Lancashire Teaching Hospitals NHS Foundation Trust Information for Patients having a Breast Reduction Operation Plastic Surgery Department Leaflet Number 2 Produced: October 2007 Review date: October 2010
This leaflet is for anyone having a breast reduction operation; it will help you to understand the operation and to know what to expect from your hospital admission. It is important that you read and understand this leaflet before agreeing to have the operation. Please bring this leaflet into hospital when you are admitted. What is a breast reduction operation? A breast reduction is major surgery involving the removal of breast tissue to reduce the size, volume and weight of your breasts. Breast reduction surgery does not alter your chest measurement, but will alter your cup size. Your surgeon will not be able to guarantee a cup size, but your breast size will be appropriate to your height and body structure. Why are you having a breast reduction? This operation may relieve some of the physical symptoms associated with large breasts; these may include shoulder grooving, sweating, rashes or discomfort beneath the breasts. What are the risks and consequences associated with a breast reduction? In the majority of cases this operation is carried out very successfully with good cosmetic results, however as with any surgical procedure there is a small chance of side effects or complications. This list of complications is not intended to put you off having the operation but you need to be aware of any potential complications before you consent to having surgery. Inability to breast-feed. You are unlikely to breast feed after a breast reduction. Bleeding. You may have excessive bleeding from within the breast envelope, which may result in a collection of blood (haematoma) beneath the wound site. If this occurs you could experience excessive pain and swelling in the breast tissue. The collected blood may need to be removed either on the ward or in the operating theatre; this may necessitate another operation. Loss of skin from your nipple. During the operation your nipples are moved to a new position, they need a good blood supply to survive. Rarely, the blood supply is disrupted and some nipple death may occur. An implication of this could be delayed healing which may result in extra scarring. Further surgery may be needed at a later date to reconstruct your nipple. Loss of skin from your breast. During the operation cuts are made through breast skin, fat and tissue. This tissue requires a good blood supply. Rarely, the blood supply to the skin is disrupted, and some of your breast skin may die; this could cause a superficial wound on the surface of the breast. If this happens healing will be delayed and it may result in additional scarring. As a consequence of skin loss you may need further surgery; this may include the need for a skin graft at a later date. Page 2 of 7
Death of fatty tissue in your breast. Normal breasts contain a large amount of fatty tissue; during the operation cuts will be made through this tissue. Rarely, the blood supply to this area becomes inadequate, causing the fatty tissue to die, this is known as fat necrosis. If this occurs the fat can liquefy and may leak from the wound. As a consequence healing may be delayed, and you may need further surgery to correct any resulting contour deformity. Wound infection. A wound infection can occur at any time following surgery. If your wound becomes infected you may need treatment with antibiotics, or you may require hospital admission for further surgery to drain the infection. Wound breakdown. In rare cases breast tissue may not heal properly and your wounds may breakdown. If this happens dressings will be required until your wounds are healed. Problems with wound healing can affect the quality of your scars. In certain circumstances surgical adjustment may be necessary to hasten healing and/or minimise the distortion that this complication can sometimes cause. Scars. You will have permanent, visible scars on your skin; scars tend to improve over a period of 18 months following surgery. Some people can develop raised red and lumpy scars; unfortunately this is often beyond surgical control. The way a scar develops depends as much on how your body heals as it does on your surgeon s skills. The risk of abnormal scarring on the breast is greater if you have already developed thickened scars elsewhere. Scars sometimes stretch as they mature and this is also largely beyond surgical control. Difference in size or shape of one breast compared to the other (asymmetry). After a breast reduction some degree of asymmetry of shape and size between your breasts may be evident. Also it may not be possible to match the exact shape, size and position of your nipples or scars. If you are concerned about asymmetry after your breasts have had time to settle, you should discuss this with your surgeon. A further operation may be necessary to achieve the best result. Over time, you may experience fullness of the lower region of your breast and rotation upwards of the nipples ( bottoming out of the breast ). As you get older, your breasts will still droop as a result of the natural aging process. Dog-ears. Once your wounds are healed you may notice an excess of skin at either end of the stitch line, these are known as surgical dog-ears. If these have not settled down after 12 months, a minor operation may be necessary to improve the problem. Nipple sensation. This may be decreased by surgery. Deep vein thrombosis (DVT). This is a blood clot that develops in the deep veins of the leg or pelvis. A DVT can happen if your mobility is restricted or you are inactive for a time following your operation. You may be given injections that help to prevent this from happening. You can reduce the risk of deep vein thrombosis by wearing the elastic stockings supplied, during and after your operation and moving your legs about whilst you are in bed. Getting up and walking as soon as you are well enough may also reduce the risk of a DVT. Page 3 of 7
Chest infection. A chest infection can occur following any general anaesthetic. You can reduce the risk of this happening by taking regular deep breaths following surgery and getting up and sitting out of bed as soon as you are well enough. If you smoke you can reduce the risk of a chest infection by stopping smoking for at least a month prior to your operation. Anaesthetic risks and complications. You will need a general anaesthetic. Your anaesthetist will give you more information about your anaesthetic and will discuss anaesthetic risks and complications with you prior to your surgery. Failure to achieve expectations. It is important to remember that after breast reduction surgery there is a risk that the end results may not meet your expectations. There may be other risks specific to your individual case; your surgeon or nurse will discuss any further risks with you. If you are concerned about any of these risks or have any further queries, please speak to your consultant or a member of the health care team. What is the alternative to having a breast reduction? The alternative to having a breast reduction is not to have it performed. You may find that wearing a well fitting bra could alleviate some of the physical symptoms associated with large, heavy breasts. How should you prepare for surgery? Your weight: If you are overweight you will be asked to reduce your weight to within more normal limits for your height. Research shows that there are higher rates of post-operative wound complications in patients classed as obese when compared to those who are not obese. Patients with a Body Mass Index (BMI) of 30 or above are classed as obese. You will need to achieve this weight reduction before admission to hospital. If your body mass index is 30 or above when you are admitted to hospital your operation may be cancelled. If you need help to reach your target weight your GP may be able to refer you to a dietician. Your medications: If your GP prescribes aspirin, clopidogrel or other medications that may increase the risk of bruising or bleeding you may be asked to stop taking these before your operation. If you normally take warfarin tablets you may be asked to stop taking these 4 days before your operation. You may also be asked to have a blood test on the day before surgery. If you take the oral contraceptive pill or HRT you may be asked to stop taking them 6 weeks before coming to hospital. If you do stop taking the contraceptive pill remember to use some other method of contraception to avoid pregnancy. If you do not hear from the hospital, then continue to take all your medications as normal. Page 4 of 7
Smoking: You should stop smoking before breast reduction surgery; smoking can increase the risk of nipple death and can impair healing. If you are still smoking when you are admitted to hospital there is a risk that your operation could be cancelled. Other information: You may be asked to attend a pre assessment clinic at the Royal Preston Hospital. If you are not asked to attend this clinic you will have pre-operative investigations carried out on your admission to hospital. These investigations will include a blood test. Photographs of your breasts may be taken for your medical records. You will be asked to bring a bra into hospital with you; this should be a nonunderwired supportive bra, such as a sports bra. What happens when you arrive in Hospital? The evening before your admission you should telephone ward 4 to confirm that there is a bed available for you. The telephone number is 01772 522244. If you arrive on the ward between 8am and 4pm on weekdays the ward receptionist will greet you. At other times, please tell nursing staff that you have arrived. The ward is often busy and you may have to wait in the Day Room for some time before your bed is ready. Prior to your surgery your surgeon will discuss the approximate amount of breast tissue that will be removed and will draw on your breasts with a skin marker pen to indicate where the cuts are to be made. Please take care not to wash off these markings before your operation. Your surgeon will discuss the risks and benefits of breast reduction and will ask you to sign a consent form. If you have any questions or concerns about your operation, please ask a member of the health care team for assistance. What happens after the operation? The operation will take about 2-3 hours to complete, however you will be in the operating department for longer than this to allow time for recovery. When you wake up from your operation you will be lying flat on your back, and you will be allowed to sit up when you have recovered from your anaesthetic, usually within 2 to 3 hours of returning to the ward. You should not lie on your sides or stomach as this will cause discomfort and may put pressure on your stitches. The nurses looking after you will regularly check your wounds, blood pressure and pulse after you return from theatre. They will also monitor the blood supply to your nipples by regularly inspecting their colour. There will be bruising, swelling and discomfort following your operation, and you will be offered pain relief either by patient controlled pump, injections or tablets. You may have a drip, usually in your hand or arm, to replace any fluid lost during your operation. If you lose a lot of blood during the operation you may be prescribed iron tablets to increase your iron levels, in rare cases you may need a blood transfusion. Page 5 of 7
You may have dressings and strapping over your breasts or you may be fitted into your bra soon after the operation. You may have a drain (tube) in each breast, which drains away any excess blood into a bottle attached to the tube. The drains will be removed when there is only a small amount of drainage. This usually takes 2-3 days. You will generally be encouraged to get up the day after your operation, but you should limit the use of your arms to routine tasks such as eating and brushing your teeth. How long will you stay in hospital? You will normally go home 2-3 days after your operation, however this depends on when your drains are removed. If you do not have any drains you may be able to go home the day after your operation. Wound care and dressings. Your dressings are normally changed after 7-10 days in the Plastic Surgery Dressing Clinic. You will need to wear a well fitting, supportive bra without wires, such as a sports bra, when the strapping is removed. Your bra can be worn over dressings if necessary and should be worn day and night for three months. If you have not already been fitted into your bra, you will need to bring an appropriate bra to your first dressing clinic appointment. Any staples or stitches will be removed in dressing clinic, usually within 2 weeks of your operation. Some patients will have dissolving stitches that do not need to be removed. You will require dressings until your wounds have healed. It is normal to have bruising, swelling and tenderness around your breasts for several weeks following the operation. You should not go back to work until instructed by your surgeon. This could be 4-6 weeks depending on your job. Additional information You will be given a discharge information leaflet prior to leaving ward 4. This leaflet will give you general information and advice about going home from hospital. Page 6 of 7
Sources of further information: www.lancsteachinghospitals.nhs.uk www.nhsdirect.nhs.uk www.patient.co.uk Useful contact numbers Ward 4 (Plastic Surgery Unit) 01772 522244 Plastic Surgery Dressing Clinic 01772 523542 Plastic Surgery Nurse Practitioner 01772 522062 Royal Preston Hospital switchboard 01772 716565 Lancashire Teaching Hospitals NHS Foundation Trust is not responsible for the content of external internet sites. English Please ask if you would like help in understanding this information or need it in a different format Page 7 of 7