Breast reduction

If a woman's breasts are very large in proportion to the rest of her body, this may lead to physical discomfort and often result in poor posture. This may cause headaches, backache and neck pain.

Large breasts frequently also put strain on the skin: The affected part of the skinfold under the breast is prone to inflammation and fungal infections as little air reaches the skin at this point. Another source of discomfort is skin irritation, caused by bra straps cutting into the shoulders.

Many women with overly large breasts also feel restricted in daily life, e.g. when playing sport or in their choice of clothing. They may also believe they look less attractive, which can result in psychological issues. Breast reduction surgery allows the size and weight of the breasts to be made more comfortable for the patient.

Information and preparation

A detailed consultation between the attending specialist and the patient takes place before the actual procedure. The surgeon outlines every aspect of the operation in detail – the treatment method to be used, possible complications as well as aftercare. The patient then has the opportunity to ask key questions. She should also inform her doctor about any illnesses or allergies that she may have, as well as any regular use of medication.

Patients should discontinue any blood-thinning medication at least two weeks before the procedure. They should also abstain from using sleeping tablets, alcohol or nicotine as they affect the circulation. Depending on the patient's familial predisposition, it may be advisable to undergo a mammography before the procedure and to rule out breast cancer. This should be clarified with the attending doctor beforehand.

When does health insurance cover breast reductions?

If it involves a purely cosmetic procedure, the costs of a breast reduction will not be borne by the basic insurance. However, if a woman is suffering either physically or mentally due to the size of her breasts, making surgery advisable, the costs can be claimed from her insurer. The question of confirmation of coverage should always be clarified before the procedure.

The level of complexity of the surgery varies significantly depending on the patient's preoperative condition. The actual costs of each reduction procedure are indicated in the individual consultation following the examination.

Requirements and risks

What conditions must be satisfied?

There are basically no age restrictions on breast reduction. The crucial factors here are the result required by the patient and her state of health. The female breast is affected by pregnancy and breastfeeding. To achieve the best possible result, surgery should not take place for at least eight months after the patient has ceased breastfeeding.

If a woman suffers from certain heart diseases, diabetes or tumours, the attending surgeon will advise her whether breast reduction is possible.

What are the risks of breast reduction?

As with all surgery, a breast reduction may be followed by complications such as infection, swelling or post-operative haemorrhaging. However, the risk of this happening is low. Patients may notice the nipple has become less sensitive, although this is usually only temporary.

Their ability to breastfeed can be affected, depending on the surgical technique used. Women should tell the attending doctor if they wish to have children so this can be taken into consideration when selecting the procedure to be used.

The result of breast reduction surgery can be affected by a subsequent pregnancy and breastfeeding.

Surgical procedure

Breast reduction is usually performed as an inpatient procedure under general anaesthetic. The intervention takes between two and three hours depending on how complex it is and the surgical technique used.

It can in principle also be performed as an outpatient procedure. The attending doctor will make an individual recommendation in this regard based the complexity of the intervention.

How is a breast reduction performed?

Before the operation, the surgeon will mark out the site of the planned incisions depending on the treatment method selected. During breast reduction, fat, lymph and skin tissue are first removed from the lower part of the breast and then the desired shape is created from the tissue of the upper part. If a large amount of tissue is being removed, the surgeon also relocates the nipple and adapts its size to produce a harmonious overall appearance.

The positioning of the incisions made in the breast varies according to the surgical technique used, extending around the areola and in the skin of the lower breast. Scars will occur around the nipple, descending vertically to the fold of skin under the breast and – depending on the treatment method – horizontally below the breast.

In particular, the Lejour (or I) method is considered to reduce scarring significantly. Here the incision runs down vertically from the nipple, which ensures optimal lifting of the breast. The Benelli technique also results in inconspicuous scars, with the incision being made around the nipple only. However, the reduction in size achieved with this method is not very significant.

The Hall-Findlay breast reduction procedure offers an alternative for women who wish to have children. Here the nipple is relocated without being detached from the adjacent lymph tissue, which largely preserves the patient's ability to breastfeed later on.

If desired, breast reduction can be combined with liposuction or breast lifting.

Aftercare and behaviour following breast reduction

After the procedure, a tightly fitting support bandage is applied to relieve the weight on the breast. Blood and wound secretions are discharged via drainage tubes. The level of pain following surgery is generally very low and easily treated with painkillers.

Patients remain in hospital for one or two days, depending on the course of the operation. The drainage tubes are removed on the day after the procedure and the compression bandage is replaced with a special sports bra. This has to be worn day and night over the next six weeks.

The stitches are then removed after a fortnight or so if they have not been absorbed by the body. Patients have to wait between six and twelve months after surgery to see the final result. Several check-ups take place during this period, with individual appointments being agreed with the patient.

How should patients behave following breast reduction?

Patients will be off work for at least a week following a breast reduction. They may also be absent for longer depending on the complexity of the procedure and their individual profession. Patients should not engage in sport for at least six weeks.

They should only move their upper arms carefully and refrain from making abrupt movements so as not to impair the healing process and the result of the breast reduction procedure. During this period, patients should avoid sleeping on their stomach where possible. Lifting and carrying heavy objects should be likewise avoided, as well as working with their arms above their head.

Will there be visible scarring following breast reduction?

After the procedure, the scars will first appear red against the skin. Wearing a shaping support bra will encourage the formation of inner and outer scarring with few complications. The stitches, which remain in the body for up to three weeks, also ensure scars look less visible. If a patient is known to have a tendency towards excessive scarring (keloids), the attending doctor must be informed without fail before the procedure.

Scars will then fade in the first few months after breast reduction, taking on more or less the same colour as the skin around them. They will heal more quickly if the patient applies skincare creams and avoids exposure to strong UV radiation, e.g. when sunbathing or visiting a tanning studio.

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