Need for the surgery:
Fall and/or excess of volume of breasts (hypertrophied breasts- ptose).
When is the appropriate time to operate?
A mammary reduction is possible only once growth and puberty are over. Schematically, the intervention is performed between 16 and 30 then after 45.
Between 30 and 45, a considerable number of women expect to be pregnant. An intervention for mammary reduction is therefore not advised during this period because the volume of the breast is variable during pregnancy. An increase in the size of the breast close to an intervention would distend the scars and compromise the aesthetic of the breast and therefore the result of the intervention. That’s why this intervention must be carried out well before a pregnancy or after it:
• Before, because the period between 16 and 30 years of age is one of high activity (sports, leisure) and a bulky chest can be physically penalizing (bad back aches) and psychologically (difficulties of social integration). Realized during this period, the intervention makes it possible for the patient to fully benefit from her youth.
• Well after, because once their children raised, many women realize that a bulky chest, and sagging following pregnancies is invalidating and that women wish to improve their body’s aesthetics.
The surgery:
You find that your breasts are too heavy or that they sag.
In both cases, it will be necessary to remove a certain quantity of skin.
When the gland is too bulky, I will remove from it the necessary quantity, when, on the contrary is flattened, dispersed, I will concentrate it.
In both cases, I will reconstitute a high and round mammary gland. Movements of the arms are not advised for a few days. The intervention will of course be performed under general anaesthesia and you will spend three days in the clinic.
Scars:
You will always have a scar around the areola, but I will decrease the size if it is too large. Below the areola, you will have a scar in a inverted T shape, vertical downwards starting from the areola, and horizontal in the fold under the breast. It is very important to me that this horizontal scar remains as short as possible. If you have an elastic skin, I will only make one vertical scar.
The stitches are removed within 15 days.
You will have to wear a standard “Pleytex, cross heart” bra or a sport’s bra with median opening, holding you well, day and night during a month.
The scars located on the breast usually improve a lot with time, whereas the longer middle and lateral scars can remain visible.
Which elements should be of concern following the surgery?
1. The swelling of a breast with a feeling of tension; this is caused by a bruise. It will be evacuated quickly, sometimes under general anaesthesia in order to avoid any after-effects.
2. Disorders in the scaring process (scabs) in particular on the level of the areola.
In the event of very bulky, falling breasts, the areola is low and facing down. During the intervention, I make lift them back up. This lifting can be significant and compromise the vascularization (provision of blood) to the areola. The areola can suffer from this and produce necroses, thus seriously compromising the final result. Such an accident must be prevented by careful postoperative supervision: using massages of the areola.
In the case of too bulky or heavy breasts, I could propose to transplant the areola, moving it higher. This process avoids the risk of necroses but modifies the aspect of the areola (depigmentation, loss of the nipple’s relief). The result is nevertheless more satisfactory than after a necroses and this process could be employed (intervention of THOREK).
If you smoke, is imperative to stop a month before the intervention to assure a good scarification.
3. In the long run, the scars can become red or thick (hypertrophied scars or chéloïde). A good preoperative investigation will allow us to identify such scars on the patient or in her family. If the patient has an antecedent of bad scarification, the usefulness of such an intervention is to be discussed with the patient. To exchange bulky and falling breasts against thick and red scared breasts will perhaps be source of serious aesthetic and psychological problems.
Repercussions of the surgery:
You were worried about the possible repercussions of a surgical operation on the mammary gland. I examined you and I asked you, starting from a certain age, to have a mammography done, to be certain that all is normal.
During the intervention, I will be able to examine more closely the state of the mammary gland and to remove a cyst or a suspect fragment, that will then be examined by the anatomopathologist, under the microscope.
Number of studies have bean carried out to know if a surgical operation could favour the later appearance of a breast cancer. They always concluded negatively, by emphasizing on the contrary that a certain number of early, small cancers had bean discovered and removed thanks to the aesthetic operation.
A reduction of the volume of an important gland also decreases in proportion the risk of appearance of a later cancer.
Heavy breasts often also involve a bad position of the back and pains, apart from the vestimentary embarrassment. There is less need to be concerned with scars in this case, the aesthetic benefit being anyway important.
The problem of the scars has to be considered most carefully in the less severe cases, in particular small breast falls, and I told you that it was necessary to measure the pros and the cons, if I didn’t simply advise against the operation.
Dr Thierry BONVALLOT