• How will I feel after Breast Reduction Surgery?

The vast majority of Mr Turton’s patients feel relaxed and comfortable immediately after surgery. Breast tenderness and a tight feeling, usually become apparent in a gradual manner. At this stage, Mr Turton is happy for the nursing staff to dispense Paracetamol and an anti-inflammatory tablet for pain relief. You will only occasionally need to have a stronger pain killer as well, such as Tramadol or Codeine. The anti-inflammatory and Paracetamol combination is very effective and can be continued for a few weeks according to how you feel, but should not be taken on an empty stomach. It is quite common for one breast to be more tender, and to swell slightly more (this is often the right side). Similarly, one breast will often recover more quickly and this is quite normal.

Although this would be very rare, the gradual appearance of a great discrepancy in size would not be normal and should be assessed. Similarly if you feel unwell, feverish and develop a temperature you would need assessment. If the skin over the breast swells and becomes reddened and tender you would need assessment. Changes like this would be very unusual indeed, but it is important to know that should they occur, a prompt review is required to assess the cause and treat it.

Occasionally patients feel nauseated as the anaesthetic leaves the system, or sometimes as a result of morphine that may have been given by the anaesthetist during the operation. Both of these are soon out of the system and generally gone by the following morning.

• What happens after the operation?

When the surgery is finished, the anaesthetic will stop and you will gradually wake up over about 5-minutes. At this point, you are taken to the recovery area. You are supervised by the anaesthetist and the experienced recovery nurse and then by the recovery nurse alone. The tube that was in your mouth will have been removed and you will feel sleepy. You stay in recovery until fully alert and then you are taken back to your room where you will be made comfortable. The nursing staff will adjust your medication as needed. Your throat may feel slightly sore from the breathing tube but you will be able to sip water straight away.

At this stage, there is still a drip in the back of your hand, and this is taken down when you are drinking properly. The Venflon (the name for the plastic needle in the back of the hand) is taken out the following morning, but can come out earlier if you are comfortable and not feel nauseated.

There will be a drain on your side and this should be kept laid out straight alongside your body so that the tube is not curled up, otherwise, it can kink, and stop the suction. This is removed the following day, and is not painful.

Your breast area feels tight and there will be a Tubigrip (elasticated support) over your breasts. Often this is in a double layer overnight and then pulled down to a slightly looser single layer the next morning. You will go home wearing the Tubigrip day and night, without removing either.

The dressings and the Tubigrip must be kept dry. This helps reduce the risk of wound infection. You should, therefore, have shallow baths (run the water just up to cover your legs) and keep the Tubigrip on (but dry) even when you are in the bath. It is good to get help with hair washing. Sponge wash the under arm area and pat dry afterwards.

You will be seen the following morning after surgery and the nursing staff informed as to when the drains can be removed. You will be given the “take home medication”- painkillers and antibiotics and should have clear instructions and understanding as to when to take them. Please ensure you discuss this with the nursing staff if not sure and if you have any queries after discharge you will be instructed to ring the ward for immediate attention. Mr Turton should be informed of any problems.

• Are there any side effects to the operation?

The commonest one is feeling sleepy for a few hours. Sometimes the anaesthetic or morphine makes you feel sickly, but usually for a short duration only.

You may feel slightly bloated for a few days. This is often due to slight constipation caused by morphine, codeine and tramadol medication. A gentle laxative (lactulose, movicol or senna) will help resolve this.

• What clothes should I bring in to wear leaving hospital after the operation?

A loose button front shirt is ideal. Nothing that needs pulling on over your head.

• Do I need to take time off work after surgery?

Yes. Please check with Mr Turton in relation to what you do, generally 2-weeks off, 3-weeks or more may be needed if your job involves lifting or heavy manual work. If very sedentary, you can occasionally return after 10-days, but remember that you may still be taking Paracetamol and Voltarol.

• When is it possible to resume household chores?

It is really important not to start household chores straight away. You may be glad to know that husbands/partners/friends will certainly need to help here. I advise against vacuuming and ironing for the first 3-weeks, and then only lightly for the following 3-weeks. The golden rule is “if it feels sore, then don’t do it”. Listen to your body. You want to avoid repetitive tasks that will slow down tissue healing and resolution of swelling.

• When is it possible to resume Shopping?

You can go shopping the following day. You should not carry heavy shopping bags for 6-weeks. I would also advise against bra shopping for 6-weeks as this is when breast tissue swelling would have generally resolved.

• When is it possible to go out to a Restaurant?

You can go out to a restaurant straight away. You should avoid a very heavy meal and avoid more than a glass of wine or champagne in the first week. Many of Mr Turton’s patients go out to a restaurant the very next day after being discharged.

• When is it possible to resume Decorating?

As this can be strenuous you should wait a minimum of 6-weeks.

• I have small children; am I okay to play rough and tumble?

As this can be strenuous as well as painful, especially if you get knocked, you should wait until after 6-weeks.

• Is it okay to sunbathe after the operation?

Yes, after 6-weeks once you have healed. But you should use factor 50 + suntan lotion, or keep scars taped and completely covered by clothes. Remember that you can get sun-burn through a thin cotton. If the scar does get a sunburn it causes a permanent redness.

• How will my breasts look & feel after the operation?

During the first 3-6 weeks, the breasts tend to feel quite tight and swollen. Near to full resolution for small reductions occurs in this time. After 3-months the breasts generally feel softer again but this can take 6-months for very large reductions.

• When can I lift my arms above my head?

After 3-weeks usually, unless Mr Turton advises you of specific exercises to perform or avoid.

• Is it possible to get further reductions in the future if necessary?

It is important to avoid unnecessary surgery. Further reductions are possible but the technique must be meticulous to avoid the risks of skin necrosis including loss of the nipple and areola. Liposuction is an option too that can be discussed.

• When can I wear an underwired bra?

Usually from 6-weeks. You should avoid trying on multiple bras at this stage. Get professionally fitted and buy from that shop initially. If the underwiring is uncomfortable go back into a sports bra and get refitted in a different shop.

• When can I lay on my stomach?

Usually at 6-weeks; before this it is uncomfortable. Some paitents will find it slightly uncomfortable even after 6-weeks.

• It says no heavy lifting – what is classed as heavy?

Heavy is anything that is uncomfortable. In general, lifting shopping bags that are full is what I would term “heavy”. Lifting a kettle is OK. Lifting a baby is not.

It is also important to try to avoid using your arms to shuffle yourself up and down the bed, for the first 6-weeks. When you do so, you are pushing hard with your hands onto the mattress and this is forcibly contracting the pectoral muscles.

• Will I be able to breast feed?

No. It is uncommon to be able to breast feed.

• Will a general or local anaesthetic be used?

The operation is carried out under full general anaesthetic and this is regarded as the safest approach. Pure local anaesthesia would be too uncomfortable. “Twilight anaesthesia” carries a level of risk of losing control of the airway if the patient’s level of consciousness falls and should be avoided unless there is a very specific reason to use this route. If a request is made for Mr Turton to perform a breast reduction under twilight anaesthesia, he would still insist on a consultant anaesthetist being present to maintain the patient’s 100% safety. This should never be an area of compromise simply to reduce the cost of breast reduction.

• How long is the scar tissue healing time?

Skin healing occurs in the first 14 days but continues to mature over 12-18 months. The scars must be cared for and you should avoid touching or feeling along the scar line for the first 8-weeks. Mr Turton advises his patients on scar care for the first 3-months to try to keep the scar line like a fine pencil line. Although they look dramatic at 3-weeks after surgery they generally soften and fade within the first 6-months. Thicker scars (if they form) gradually fade over the first 3-years to a more pale colour. There are special techniques that reduce scaring & this can be speeded up by using a silicone scar gel called Dermatix or Boot’s Brand of their own product. The visibility dramatically reduces over 12-months. Around 5% of patients form thick red raised (sometimes itchy) scars, which are called hypertrophic scars. If this occurs it tends to be on the lower outer or the lower inner aspect of the scar in the crease under the breast. This sort of scar tends to form more readily in some patients than others. If you have a history of bad scars please let Mr Turton know in advance of any surgery.

• Where will the scars be & what will they look like?

Scarring will be around the areola, Vertically: areola to lower crease & Horizontally: in the crease under the breast. In larger reductions, to tighten the skin fold that runs up towards the armpit, it may be necessary or helpful to continue the excision in this area, resulting in a longer curving scar from the under-crease, on the outside of the breast. Scars take around 18-months to mature. Around 5% of patients get hypertrophic scars that are thick and raised and initially quite red. These can feel itchy and occasionally they can be tender too. If you know you have a tendency to hypertrophic scars you should discuss this in detail with the surgeon as you are more likely to have them with breast reduction surgery.

• Are there any foods that help heal scarring & skin recovery?

Vitamin C is needed for wound healing; in general most people who have a balanced healthy diet will have normal healing. Please eat sensibly.

• What are the effects of smoking on scarring?

Wound healing is slower, and the risks of wound breakdown and necrosis very much higher. Scaring is worse. Mr Turton will insist that you stop smoking if he is to perform the surgery and this is a categorical guarantee that you must give. You must also avoid passive smoking. It impairs the microcirculation at a critical time when wound healing is most needed. Smoking when having this type of surgery is a recipe for a disaster. If you do not think you can give up smoking please do not ask for this surgery, or advice Mr Turton prior to surgery so that at the very least he can post-pone the operation.

• What are realistic recovery times?

6-8 weeks.

 

• Is breast reduction surgery the correct surgery for me?

It may be that you suffer from many of the typical symptoms of heavy breasts such as upper back pain, neck pain, postural difficulties, bra strap pain, skin sores underneath the breasts. Or it may be that you simply feel that your breasts are out of proportion with your body and that you find it difficult to find clothing that fits. In any of these cases, breast reduction surgery could be right for you. It is essential that you discuss with your surgeon your symptoms, current size and expectations in terms of your post-operative size and appearance.

 

• How long will it take for the swelling to subside entirely

It can take six to nine months, but in most patients it has settled fully by 3-months.