Before Breast Surgery FAQ's

Q: What guidelines should I follow prior to my procedure?

Eat a normal diet. You can do all your normal activities right up until the day of the procedure.

No special supplements are required.

We will discuss any medication you are on and advise you if we need to change this in any way.

Please avoid taking any herbal or other vitamin supplements for 2 weeks prior to the procedure, unless you have checked with us first.

If you need to take pain medication for a headache or any other reason, please take Paracetamol (Panadol) based medicines only. Please avoid aspirin and/or Ipobrufen/anti-inflammatory type (Nurofen) medications for 10 days prior to surgery as these can affect your blood clotting and lead to much greater bruising after surgery if you have taken them at any time in the 10 days prior to surgery. If in doubt please check with us first.

Q: Am I too old to have a breast reduction?

There is no hard rule as to when you may be too old to consider breast reduction. Currently it is uncommon for women over 65 years to choose to have a breast reduction.

Accepted age limits for all medical treatments are constantly being revised as more and more people are living very long healthy lives. Most people (particularly women) don't seem to realize how long they are going to live. Currently a female child born in Australia is likely to live to 84 years but more relevantly a woman who reaches the age of 65 years in Australia is likely to live to be 90 or beyond (and these figures are getting better much quicker than the statisticians predict).

The standard approach in assessing any person for any medical procedure in Australia is no longer age based (and has not been for a long time now). No one is denied surgery for any problem based purely on their age. So if you are a 68 or 70 year old healthy active woman and your breasts are a significant source of difficulties you are absolutely entitled to come along and talk about your individual situation and consider breast reduction as an option.

It is important to note ultimately you make the decision about whether you proceed. The doctor's role is to give you high quality information so you can make and informed decision.

It is also important to understand that there is some evidence to suggest women who have a breast reduction significantly reduce their risk of breast cancer. In the over 50 age group the risk reduction may be up to 40%.

See also Dr Burt video response.

Q: What would be a reason why I should not consider breast reduction surgery?

1. If your concerns about your breasts are purely cosmetic. Women who have breast reduction surgery have large, heavy breasts causing physical symptoms (neck ache, back ache, shoulder pain). Due to the scars resulting from breast reduction it is not a procedure commonly perfomed for cosmetic concerns. Breast reduction is restorative surgery. It restores body proportions. It is not cosmetic surgery. Unless your breasts are significantly out of proportion to body it should not be considered.
    
2. If you have a strong family history of breast cancer you may wish to avoid any elective breast surgery. Breast reduction if anything reduces your risk of breast cancer but if your family history is significant you need to seek specific individual advice about your situation.This is very important. Unfortunately breast cancer is a common disease. If you have a family history (specifically, if your mum and/or sisters have had breast cancer) you should make it your business to get that advice. Normally the doctors who have treated your relative are more than happy to assist you. If you find yourself in this situation please see your GP or one of these doctors.
    
3. If you have a personal history or family history of making unsightly, raised, red or ugly scars (medically we call these hypertrophic or keloid scars) then breast reduction is not likely to be a procedure for you. Often the scars for breast reduction are extensive so if you are likely to make bad scars it can be a significant issue. Fortunately this is rare. Liposuction may be an option as a compromise if you fall into this category.
    
4. If you will be very distressed if you could not breast feed your babies breast reduction should be deferred until you have completed your family.
    
5. If you have a personal or family history of bleeding or blood clotting problems or you are taking particular blood thinning medications then breast reduction may not be appropriate.

Q: What about my general health?

If you want the best outcome from breast reduction you need to be at your ideal body weight. If your body proportions are as close to ideal as possible at the time of surgery you are most likely to get the best possible shape and proportions from the reduction.

If you are overweight not all the tissue on your chest is breast tissue (particularly tissue on the sides of your chest wall is often fatty tissue). This gives your chest a broader width and breast reduction results in wider, less projecting, less shapely breasts. The risk of complications such as wound healing difficulties, infection, loss of nipple sensation and damage to the blood supply of the nipples is also increased. It is far better to lose weight prior to a procedure and maximise the benefts where possible.

If you have a chronic illness such as diabetes, normally after consultation with your doctors a plan to proced safely can be formulated but some increased risk of complications exist.

Q: What if I am a smoker?

You should not be actively smoking if you are preparing for this procedure. This is a completely elective procedure .You should give up smoking first and consider breast reduction after this has been achieved. Smoking increases the risk of having a complication from the surgery. In particular it increases your risk of a wound healing problem and damage to the blood supply to the nipple.

You must not smoke for at least 4 weeks prior and 2 months after surgery.

Q: Do I need to have any tests?

If you are over forty we will recommend you have a mammogram performed to rule out any unsuspected breast problems prior to any breast reduction procedure.

You may require a simple blood test to check your blood count (haemaglobin levels) and basic blood chemistry. Sometimes menstruating women can be anaemic (have a low blood count) without knowing it. If you are going to have an anaesthetic and surgery we want to know about these things beforehand. It is part of caring for you properly. Most often preoperative tests will be completely normal and even if your blood count is low it is easily correctable over a couple of weeks with some iron supplements.

Q: Will you take photos of my breasts?

Yes. I realise this is a sensitive issue. Photographs will not be taken until you have made a firm decision about whether you wish to proceed to surgery. At that point photographs become a necessary part of your medical record. Photographs will be taken at the office visit prior to your surgery. This allows the photos to be used for planning your operation. It is also usually more private and less stressful to have photos taken at the office and not at the hospital.

On the day of surgery at the hospital you will be a little anxious (this is normal for any person) and if the photos are already taken it is one less stress to deal with.

Q: When will I be admitted to hospital?

You come into hospital on the day of the operation one to two hours ahead of time. The anaesthetist will have spoken to you on the telephone prior to the day. We will have organised any individual requirements prior to the day if required.

Q: Am I big enough to justify surgery?

There is no hard rules which suggest how big you need to be before you consider breast reduction. It is really all about how severe your physical symptoms are. This determines if considering breast reduction makes sense for you. Women who decide to have breast reduction are suffering pain (neck, shoulder, back pain and associated symptoms). If you are not experiencing symptoms such as these breast reduction is not for you.

Taking our survey may help you think your way through this process.

Take our survey to find out more.

Q: I am dieting to try and lose weight, how much do I need to lose before surgery?

In the perfect world you would be at your ideal body weight when you had a breast reduction perfomed. Breast reduction is restorative surgery. The goal is to restore your breast proportions to your body proportions. It makes sense then that if you are at your preferred proportions at the time of surgery you are more likley to get the optimal outcome. In the real world sometimes that is not going to be the case. If you are within a reasonable range of you ideal BMI (Body mass index) then the operation can be perfomed safely (BMI<30). If you are way over weight your risk of complications increases substantially and it is best to lose weight before considering surgery.

Try this BMI calculator

 

 

Q: Can't I just have liposuction?

Yes you can have liposuction. We can talk about that. Whether you ultimately choose liposuction will depend on your personal circumstances. In broad terms liposuction removes fat cells from the breasts. Once the fat cells are removed, the breast is made lighter. The hope is that once these fat cells are removed the skin will be elastic enough to shrink up and therefore contribute to the overall reduction of your breast size. When you think about this there are several questions we need to answer before deciding if liposuction alone will be the correct technique for you.

1. Is your breast tissue mostly fatty tissue (usually the case after you have had your children) or is your breast tissue dense breast glandular tissue (often the case in young women and those who have not breast fed).
2. Is your breast skin elastic, free of stretch marks or is it thin and saggy with obvious stretch marks? (Is my skin part of the problem or part of the solution?)
3. Do I have large breasts but my nipples sit up high at or close to the breast fold (within 4 cm would be good) or do i have a major problem with sagging? These are some of the issues we would talk about and work through in our decision making discussions.

Q: What generally is considered a big enough size to get the surgery done?

This is totally dependent on your symptoms. Breast reduction in terms of weight of tissue removed range over a very broad range from 250 grams to 2.2kg each breast in my experience. An "average" reduction would be upwards of 700 grams each side (i.e. upwards of 1.4kg in total). The most common situation is a reduction of over 1kg each side (total bilateral reduction of over 2kg).

In terms of cup size it would be uncommon to consider breast reduction if your breasts were less than DD cup.

Q: Can I talk to a past patient?

Yes. One of the things about breast reduction patients is once they have had the procedure they want to spread the word and help other women like themselves. Most of our patients are only too happy to talk to someone else about the procedure.

Chat with a nurse or past patient.

Q: What are my alternatives to surgery?

You should not rush into surgery. Often weight loss is a good first strategy with no downside risk. If it does not work you have just got yourself in the best shape for optimising the outcome of a breast reduction if it is required. If you do proceed to breast reduction there are many different techniques all of which have a role in specific situations. These include liposuction, vertical techniques, "anchor scar " techniques (also known as inferior pedicle, central mound techniques). Very rarely free nipple grafitng techniques might be considered. This is only considered if a reduction of greater than 4kg (2kg or more each side) is required.

Q: Some of my friends and family say if I lose enough weight my breasts will reduce on their own

For reasons which we do not understand often the breasts do not substantially reduce in size as you lose weight. Of course the actual size of the breast is only part of the problem adressed by breast reduction. In my experience all women having breast reduction have ptosis (sagging) of their breast as well as increased weight of breast tissue. Losing weight does not improve this and sometimes makes it worse. The symptoms caused by your breasts are in large part due to the excess weight but the more saggy the breasts are the more they pull on you shoullders, neck and back.

Having said that, weight loss is unlikely to solve your breast problems. Weight loss is really important if you wish to get the best outcome from any planned breast reduction procedure.

If you are not, at or near as possible to your ideal body weight it is difficult or impossible to get the best size and shape for you at the time of surgery.

Q: What is BMI? (Body Mass Index)

Body mass index is a suggested way of classifying a person's weight compared to their height. It is not a perfect method of classifying weight but it is widely used and gives a reasonable guide.

BMI is calculated by the formula Weight (kg) / {Height (m) x Height (m)}

For example If you weigh 82kg and are 175cm (1.75metres) the calculation looks like this.
BMI = 82/(1.75x1.75) = 82/3.0625 = 26.78

Try this BMI calculator