Overly large breasts can cause some adolescents, both male and female, to have health problems, or emotional problems.

In addition to self-image issues, they may also experience physical pain and discomfort. The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large breasts is as important an issue as any physical discomfort and pain. Also known as reduction mammaplasty, this procedure removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with the body and to alleviate the discomfort associated with overly large breasts.

Is it right for my child?

Breast reduction is a good option for your child if he/she:

• is physically healthy
• has realistic expectations
• is bothered by the feeling that their breasts are too large
• finds that their breasts limit their physical activity
• experiences back, neck and shoulder pain caused by the weight of their breasts
• has regular indentations from bra straps that support heavy breasts
• has skin irritation beneath the breast crease

Things to consider

What to expect from your consultation

Be prepared to discuss:

• Why you and your child want the surgery, your expectations and desired outcome
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins and herbal supplements
• Previous surgeries
• Family history of breast cancer and results of any mammograms or previous biopsies

Your surgeon will also:

• evaluate your child’s general health status and any pre-existing health conditions or risk factors
• examine your child’s breasts, and may take detailed measurements of their size and shape, skin quality, placement of their nipples and areolas
• take photographs for their medical record
• discuss options and recommend a course of treatment
• discuss likely outcomes of breast reduction and any risks or potential complications
• discuss the use of anaesthesia during your child’s breast reduction

Preparing for surgery

Prior to surgery, you may be asked for your child to:

• get lab testing or a medical evaluation
• take certain medications or adjust their current medications
• get a baseline mammogram before surgery and another one after surgery to help detect any future changes in their breast tissue
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

• What to do on the day of surgery
• Post-operative care and follow-up.

Your surgeon will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure your child will undergo and any risks or potential complications.

The risks include:

• Unfavourable scarring
• Infection
• Changes in nipple or breast sensation, which may be temporary or permanent
• Anaesthesia risks
• Bleeding (hematoma)
• Blood clots
• Poor wound healing
• Breast contour and shape irregularities
• Skin discoloration, permanent pigmentation changes, swelling and bruising
• Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
• Breast asymmetry
• Fluid accumulation
• Excessive firmness of the breast
• Potential inability to breastfeed
• Potential loss of skin/tissue of breast where incisions meet each other
• Potential partial or total loss of nipple and areola
• Deep vein thrombosis, cardiac and pulmonary complications
• Pain, which may persist
• Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents.
• Fatty tissue deep in the skin could die (fat necrosis)
• Possibility of revisional surgery

You should know that:

• Breast reduction surgery can interfere with certain diagnostic procedures
• Breast and nipple piercing can cause an infection
• Ability to breastfeed following reduction mammaplasty may be limited; talk to your surgeon regarding this
• The procedure can be performed at any age, but is best done when breasts are fully developed
• Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations

When you go home

If your child experiences shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, hospitalization and additional treatment may be required.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedures and another surgery may be necessary.

Be careful

Following your surgeon’s instructions is key to the success of your child’s surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your surgeon will give you specific instructions on how to care for your child. Be sure to ask questions: It’s very important to address all your questions directly with your surgeon. It is natural to feel some anxiety, please discuss these feelings with your surgeon.

My recovery

When your child’s procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions that may include: How to care for your child’s surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your child’s general health, and when to follow up with your surgeon. Be sure to ask your surgeon specific questions about what you can expect during your child’s individual recovery period.

• Where will my child be taken after surgery is complete?
• What medication will they be given or prescribed after surgery?
• Will they have dressings/bandages after surgery? When will these be removed?
• Are stitches removed? When?
• When can they resume normal activity and exercise?
• When do we return for follow-up care?

The results will be long lasting

The results of breast reduction surgery will be long-lasting. However, over time breasts can change due to aging, weight fluctuations, hormonal factors and gravity.

Procedure details

What happens during breast reduction surgery
Breast reduction is usually performed through incisions on the breasts with surgical removal of the excess fat, glandular tissue and skin. In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used for breast reduction. The technique used to reduce the size of the breasts will be determined by your child’s individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice.

Step 1

Anaesthesia Medications are administered for your child’s comfort during the surgical procedure. The choices include intravenous sedation and general anaesthesia. Your doctor will recommend the best choice for your child.

Step 2

The incision options include:

• A circular pattern around the areola
• A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease
• An inverted T or anchor-shaped incision pattern

The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.

Step 3

Removing tissue and repositioning

After the incision is made, the nipple-which remains tethered to its original blood and nerve supply-is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary. Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

Step 4

Closing the incisions

The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.

Step 5

See the results

The results of breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade.

Post-operative advice

• Your child will return from theatre with a dressing under the breasts and over the nipples. They may have a drain tube attached to a small bottle on either end of the suture line. This is usually removed within 24-48 hours. They may also have a binder around the chest for support.
• Your child will usually be in hospital for 1 -2 days dependent on their recovery. Their dressings will be changed in hospital before discharge and an appointment will be made to have a check-up in 7 days and to change the dressings again. You may notice a certain amount of discharge on the dressings, this is quite normal. If however there is blood or the dressings are leaking, you should contact the hospital to have these changed. The sutures will be removed the following week. When the suture line is dry, it will be left open to be massaged and moisturised.
• If the dressings are waterproof, bathe as usual, patting dressings dry. If these dressings leak or become wet, remove them and cover the wounds with a clean, dry dressing or contact the hospital.
• You should be aware that some bruising and swelling is to be expected and this will resolve between 3-12 weeks.
• Avoid wearing a bra for the next 2-4 weeks. A bra top, fastening at the front, should be worn at all times for support, until your child’s next appointment.
• Avoid heavy lifting or exercise involving the arms until instructed otherwise.
• Following surgery, your child should rest as much as possible, to assist in their recovery.
• If your child experiences pain, take Panadol or Panadeine, or their prescribed medication. If this does not provide adequate relief, please notify us.
• Report any excessive swelling, discomfort or bleeding. If you have any questions regarding your child’s recovery, please contact the plastic surgery department.