Dr. vanVliet | Breast Reduction Surgery

Breast reduction surgery is accomplished by removing excess breast tissue, fat and skin from the breast. The overall goal of surgery is to make the breasts lighter and lifted with a better shape and proportion to the rest of the body. The procedure takes approximately 2 hours and may involve an overnight stay in hospital. The most common breast reduction procedure is the anchor technique which is comprised of 3 components or scars: around the areola, a vertical extension from the areola down to the breast fold, and then a horizontal extension following the lower breast fold. Dr. vanVliet's technique eliminates the lower horizontal scar (pictured above left), preferring instead the lollipop (as seen on the right) or vertical scar technique of breast reduction surgery. This modification in her technique allows her to reduce subsequent scarring on the breast with the added benefit of improving breast projection and contour. Additional liposuction is often employed at the time of the surgery to help further contour the breast and reduce fullness under the arms. The best choice of procedure is determined and tailored to the patient's wishes and goals at the time of their initial consultation.

Most women who request breast reduction surgery have physical discomfort related to their heavy, sagging breasts. They often complain of neck and shoulder girdle pain, painful bra strap marks and/or rashes in the breast fold. The best candidates for surgery are emotionally mature and realistic about what surgery can provide them. They are aware that the reduction procedure can lighten and lift the breasts but at the cost of extensive scars on the breast mounds, the potential loss of breast-feeding capability, and or the permanent loss of nipple areolar sensibility. Adolescents preferably should defer surgery until their breasts are fully developed and of a stable size. Smokers and over-weight patients (weight >200 lb, or BMI >35) are at an increased risk for post-operative complications and subsequent poor quality scars and breast contour. Dr. vanVliet will counsel her patients regarding the modification of any necessary risk factors a the time of the initial assessment.

Dr. vanVliet will personally assess her patients prior to their discharge home. The patient will be wearing a compression bra over a special light dressing that is intended to stay on until the first post-operative office visit. The patient can expect some bruising and tenderness related to the surgery, but the pain should not be severe. Dr. vanVliet will prescribe medication to reduce swelling and discomfort. During the first post-operative week the emphasis should be on rest, convalescence and minimal arm use. After the first office visit the patient can resume light sedentary activity, including driving. At this time instructions will be given regarding showering, and washing. Patients will wear their supportive compression bras 24/7 for the first month, and will refrain from physical exertion and sporting activities. This combination of compression, relative rest of the chest wall, and moisturizing agents during the first month of healing are integral to preventing the spread of scars and the subsequent loss of breast lift. The integrity of the scar and shape are determined in the first month of wound healing. After this protective time the patient will be instructed regarding resuming activity, touch and massage of breast scars.

The scars will initially be red, puckered and firm. Over the first 4-6 weeks they will gradually soften and become less raised. This will coincide with progressive changes in breast swelling and improved contour. The scars will continue to soften and lighten up to a full year.

Although breast reduction surgery is an extensive procedure it is a relative safe procedure. As with any surgical procedure, there is always the probability of complications related to the surgery or reaction to anesthesia. Bleeding and infection following breast reduction surgery is uncommon but may necessitate further surgery. Although the breast mound scars are extensive and permanent they will commonly be of good quality and can easily be covered by bras and bathing suits. In less than 5% of cases do the surgical scars remain firm or of poor quality. The quality of scar is partly determined by gene stock, but also by associated risk factors such as post-operative infection or delayed healing. Disease states related to obesity, smoking or diabetes can contribute towards poor wound healing and scar formation, and rarely nipple death. The patient can reduce these risks by following Dr. vanVliet's pre-op instructions and advice.

There is potential for some permanent variance between breast mounds with respect to nipple position, breast size and shape. Also, although most breast skin and nipple areolar numbness is short term, there is nevertheless a low probability that these changes are permanent. The potential for breast feeding after reduction surgery is significantly reduced and therefore surgery should be deferred if it is the patient's intention to ultimately breast-feed. Dr. vanVliet is limited by technical considerations as to how much breast tissue she can safely remove during the breast reduction procedure and therefore it is important for the patient to be realistic regarding their eventual cup/breast size. Liposuction at the time of breast reduction surgery is often helpful to optimize the reduction and shaping of the breast beyond what reduction surgery alone can provide.