Question: I have always had a large chest but since I had my baby a year ago, my breasts have stayed much bigger, even though I don’t have excess weight anywhere else. I am considering a breast reduction and I was wondering how it will affect breastfeeding as I plan on having more children and feeding them for six to eight weeks as I did with my son. Will I be able to feed after a reduction?
Dr Grant replies: In general, women who seek breast reduction surgery (reduction mammoplasty) have 0.9kg to 2.2 kg of excess breast tissue weight. There is typically some form of chronic pain in the breasts, shoulders, neck, or midthoracic-back (between the shoulder blades). These symptoms are generally worse at the end of the day, particularly after prolonged standing. Other problems such as skin rash and skin infections around the breasts, and difficulty performing some sports are common complaints in patients with enlarged breasts (macromastia).
Most surgical procedures to reduce breast size will include an elevation in the height of the nipples and reorientation that allows the nipples to point outward (not downward) thus small scars will be visible around the nipples.
The positive aesthetic results include breasts that are higher, more rounded, and in better proportion to the rest of the body. Moreover, there is generally a significant improvement in quality of life.
The minor and self-limiting common complications of breast reduction include cellulitis (skin infection), hematoma (collection of blood) or seroma (collection of serous fluid), and minor skin necrosis (failure of the skin healing) at the site of a scar. There is a risk of serious post-operative bleeding that may require going back to theatre, usually within the first 12 hours after surgery. More serious complications, such as the loss of the nipple-areolar complex, or flap necrosis, can occur but are rare with proper planning.
Some post-operative women experience sensory changes. There can be complete (or diminished) sensory loss to the nipple, or possibly even improved sensation in some patients. If simply diminished, improvement in sensation of the nipple-areolar complex can be expected over several months, as the sensory nerves recover. Other possible complications are nipple-areolar necrosis (failure to heal), areolar pigmentary changes, wound healing complications, fat necrosis, and abnormal pathologic findings.
Before any elective breast procedure, the need for breast cancer screening should be determined. Patient age, family history, and physical examination will be the most important determinants of need for cancer screening prior to surgery.
Unfortunately, there is a chance breastfeeding may not be possible, depending upon the type of breast reduction surgery performed. The preoperative breast size and estimated reduction volume are the most important factors influencing the selection of technique for breast reduction surgery. Almost any surgical technique will work well for smaller breast reductions (aiming for 200g to 400g per side), but when aiming for more than 1200g reduction per breast, surgery is technically challenging.
The majority of plastic surgeons will advise you to complete your family before considering breast reduction, as the effects of future weight gain will impact breast size. Much like varicose vein or abdominal wall hernia repair surgery, your breasts may grow during subsequent pregnancies and with further breastfeeding, and the benefits of your surgery may be lost.
Dr Jennifer Grant is a GP with Beacon HealthCheck
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December 12, 2022 at 09:30AM
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