Plastic Surgeon’s Casebook – Series 1: Breast Reduction Candidate

Written by Mr Allan Kalus, Head Plastic and Reconstructive Surgeon at Avenue Aesthetic Surgery, Melbourne Australia.

Doctors are taught in medical school to be “empathetic”. This means that doctors are taught to try and imagine themselves to live in the shoes of their patients. What is their life really like? Does their condition cause physical strain? Do they suffer socially or emotionally as a result of their condition?

Occasionally we see a person who is able to describe in great detail the way their ailment affects their daily life. Today I had the privilege of meeting a young woman who described to me in great detail the way her large breasts affected her daily life.

Joanne (not her real name) is a vibrant 25 year old woman working hard to forge a career in media. Unfortunately, her teenage and adult life has been plagued by her large breasts.

Joanne told me that she was a D cup by the age of 12. As a result, even at that tender age, Joanne found herself attracting the attention of older men and was constantly aware of people making comments about her large bust. As a result she has grown up to be profoundly self-conscious about her bust and told me that she was constantly being “hypersexualised”.

Joanne currently wears a size H or J cup bra and, as a result, has constant pain and discomfort. She suffers from neck ache and back ache and has to have regular massages to relax her back muscles. She wears special large underwire bras and has pain from the wires “digging in”. Especially during the summer, she suffers from irritation and rashes in the groove under her breasts and she feels that she is unable to run or exercise without holding onto her bust.

Joanne told me that she found buying clothes “embarrassing and depressing”.

“The sales girls look at me pityingly” Joanne said.

I feel that I’m the problem, but it’s not me it’s the fashion industry”.

Up until early last century, clothes were “made to measure”. Women were therefore not made to feel that they were in some way “abnormal”.  Today, however, with the fashion industry mass producing clothes designed to fit the “average” size woman, many women are lead to believe that, because they are not average, therefore they are not normal.

Joanne was clearly profoundly self-conscious about her bust and did her best to conceal it by wearing loose fitting clothing.

When I examined her I found that she had an exaggerated curvature of her upper spine. This is known as “kyphosis” and is due to the weight of the bust distorting the spinal column. If a woman develops osteoporosis (and this can be quite common after the menopause) the kyphosis can progress to multiple vertebral fractures producing what is known as the “Dowager’s hump”.

With so many symptoms, it is little wonder that Joanne was seeking information about breast reduction surgery. We are just so lucky to live in an era when breast size can be reduced by a surgical procedure that takes only about 1 ½ hrs and is safe enough so that our patient is able to go home the same day.

I explained to Joanne that, with breast reduction surgery, “it’s what you leave behind, not what you take away that’s important!”. The aim of the procedure is to reduce the size of the breasts and to move the nipples to a higher position approximately at the midpoint of the upper arms (Joanne’s nipples were at the level of her elbows and I was able to show her photograph of women whose nipples had descended as far as their umbilicus!) There are different ways of moving the nipple but in Joanne’s case I felt the best way would be to leave the nipple attached to the central part of the breast so that it has an excellent blood supply, nerve supply and is connected to the main milk ducts. It is a little like “coring an apple” with the core being retained. This allows us to move the nipple to its new higher position on a stalk of breast tissue while all the peripheral breast tissue is removed. The skin is then wrapped around the retained breast tissue like a supportive bra. This technique preserves the best blood supply, nerve supply and mild duct supply to the nipple and we have had many patients who have successfully breast fed following this procedure.

Because we are able to do the operation as a Day Case there is little inconvenience for the patient. A firm bandage is applied after the operation and this is replaced with a bra the next day. Most women report an instant relief in their neck ache and back ache and have an enormous sense of wellbeing following breast reduction surgery. Most women are able to drive and return to light household duties after only 2 or 3 days but healing does take a couple of weeks and heavy lifting and exercise is not recommended for about a month. In young women the kyphosis (or curvature of the spine) will improve after the surgery.

Joanne asked if there was anything that could go wrong with the surgery. I explained that it was unusual to have any major complication. The main complication surgeons think about is excessive bruising and bleeding. That is why we carefully seal all blood vessels during the operation and place a small drain tube overnight so that any blood is removed from the breast tissue. Patients can also help avoid bruising and bleeding by not taking any medication which “thins the blood” such as neurofen, aspirin or disprin for at least 2 weeks prior to the surgery. Infection is extremely rare as all patients are given antibiotics during and after the surgery. I showed Joanne photographs of the post-operative scarring that she could expect and advised her that the scars usually mature and settle over a period of 6-12 months.

I invited Joanne to contact me again should she require any further information and hope to be able to do the surgery for her early next year.

Click here to learn more about Breast Reduction at Avenue Aesthetic Surgery, Melbourne Australia.