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Before and After Breast Reduction Surgery

Before Your Breast Reduction Surgery

Before you undergo breast reduction surgery, Dr. Pautler will ask you to do the following:

  • Have a mammogram: If you are 30 or older, Dr. Pautler will send you for a mammogram. A mammogram is a special way to take a digital image of your breasts. Having a mammogram is purely a precaution to make sure that there are no suspicious areas in your breast. If there is a positive finding on the mammogram, Dr. Pautler will consult with you and refer you to a general surgeon before proceeding with breast lift surgery. If you have a very strong family history of breast cancer, Dr. Pautler may send you for a mammogram even if you are younger than 30.
  • Stop Smoking: Cigarettes contain nicotine, a powerful substance that decreases blood circulation especially in the areas that need it most: your plastic surgery wounds. Smoking after your breast reconstruction, your plastic surgery wounds heal slowly, infection risk increases, and recovery from breast reconstruction surgery may be prolonged. You need to stop smoking at least four weeks before and six weeks after your planned breast reconstruction surgery. In many cases, Dr. Pautler prescribes a smoking cessation medication called Zyban, however, it is not always covered by insurance drug plans. Nicotine-containing chewing gums and patches are as harmful as cigarettes, so do not use them. If you absolutely cannot curb your smoking, Dr. Pautler asks that you be honest about it and let her know because she may need to alter her breast reconstruction surgical plan for you.
  • Take Vitamin C: This vitamin helps boost plastic surgery wound healing. It is available over-the-counter and is helpful to take two weeks before and two weeks after breast reconstruction surgery.
  • Stop taking aspirin, ibuprofen or other non-steriod, anti-inflammatory medications including herbals and supplements that cause blood-thinning such as Ginko Biloba: These types of medications and supplements can increase your risk of a bleeding complication during and after breast reconstruction surgery, so avoid them. Aleve, Advil, Motrin, Naprosyn, Bufferin, Anacin, Toradol and Alka Seltzer and similar products are examples of products to avoid before and after breast reconstruction surgery. Inform Dr. Pautler of all medications and supplements that you take to see what you need to avoid. Tylenol is permitted, as are the pain medications that Dr. Pautler prescribes after breast reconstruction surgery. Examples of blood thinning medications include Plavix, Lovenox, or Coumadine and their generic alternatives. Inform Dr. Pautler if you are taking this type of medication, as these will need to be stopped as well for breast reconstruction surgery.
  • Discontinue birth control pills three weeks before breast reduction surgery if you are a current smoker or if you have a history of blood clots, high blood pressure, or heart disease. Resume the birth control pills three days after breast reduction surgery.
  • Bring button-down top to wear home from breast reduction surgery: Pullovers are cumbersome and can cause discomfort or damage at your plastic surgery wound sites as you raise your arms to get the top on and off. Wear button-down tops during your recovery from breast reduction surgery because they will be easier to put on and take off without risking injury from your breast reduction.

After Your Breast Reduction Surgery

After your breast reduction surgery, there are several items to do and consider for your own health and plastic surgery wound healing. They are:

  • Refraining from taking aspirin, ibuprofen, other non-steroid anti-inflammatory medications, blood thinners and other herbals and supplements for at least two weeks after your breast reconstruction surgery.
  • Diet: No restrictions. You can eat what you like provided you don't have an upset stomach from the anesthesia you received during your breast reconstruction surgery.
  • Limit activity: Refrain from any exercise or strenuous activity for the first week after breast reconstruction surgery including: housecleaning, vacuuming, anything with requiring arm movement, and brisk walking. After about 10 days from your breast reconstruction surgery, it is permissible to go out or run errands but do not carry any heavy bags. Limit your lifting to no greater than 12 pounds. Do not lift or carry small children. Instead, have someone else put them on your lap and you can hold them. Six weeks after your breast reconstruction surgery, Dr. Pautler will assess your level of plastic surgery wound healing and determine whether or not you can increase your activity level. Typically six weeks after breast reconstruction surgery, restrictions are lifted and exercise can be resumed.
  • Obtain compressive sports bras: A compressive sports bra must be worn day and night for at least 2 weeks or so after your breast reconstruction surgery. Afterwards, you will need to wear a compressive bra up to 6 weeks for the daytime and for long trips where you will do an extensive amount of walking. After 6 weeks from breast reconstruction surgery, the compressive bra must be worn for exercise. The recommended type is one that zips in the front. It must be worn day and night for at least the first week or so after your breast reconstruction surgery. After your sutures come out, you can wear other bras but light compressive bras and full-coverage bras are still recommended. In some cases, especially if you have a large cup size, you should even wear a light compressive bra while you sleep.
  • Stop smoking: NO SMOKING FOR AT LEAST 6 WEEKS AFTER BREAST RECONSTRUCTION SURGERY! Dr. Pautler strongly advises that you stop smoking altogether for your overall health as well.
  • Bathing: It is permissible to shower after being discharged from the hospital from breast reconstruction surgery. NO BATHS OR SWIMMING until your plastic surgery wounds are healed and Dr. Pautler approves.
  • Scar maintenance: You should massage your plastic surgery scars a few times a day with a product such as vitamin E oil, cocoa butter or Mederma applying pressure while massaging the scars. The pressure during the massage is more important than the type of cream product used. Combined with massage, these emollients can help accelerate softening, fading, and maturation of scars from breast reconstruction surgery. Silicone preparations are also available, but costly, and more suitable for patients that have a known tendency to form poor scars. Every individual is unique. Some women heal quickly and some heal slowly. In general, skin type determines the quality of the scar. Despite the most meticulous technique, some individuals heal poorly, while others heal beautifully. Age can also play a factor in healing time after breast reconstruction surgery. The older you are the less red and tender your breast reconstruction scars may appear while younger women may have pink or reddish scars that will be tender for several months and may take up to a year to fade.

Risks with Breast Reduction Surgery

The following lists the possible complications that could occur following a breast reduction surgery.

  • Numbness of the breasts: There will be some numb areas on your breast. This may or may not be permanent, but sensation can return in most breast areas even up to 2-3 years after the breast reduction surgery. As sensation returns it is not unusual to experience shooting pains, or "pins and needles."
  • Asymmetry: Some asymmetries may appear in your breast and abdominal plastic surgery scars after breast reconstruction surgery and parts of your plastic surgery scars heal at different rates. Most of these plastic surgery asymmetries in the plastic surgery scars are cosmetically insignificant, but in rare cases, a plastic surgery scar revision is considered. Regarding asymmetry between the reconstructed breast and the natural breast, it is almost expected. Gravity will alter the shape of the reconstructed breast and plastic surgery revisions may become necessary.
  • Scars on the breasts: These may be quite pink initially. With time, massage, and use of emollients, they should improve and fade considerably. See Scar maintenance in the After breast reconstruction surgery directions.
  • Tissue loss: Rarely, due to some compromise of circulation to the abdominal skin and fat (such as smoking, diabetes, steroid use, or excessive tension and infection), there can be some tissue loss from breast reconstruction surgery. This breast reconstruction surgery complication can occur at the abdomen, but more commonly, at the breast reconstruction surgery area. Some of the dead skin or tissue may need to be removed in the office and dressing changes may be necessary. This breast reconstruction complication may require additional plastic surgery wound healing time. The breast reconstruction surgery scar in the breast and abdomen may be a little wider or pinker and necessitate plastic surgery scar revision in the future, but overall, the shape and appearance of the breast or abdomen is usually not affected.
  • Dog-ears: Little cones of excess skin can form at the end of the abdominal scar received during breast reconstruction surgery. These cones usually show up after the settling and healing of the plastic surgery is concluded. If bothersome to the breast reconstruction surgery patient, they can be removed in the office.
  • Hematoma or seroma within the breasts: Rarely does a collection of blood or body fluid become large enough to necessitate aspiration or removal with plastic surgery. If so, it needs to be done to prevent infection or plastic surgery wound healing problems. Small collections of blood or body fluid are normal but watched carefully until they absorb on their own.
  • Bottoming out of the breasts: If this breast reduction complication occurs, it does so months after the breast reduction surgery, and the nipple and areola may appear higher on the breast mound. This breast reduction complication can happen in individuals who have very stretchy skin or heavy breast tissue. If necessary, the breast appearance can be corrected by removing a wedge of skin under the breast through plastic surgery techniques.
  • Fat necrosis of the breasts: In some breast reduction cases, fat in the breast may scar internally and form a lump. Typically, these lumps soften in time, but in rare instances, they can persist. Dr. Pautler can remove the lump through a plastic surgery technique using the same incision as the breast reduction. The lumps are then sent off and analyzed by a pathologist to make sure that all they are, indeed, are fat.
  • Breast size unpredictability: During breast reduction surgery, Dr. Pautler will try her best to get you the breast size that you desire, but it is always possible to be either slightly larger or smaller breast size than anticipated. Pre-operative communication and looking at pictures before the breast reduction surgery is the best way to avoid disappointment with breast size.
  • Breast cancer: Studies show that a breast reduction can reduce cancer risk by 40% but it cannot eliminate the risk. It has been documented in the literature that on RARE occasions, a cancer has been detected in the breast during breast reduction surgery. A mammogram is obtained prior to the breast reduction surgery to see if there are any breast areas that should be studied prior to breast reduction surgery, but an occasional lump can be missed. Should this unusual circumstance arise during breast reduction surgery, it is possible that breast conservation surgery may not be possible and that eventually a mastectomy may need to be performed.
  • Shape change of the breasts: The breasts will be quite snug after breast reduction surgery and need to be supported to maintain shape. However, gravity cannot be eliminated, and despite best efforts to compress with bras and tape, the skin may stretch with time. Usually a flatter, upper-portion of the breast appears. For breast reduction surgery patients who have very stretchy skin, Dr. Pautler may perform the breast reduction surgery in such a manner to account for eventual shape change of the breasts. Consequently, the breasts may initially have an unusually full, upper-portion of the breast after breast reduction surgery. By anticipating the settling and stretching of skin during breast reduction surgery, the fullness dissipates and the desired breast shape eventually evolves.
  • Breastfeeding after breast reduction surgery: Many women are able to nurse successfully after breast reduction surgery; however, it cannot be guaranteed. If breastfeeding is something you absolutely wish to do, you may want to consider holding off on the breast reduction surgery until finished with childbearing.

Volume change: Weight loss or gain, or the use of oral contraceptives can alter your breast size after breast reduction surgery. Also, it is possible to have re-growth of breast tissue, which can occur with hormone changes. In the case of this unlikely breast reduction complication, it may necessitate further plastic surgery.

View our Glossary of Breast Surgery key terms Here.

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