Reduction Mastoplasty

The reduction mastoplasty means plastic surgery of breast reduction. Besides indicated to improve the aesthetic aspect of the breast, it is also indicated as complementary resource in the prophylactic treatment of certain breast diseases (in special cases) and to prevent back problems caused by too large breasts.

Also known as reduction mammoplasty, breast reduction removes fat excess, glandular tissue and skin to achieve a breast size proportional to your body and relieve the discomfort associated with too large breasts. Overly large breasts may cause, in some women, emotional and health problems. The weight of breast tissue excess, may even damage their ability to have an active life.

Who is it indicated to?
• You are physically healthy;
• You have realistic expectations;
• You do not smoke;
• You are bothered by the feeling that your breasts are too large;
• Your breasts limit your physical activity;
• You have backache, neck and shoulder pain caused by the weight of your breasts;
• You have depression in your shoulders; on the place of the bra straps, due to the weight of your breasts;
• You have skin irritation beneath the breast furrow;
• Your breasts are saggy and drooping;
• The nipple is below the breast furrow when your breasts are not supported;
You have areolas enlarged and flaccid skin.

Preoperative
In the preoperative, you must:
- Communicate with us until 2 days before the surgery in case of flu and ailment;
- Avoid alcoholic beverages or heavy meals on the surgery eve;
- Avoid any medicine to lose weight, diuretic, aspirin and/or derivate 10 days before the surgery;
- If you can, schedule your social, domestic and professional activities after a period of 15 days;
- Be in the indicated place of surgery obeying the time previously established;
- Take to the hospital light clothes and easy to get dressed (buttons on the front) and lycra bra, tight and with no lace.

Anesthesia
The anesthesia is, currently, general.

Hospitalization
In most cases, the surgery is performed in an outpatient basis, i.e., the patient goes to the hospital or clinic on the day of the surgery in the morning and is discharged in the evening of the same day.

Based on texts by SBCP.

Operation
Mammary plastic involves removal of the breast tissue in excess, or a reshaping of its tissue which can be dispersed or, more commonly, a combination of both. As consequence, its shape and consistency are also improved with the intervention and thus, in cases of volume reduction and lifting of its position, we can choose several volumes, within the possibilities that the original breast allows us to plan and without compromising the final result. The proportions between volume of the new breast and thorax must be balanced in order to seek a balanced and harmonious result.
It should be noted that each breast has a specific shape and it is impossible to match it with one of another patient.

Postoperative
The postoperative period is usually very calm and cares are mainly related to the movements of the arms. The pain sensitivity is rare and this surgery is practically painless. The dressing is made with a sterile and hypoallergenic tape, which will only be replaced after 12 to 18 days from the postoperative. In this period, the patient should wear a tight bra. After this period, we keep this tape (MICROPORE) for more 3 months on the scars, which does not prevent that they are wet and changed every 10 to 15 days approximately.

It is not often, but it is possible that a short depressive state period happens in the immediate postoperative period in some cases, without this being considered abnormal. The doubts and anxiety that may arise should be transmitted to us and the necessary explanations will be given for your peace of mind. In some cases more exacerbated it may be necessary an eventual retouching (mainly of the scars), which is usually performed after 4 to 6 months under local anesthesia. However, without this being a new surgery.

Evolutionary period in the postoperative:
- Immediate Period: The first 30 days. At this stage, the breasts have become super corrected and they will improve over time. Although they are presented with their improved aspect, their shape is still below the planned result for some apparent initial “minor defects” (inevitable) that will fade with time.
- Mediate Period: Until the eighth month. In this period, the breast begins to present an evolution that tends to the final form (which will occur after 8 months) characterized by an edema change and a change on the nipple feeling to more or less.
- Late Period: Until 18 months from the postoperative. It is the stage when the breast reaches its final appearance in relation to the scar, shape, consistency, volume and feeling. It is the period we usually take pictures the cases operated to compare them to the preoperative aspect of each patient.

The final result will appear after 8 to 18 months from the postoperative, despite the immediate result is very good.

Caution
In the postoperative, you must:
- Avoid physical efforts (exercise) on the first 20 days;
- Avoid harsh and violent movements with your arms and body. Obey the recommendations that will be given during the discharge concerning the mobilization of arms;
- You can wet the dressing from the second day;
- Not carry excessive weight;
- Maintain normal diet;
- Return to the clinic and follow the guidance as stipulated;
- We usually release to drive from 7 to15 days. Try to solve your eventual doubts with us whenever necessary.

Scar
The patient should be informed that the consequence of any surgery results in scar. However, it is proper to the surgeon to give the best quality to the scars in relation to its aspect and wide and, at the same time, place them in hidden places in order to make them disguised. Therefore, depending on the technique performed and, according to each case, we can have variations from the location of the resultant scars that may be only around the areola (in very restrict cases), around the areola and vertically down and, in most cases, an inverted T shape, the lower scar will be the on the breast furrow. With time, the scars become quite disguised and may even become unapparent in some cases.

- Immediate Period: Comprehends the first 30 days. It has good aspect and is a little visible. Eventually there is a slight reaction to the stitches or dressings.
- Mediate Period: From 1 to 12 months. In this period there will be a natural thickening of the scar, as well as a change in its color, reddish beginning, going to brown, which will gradually clearing. This period is what most worries the patients, the less favorable of healing evolution. However, the patient should not worry because the late period will be in charged of concealing the scar remains.
- Late Period: Until 18 months from the postoperative. In this period, the scar will become clearer and less consistent, reaching the final appearance. Any evaluation of the surgery result should be done after this period.

Important: Do not rely on information from well-meaning friends. Get the necessary information directly from the doctor and you will avoid having doubts and anxiety in the postoperative period.

There is great complexity in breast surgeries, because we have to consider not only the volume, but also its position. As a result we only have surgery to increase or reduce its volume, but also associate increasing with replacement or even mammary reduction and prosthesis use at the same time. I always remember that volume breasts always have the tendency to fall over time; is their nature!

In practically all cases, the reduction mammoplasty, besides reducing the size, we have to reposition the breasts and internal structure them so that the tendency to fall is the lowest as possible. Also, in general, the greatest onus of this procedure is that the resulting scar in most cases will be an inverted “T” or anchor. As the scar is already something undesirable, we have to make up for it making it as less extensive as possible, well located (i.e., well round around the areolas, well vertical and on the center of the breast and on inframammary tuck) so that you can wear a bikini or neckline without denouncing the scar. Also, as or more important, is the quality of the scar to be uniform, straight and very thin, so that over time becomes unapparent or at least do not call attention. It is possible depending mainly on the surgeon’s care with the scar.
Nowadays, the postoperative period is much faster, and the patient already can return to daily activities 3-4 days after having surgery done (work, attend classes, etc.), avoiding harsh and violent movements with the arms and body. The patient is free to move the arms since the day of the surgery in normal way, provided they are in a light and gentle way, but she can open the arms, get dressed by herself, without anyone’s help, as well as bathing, etc. I remember that the patient is operated with open arms by 90°.

We maintain special attention to the scar in the postoperative period, in which we change the first dressing after 14 days and maintain micropore tape on them for a minimum period of 3 months. Overall, from seven to ten days, the patient is released to drive (nowadays, most cars have lighter driving and have automatic transmission).
In this surgery, we always wear a tight and specific bra for postoperative for a minimum period of 30 days.

About the mastopexy (breast lifting)

Mastopexy is a surgery in which everything is faster and simpler than in breast reduction and as a consequence, we have a faster postoperative. It attempts to remodel and internally set all mammary tissue in the musculature and besides, withdraws skin excess, and the resulting scar is almost always an inverted “T”. As well as in reduction, the great attention is with the quality of the resulting scar, being well positioned and very thin and tenuous.

In an outpatient basis, the patient is discharged on the day of admission, while the procedure has duration from 1 hour and a half to two hours under general anesthesia. Returns to daily activities within 2-3 days after surgery, released to mobilize arms and take bath without help since the first day after surgery. The patient is released to drive only after a week. We keep special care with the scars using microporous tape on them for at least three months.

Important: All surgeries will be monitored for at least 6 months.