the
reduction so that a sexy, feminine result is obtained.
Despite Dr. Cruise has the ability to
perform breast reduction with a shorter than normal scar,
a scar is inevitable. The scar goes completely around the
areola and then travels down the breast to the level of the
fold underneath the breast. If your breasts are exceptionally
large a short scar within the fold may be necessary. This
is very unusual. The scar usually becomes quite red the first
2 months after the operation but fades within 1 year. The
patient considering breast reduction must be prepared to accept
the scar as a trade off for lighter, perkier, more attractive
breasts. The reality is, these scars are not noticeable even
when wearing highly revealing clothes.
 Dr. Cruise's philosophy regarding Female Breast Reduction
 To put it bluntly, large breasts can be a significant handicap. Their sheer weight makes them very difficult to carry around and prevents many women from doing the things they want to do. They cause neck and back pain, rashes, and a myriad of medical problems. In addition to this, they cause significant psychological problems as well. Here you have a body part that is supposed to be sexy and feminine, yet the bearer of large breasts sees them as no more than a burden. The problems from this paradox are beyond the scope of this web site. Suffice to say, I feel very strongly that something should be done soon so that problems do not snowball.
In my practice breast reductions are as much cosmetic as they are reconstructive. There is no question that excess weight in the breasts is the primary cause of the physical problems, but if the breast reduction is done in a sexy, cosmetically pleasing way the patient benefits in both a physical and psychological fashion. This is why I perform my breast reductions the same way I perform my breast lifts except, of course, I also remove breast tissue in the process. I perform what is known in the plastic surgery literature as a "short scar" breast reduction. I believe that breast surgery, whether it is brest reduction or breast lifting, is art work as much as it is surgery. This is why I have developed this technique. It is more technically demanding but it achieves more sexy, feminine breasts with more projection and cleavage than the standard breast reduction; yet it is done with a shorter scar.
Anyone considering breast reduction must realize that the cost of removing breast tissue, elevating the nipple, and making a more appealing breast causes a scar. This scar travels around the nipple, down the breast, and, in rare cases, forms a T underneath the breast. It is true, that even with revealing clothes the scar is not visible but the person considering undergoing this procedure must still be aware that scars will be created.
Other cosmetic procedures such as liposuction or abdominoplasty can be done at the same time in certain patients.
Benefits
The benefits of breast reduction are
physical, mental, and cosmetic. If done properly, breast
reduction can simultaneously remove excess breast tissue and
provide you with breasts that you can have a pride in instead
of a burden. There are many reasons for breast reduction. Here are a few:
- Relieves back and neck pain.
- Relieves rashes underneath the breast.
- Reduces weight so that exercise and
other activities are easier.
- Improves breathing and bad posture.
- Removes shoulder grooving from bra
straps.
- Makes clothes fit better.
- Repositions nipple into a more youthful
location.
- Provides a breast lift as well as
breast reduction.
Possible complications
The most common complication after breast reduction is asymmetry. It must be pointed out, however, that all breasts have some asymmetry. A breast reduction, in fact, can do a lot to correct asymmetry but it is unreasonable to expect both breasts to be exactly identical.
Another potential complication is inadequate reduction or over reduction. Dr. Cruise spends a great deal of time before the operation finding out exactly what size you would like to be to avoid this. Some women would like to be as small as possible. There is a limit to how small they can be made without compromising blood supply and safety. Dr. Cruise has considerable experience in both cosmetic and reconstructive breast surgery and will do all that is possible to provide you with the size and shape of breasts you desire.
A complication that has already been discussed but must be emphasized is really not a complication. It is the fact that a scar is a requirement in order to achieve breast reduction. Over time the scar will fade but will never go away completely.
After breast reduction, there is a significant likelihood that breast-feeding will not be possible. Also possible is the loss or a decrease in sensation to the nipple. Usually sensation does return but this cannot be guaranteed. Other complications that must be considered, but are possible with any operation, are the risks of infection, wound healing problems, fluid or blood collection, and contour irregularities.
Are
you a good candidate?
In general, patients that are good candidates
for breast reduction know it before even reading this web
site. They are plagued with the problems outlined above. Quite often the biggest question is whether a breast reduction
or a breast lift is needed. Both procedures involve lifting
and shaping the breast. The reduction also involves removal
of a significant amount of tissue as well. This will be evaluated
during your consultation. Usually, however, the patient knows
whether or not the procedure is a cosmetic one. In order
to qualify as a breast reduction, the insurance company usually
requires a certain amount of breast tissue be removed.
Here is a summary of problems plagued
by patients who need a breast reduction.
- Do you have back or neck pain caused
by large breasts?
- Do you have persistent rashes below
the breasts?
- Are you unable to exercise because
of your large breasts?
- Do you have grooves in your shoulders
from bra straps?
- Are your breasts way out of proportion
to the rest of your body?
- Are your breasts large and droopy?
- Are you self-conscious and/or unhappy
about your large breasts?
If you answered yes to any of the above
questions a breast reduction is probably worth while.
Prior to surgery
BEFORE SURGERY
- Avoid sunbathing for 2 weeks prior to surgery.
- Quit smoking at least 2 weeks prior to surgery as nicotine can impair and delay healing.
- Stop all aspirin containing products, medications that contains blood thinners (motrin, advil etc.) vitamin E and herbal supplements 2 weeks prior to surgery. You can take 1 multivitamin a day.
- Let the doctor know of all medications taken daily.
- Make sure all requested labs, mammogram and doctors clearance are delivered to Dr. Cruise's office on time.
THINGS TO PURCHASE BEFORE SURGERY
- Medications. Prescriptions will be given during pre-operative appointment.
- Garment. You will be provided with a surgical bra immediately after surgery. You should also have two other support bras available in a cup size you are anticipating going to or slightly larger. The bra should fit snug around your chest.
- Gauze. Make sure to have a box of 4x4 gauze. You can purchase this at drug store.
Optional
1. Arnica - available at Dr. Cruise's office - may decrease bruising, or help it to go away faster.
THE DAY OF SURGERY
- Do not eat anything for 8 hours and drink for 6 before surgery.
- You may shower and shampoo your hair the night before or morning of your surgery .
- You may brush and rinse your teeth, but do not eat or drink anything. Do not wear makeup or moisturizers on your face or eyes.
- Do not bring any jewelry or valuables with you on the day of surgery.
- Wear comfortable, loose-fitting clothes, preferably button up or zipped up top. Wear flat, comfortable shoes. Remove contact lenses, dentures and nipple rings before surgery.
- Someone must drive you home and stay with you the first night.
- Take 2 pills of Zofran and 2 pills of Celebrex at 1-2 hours before surgery.
Anesthesia
Dr. Cruise works only with board certified anesthesiologists
to make sure you have the best anesthesia possible. The anesthesiologist
will discuss with you what type of anesthesia is best for
you. He/she will take into consideration your medical history,
the procedure, and your personal wishes.
Normally, general anesthesia is required
when performing breast reduction to make sure the patient
is completely comfortable throughout the procedure.
After
the procedure
The procedure itself will take approximately 3-4 hours.
AFTER SURGERY
- Get plenty of rest and limit yourself to light activities the first 10 days after surgery. Sleep and rest with head slightly elevated for the first 3 days.
- You may take a cool shower the day after surgery. Make sure you have someone helping you. Put your bra back on . Let water run gently over the drains exits. Dab dry. Place gauze over drain exit.
- At 2-3 weeks after surgery take your steri-strips off. Apply ScarLess®, allow it to dry and then re-apply silicone sheets twice a day for two months.
- Sutures will dissolve on their own.
- Do not drive for the first week or while on pain medications. Do not do heavy housework and do not work out at all for the first 3 weeks, no upper body workout for at least 8 weeks.
- Avoid lifting anything heavier than 5 pounds for 2 weeks.
- Wear a surgical bra 24 hours a day for 8 weeks unless Dr. Cruise instructs you differently.
- Avoid direct exposure of incision to sunlight for at least 6 weeks. After 6 weeks, apply sunscreen (at least SPF 15) to the area of the incision, if you will be in the sun for extended periods of time.
- Do not smoke for at least 1 week after surgery.
- Do not use aspirin-containing products for at least 1 week. You may take Tylenol or pain medication as prescribed.
- You may apply ice or frozen peas or corn on the breast for the first 48 hours to decrease swelling. Do not apply it directly on your skin.
- Be sure to use all you medications as directed.
- It is not uncommon for a small part of incision to open up and look like a pimple at 4-8 weeks. This is called a Stitch Abscess - it is caused by a suture which is expelled by the body. Simply wash it with soap and water and apply Neosporin or Polysporin on it. If the redness is larger than a dime call the office.
WHAT TO EXPECT AS YOU RECOVER
- Immediately after surgery, some patients feel groggy or nauseous. These feeling normally subside by the next day.
- Many patients experience some pain for the first 3-4 days and soreness for the first 2 weeks
- Most of the time the breasts are very swollen and tight for the six week. Do not be concerned they will drop with time. At your follow up appointment Dr. Cruise will show you how to massage them to make sure you positioning is appropriate. The body heals asymmetrically. One breast might be swollen, hurt more and appear higher or lower than the other, do not be concerned.
- Swelling and bruising usually clears up within 2 weeks.
- Pink scars will eventually fade to an unnoticeable color. It may take up to a year for the scar to fade to its minimal color.
- Some firmness may develop. Once the tenderness subsides, you may begin to massage the breasts to help soften them. After 3 months you should massage your breasts daily during your shower for 30 seconds for the rest of your life.
- Your nipples might become hyper sensitive or lose sensation for the first 3 months. This usually goes away.
WHEN TO CALL US
Post surgical complications are rare and are often easily solved by the doctor if you notify us. Call us if you experience any of the following:
A temperature of 101 F or higher, increased local redness or warmth, chest pain, shortness of breath, legs swelling, calf pain, or if you feel that anything might be wrong. Please call the office during regular business hours @ 949-644-4808 after page Dr. Cruise @ 714-304-8050. In addition, call if you have continuous discharge from the incision line, if one of the breasts appears significantly larger and more tender, if the pain increases instead of decreasing after 5 days or the breasts become red.
POST-OP VISITS AND CARE SUMMARY
| Blood Clot |
- It is important to walk at least every 2 hours while you're awake to prevent blood clotting- do not over do it. Right after surgery you will be instructed to walk around every 1 hour.
- Pay specific attention to leg swelling. If you notice swelling on only one leg or calf pain contact the office.
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| Drain Function |
- Make sure that your drains are functioning.
- Empty drains every 8 hours or when they become more than half full and write down amount of drainage.
- Do not be concerned if the fluid from the body comes around drain.
- You may need to milk the tube if it appears to be clogged.
- Drains come out at about 2-3 days, depending on amount of drainage.
- Note - the drain is always uncomfortable but it is absolutely necessary to prevent fluid accumulation.
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| Constipation |
- If you are constipated at day 2 stop taking Vicodin or Darvocet.
- Encourage walking, drinking a lot of fluids, consider laxative( Ex-lax or Correctol).
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| Fever |
- Make sure to cough and breath deep as fever is usually in lungs for the first 3 days after surgery.
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| Activity |
- You can take a cool shower the day after. Dab dry. Make sure you have someone helping you.
- Walk every hour while awake for the first day and then every 2 hours.
- Sleep at 45 degree angle for the first 3 nights.
- Begin massage after the first post-op visit.
- Regarding exercise: If it hurts don't do it. Wait for your body to tell you what you can do.
- You can exercise areas other than your chest at 2 weeks.You can work out your chest at 8 weeks.
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| Wound Care |
- Make sure your bra is on as directed.
- Keep surgical area clean and dry at all times.
- At 2-3 weeks after surgery take you steri-strips off. You will apply surgical tape for about 3 months, changing it every week.
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Recovery
time
Some people with sedentary jobs go back
to work after 1 week. If your job, however, requires aggressive
arm movements it may take as long as 4 weeks to return to
work. Most people return to work after 2 weeks.
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