Breast Reduction

Breast Reduction

What is a Breast Reduction?
Many women with large breasts encounter a variety of medical problems, as well as feeling self-conscious and at times negative about their appearance. The most common problems encountered are upper back, neck and shoulder pain, inability to exercise, limitation of clothing choices and intertrigo (rash under the breasts).

A breast reduction is the surgical procedure used to remove excessive fat, glandular tissue and skin from the breast. The new breasts will be smaller, lighter, and usually more in proportion to your overall shape and size. The nipple and areola (the pigmented skin surrounding the nipple) is lifted, and often reduced in size (if it has been stretched).

There are a number of techniques to perform this surgery. Newer techniques have less scarring and do NOT require the use of drains.

Dr. Eckhaus’ preferred techniques are the short scar vertical breast reduction and the modified Wise pattern reduction. Dr. Eckhaus will go through the best option for you at the time of your initial consultation. These techniques minimize scars and improve the final breast shape. Much of the reduction is performed first with liposuction not only to the breast, but also to the lateral chest wall (an area that can feel full or spill over in a bra). Other advantages of these techniques include:

• liposuction to the side of the chest wall/back and towards the armpit area improves the overall final shape of the breast and overall cosmesis
• by removing much of the tissue with liposuction, there is less breast tissue that needs excision, thereby minimizing blood loss during surgery
• less overall scarring
• a lower horizontal incision is often not needed

An application to the Ministry of Health and Long Term Care is required for the excision portion of a breast reduction to be covered under OHIP.

Please note that the liposuction portion of the procedure is not a covered benefit of OHIP and there are out of pocket expenses for this portion of the procedure.

Pre Surgery Instructions

Before the procedure
No aspirin or blood thinning medications for two weeks prior to surgery. Fasting begins at midnight the night before surgery. Any medications that you take in the AM may be taken with a sip of water (except for blood thinning medications). If you get ill prior to surgery please notify us.

The Surgery

During the procedure
Performed under general anesthetic (nothing to eat or drink after midnight) breast reduction surgery takes approx. 2.5 hours and is a day surgery (there is no overnight stay). On the morning of surgery, Dr. Eckhaus makes all the markings on the chest wall and breast in the pre operative area.

The final scars are placed around the areola and vertically down towards the lower breast fold. Sometimes a modified horizontal scar along the lower breast fold/crease is needed as well. Only dissolvable sutures are used and a compression garment is applied at the end of the procedure. There are no post-operative drains used.

After Your Surgery

Post procedure
While In Hospital or Clinic
You will be in the recovery room anywhere from 1-3 hours where the team will ensure you are comfortable, eating and drinking, walking and able to urinate.
On discharge home
Immediately upon discharge from the recovery room, you are encouraged to rest under supervision and start a light diet as tolerated.

You will have been given a prescription for antibiotics that is started when you return home from surgery and is taken for 1 week.
Day 1
You should be up and walking, drinking fluids, taking your antibiotics and pain medication as described below. Increase activity as tolerated, but there is no heavy lifting for 4 weeks. Leave the dressings alone.
What do I take for pain?
If you have pain, you are encouraged to start with:
• two Tylenol extra strength (total of 1000 mg of Tylenol) and one Advil extra strength (400 mg of Advil) to be taken at the same time as they work by different mechanisms and work very well together.
• You can take the above three pills (two Tylenol extra strength and one Advil extra strength) every 8 hours around the clock for the first day or two. This is often sufficient for pain medication and can avoid the need for stronger medications such as narcotics (Percocet, Tylenol #3 etc.).
• However, you will also have a prescription for a stronger pain medication that can be taken as needed if the Tylenol and Advil combination mentioned above does not suffice. This stronger pain medication may be taken on top of the above regimen. Please ensure the maximum dose of Tylenol in 24 hours does not exceed 4000 mg.

** Please be aware that with any medication and particularly Advil (a type of non-steroidal anti-inflammatory) there are risks of allergy, severe allergy, gastrointestinal bleeding and stomach ulcers. Taking your medication with food can sometimes help with some of the stomach symptoms.

An initial wrap and post-operative compression bra are left in place for 2-5 days. During this period of time, you may use a hand held shower or sponge bath but the dressings must stay dry.
First post-operative appointment
The initial dressing change is done on day 2 or day 5 after surgery. The gauze and foam pads are removed and the white steri strip tapes are left on. Dry gauze or padding is used daily to protect the tapes from the compression bra band.

In the first two weeks following surgery, the post-operative compression bra is worn 24 hours a day (day and night, except for the shower).

The subsequent two weeks (week 3 and week 4 following surgery), the compression bra is worn during the day only.
Second post-operative appointment
The second appointment is close to 2 weeks after surgery and the white steri strip tapes will be removed. Dry gauze once daily is used for the next week and then you will start the silicone gel sheeting for scar management (given to you at this appointment).

Post-operative swelling and bruising begins to subside after 7 days but can take up to 2-3 weeks. Though most of the swelling will have subsided by week 3, you are advised to wait 2-3 months to be re-sized for a new bra. Patients usually require 1-2 weeks of downtime and should avoid strenuous exercise for 4 weeks.
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