• What happens at my first consultation?

Your consultation is always with Mr Turton. This is a detailed meeting to assess your current situation, medical history, suitability for breast reduction, and to perform the bio-dimensional assessment. You will have a full breast examination, and comprehensive measurements made of your frame, existing breast size, glandular analysis, tissue characteristics, and anatomical variations in typical dimensions. Mr Turton will also detail the potential complications, any limitations, short and long term breast changes, costs, the need for future surgery, mammography and follow-up.

• How much breast tissue can be removed/what size can my breasts be reduced by?

Usually 300gms to 500gms. Larger volume reductions are typically 500-900gms

Massive reductions involve 1-2kgs/side.

Small reductions are also quite commonly performed (100-300gms), with emphasis on tightening the skin, reshaping the breasts and raising the nipple up to its normal position. This may be referred to as a mastopexy-reduction.

• What happens on the day of the operation?

You should avoid any medication, herbal preparations, and vitamins except those that Mr Turton has said it is OK to take. For example- No NSAIDS such as Neurofen the week before surgery. You will also be fasting, and cannot take any liquids, any sips of water, or any food (no sweets, or chewing gum even), from the time specified (usually 6-hours prior to surgery). Avoid moisturiser on the breast area, please. Arrive in good time, and you will be checked in first by nursing staff. You will be admitted several hours in advance of your operation so that it is completely unhurried.

You should relax in your room (bring a book and magazines, get the wifi code!). Mr Turton will take your pre-op photo if not already so in the clinic, and mark you up. Mr Turton’s anaesthetist will evaluate you and confirm that you can proceed (If you are unwell or have developed a chest infection your operation would obviously be cancelled and rescheduled). You will be walked from the ward to the operating theatre reception for your check in, and then your anaesthetist will commence your anaesthetic- you will drift off to sleep in about 5 seconds! You will be under full anaesthesia for the full duration of the operation. Mr Turton will additionally use local anaesthesia which provides additional comfort on awakening.

Every thing is geared around you, your 100% safety, and well-being. You will be woken up in the recovery room, and supervised 1 to 1 with an experienced recovery nurse after the anaesthetist has reviewed you. You will then be taken back to your room where you may start your recovery within the comfortable surroundings provided.

• How long does the operation take?

Your operation will be conducted meticulously and unhurriedly. You are positioned on a padded operating table. There are additional gel supports that will be placed under your ankles and for your arms to rest on. Your head is on a pillow. There will be pneumatic anti-thrombotic boots around your lower legs which will gently squeeze your calf muscles throughout the operation (Mr Turton has never had a cosmetic surgery patient develop a DVT), and there will be a special sterile operative warm air blanket covering your lower body (this is called the “huggy bear”. An operation time 2 – 4 hours is typical. Mr Turton places great emphasis on the suturing and will usually spend an hour on this specific aspect. Mr Turton uses various techniques to reduce operative risks such as haematoma and infection; consequently, his re-operation rate is well below average. You are fully monitored throughout the operation and the consultant anaesthetist is sole with you (one-to-one consultant care).

• Is it painful?

Most patients use Paracetamol for a few days only, but an anti-inflammatory is included in addition by Mr Turton. The careful surgery often means discomfort is truly minimal. A mild aching is reported by a very small number of patients weeks or even months after surgery.

• When can I drive?

Individual advice varies: From 7-days to 3-weeks. You should have come off any strong painkillers before driving (such as Tramadol, Codeine, Dihydrocodeine or Tylex). You should be comfortable that you could make an emergency stop or be able to swerve sharply if needed before driving.

• When can I return to work?

Usually after 1-week. Some patients return after a longer period, typically 2-weeks. Jobs that involve strenuous lifting should be avoided for 3-weeks, and then discussed with Mr Turton.

• How do I decide on what size I want to be/ What size will my breasts be after surgery

Most patients want to be between a C and D cup. The starting size and the health of the remaining tissue during the operation dictate how much of the gland may be reduced. Mr Turton uses his extensive expertise in balancing the volume of the reduction, the goal of the desired breast size, and the blood supply to the remaining tissue. With massive macromastia, he will not compromise on the safety aspect at any point, and if he needs to curtail the resection just before a particular estimated cup size is reached he would always do so. For example, this may mean a patient is a DD rather than a D afterwards, or a D as opposed to a C. To reiterate, most patients want to be between a C and D cup, and this is achieved. Please note that there always will be imprecision trying to work to any particular cup size due to the vagueries of this measurement and that it can’t be precisely measured during surgery. It serves as guide only.

• How long will I be in hospital?

If you have surgery in the afternoon or evening you will normally stay 1- night. This is for your comfort and allows your drains to stop any fluid building up pressure under the tissue and hence on the scar line. You will be reviewed the morning after surgery and only released when ready the next day. This is normally always by mid-day.

• Can sex be resumed immediately after the operation?

For your comfort, Mr Turton advises waiting at least 3 weeks as the breasts will be too tender to touch during this time. After this gentle sexual activity, without pressure on the breasts, can resume as long as no pain is experienced. Generally, it takes 6-weeks before you are able to lie on your front at night, which is a useful guide as to how pressure will affect your comfort. Breast massage must be avoided for a minimum of 8-weeks.

• What forms of sports activity can I do after surgery?

Walking – Mr Turton encourage all patients on walking- no restrictions, and it is important to mobilise straight away.

Arm exercises – You must avoid raising your arms above shoulder height for 2-weeks (either to the side or in front). eg No reaching for top cupboards! Get help with hair washing. Avoid using your arms to lift yourself up or push yourself along on a mattress.

Cycling – from 6-weeks

Paddling in a pool, Sauna/Steam room use- from 6-weeks

Jogging – from 6-weeks; Weightlifting – from 3-months

Cross trainers, Gym, Yoga, Pilates – from 6-weeks

Gentle swimming- from 6-weeks

Pole dancing, Belly dancing – from 6-weeks

Aerobics- gentle reintroduction from 6-8 weeks

Golf- from 3-months (except chip-and-putt); Scuba diving -from 3-months

Tennis/Squash/Badminton – from 3-months

Athletic swimming – from 3-months

• If I lose/gain weight will my breast size reduce/enlarge?

In general, “Yes”. Breast tissue is composed of thick glandular tissue and soft fatty tissue. Just as when you put on weight you find that it goes onto the bottom/hip area, you will also often find some of it goes onto the breast area. Big shifts in weight are therefore not desirable. Most people have minor weight fluctuation of 2-4 lbs, which has negligible consequences.

• Is it better to lose weight before reduction surgery?

Yes. The breast shape will be better controlled if you have lost weight and assumed a normal body mass index prior to surgery. At the very least you should bring your body mass index (BMI) to less than 30 through a diet. Some patients struggle with weight loss when they have very large macromastia as is difficult to exercise. Mr Turton would be happy to offer his professional advice in this situation. He has access to a very helpful professional dietician and physiotherapy services. Occasionally patients with a BMI over 40 who are unable to achieve weight loss, will need to consider seeing a bariatric surgeon for a bypass or gastric restriction operation. Your General Practitioner can give you further advice, otherwise, there are services available relating to this at both Roundhay Hall Leeds and the Leeds Nuffield.

• How can I prevent sagging in future years?

You can’t. However careful weight control can modify your risk. Your breasts will always change as you get older, and this is irrespective of whether you have the breast reduction and mastopexy or not. This is because of biological changes that occur with ageing: loss of elastin, stretching of collagen, atrophy of breast tissue, loss of skin elasticity, sun damage to skin, smoking-related damage, effects of weight change on skin and breast tissue, effects of pregnancies and breastfeeding on skin and breast tissue, hormonal changes, weight of breast tissue and quality of supporting tissues.

Wearing a well-fitting bra after your recovery is important (usually from 6-weeks). An underwire bra is safe and recommended. Wearing a comfortable sports bra at night is also very useful. A shock-absorber type bra should be worn during sport. Keeping the skin over the breasts moisturised helps to maintain the elasticity (bio-oil is possibly advantageous here). Avoid the use of sunbeds and do not smoke at all (both have a very detrimental effect on skin elasticity and quality, as well as microvessel blood flow). Maintain your weight in the healthy range for your body mass index.

• Is the surgery guaranteed for any length of time?

You are covered by the fixed price package for the management of surgery-related complications. As these would manifest early, and usually in the first 2-weeks, the cover is typically for the first 3-months for peace of mind (check specific details at each hospital please). Breast problems that are unrelated to the surgery can occur subsequently in any patient (whether you have surgery or not) and are of course not covered.

• In the unlikely event that something did go wrong during/after the operation is further surgery included in the fixed price guarantee and will problems be resolved where possible within cost?

Complications from breast reduction surgery under Mr Turton are very rare, and although he is unable to give each individual patient a categorical guarantee that they won’t occur, he can attend to any surgery-related complication under the terms of the fixed price guarantee.

The sort of problems that can occasionally occur are a haematoma (collection of blood under the skin) in the first 24-hours needing evacuation; this will occur in under 5% of operations and there are techniques that are used to minimise the risk. Infection or slow wound healing can occur at the T-junction. Mr Turton has never had a major wound-related infection after breast reduction and has never had a patient develop MRSA. If such a complication was to occur then you will not only have the technical expertise at hand to deal with it, but also the peace of mind that it is covered by the fixed price package for further surgery, or for further outpatient treatment, should it be needed.

Fixed price packages tend to cover you for complications during the first 3-months after the operation, as this is the time that surgery-related complications occur. They do not cover the more long-term changes that can occur in breasts in most women. Such as developing a breast lump, or changes in sensation, and future breast sag, They also do not cover dissatisfaction with the size, or shape, unless it is related to a surgical problem. Mr Turton’s post-operative pictures are the typical results achieved and not carefully selected photos simply to impress patients. These are the results he will expect to achieve with you unless there are other limitations.

Mr Turton will always strive to meet your expectations but if there are limitations as to what can be achieved (this may be related to your starting point) then these will be discussed. It is important to be realistic.

• Are follow up consultations chargeable – even at the request of the consultant?

Your first two post-operative follow-ups are included in your surgical fees. You will generally only require a follow up at around 2-weeks and again at around 2-3months. Most patients are discharged by 3-months. Subsequent follow-ups will always incur a standard follow-up fee (cost approximately £150; please check with Mr Turton’s secretary).

Some patients desire annual or 2-3 yearly review depending on circumstances. Mammography and USS (cost approximately £175 and £350 each on top of consultation fees) can be arranged depending on your age during the follow-up period if required. Costs reflect Mr Turton’s time, and the charges for his rooms, administration and running costs. You are not charged if you attend for review by an out-patient breast nurse. At your follow-up with Mr Turton, you will always see Mr Turton- any follow-up is not delegated to someone else.

• Will breast reduction change my life?

Breast reduction may make you feel more confident within yourself but will not change things if you are dissatisfied with your lifestyle. Surgery in itself will not change a life situation, but the confidence and self-assurance which result from it can indeed empower you to make the required changes, allowing you to live and enjoy your life, to the full. Some patients can rarely have a general problem with body image and remain dissatisfied with their appearance even when the result has been within the expected and described range. This may be because of something called “dysmorphic body image syndrome”. Patients who have a general body image problem are unlikely to gain benefit from cosmetic breast surgery or any cosmetic surgery and should avoid it. Mr Turton would also want to avoid operating on someone who he suspected of having such a problem.

• Will I still have to wear the same style of underwear?

Due to possible changes in shape it should be possible to wear more feminine underwear.

• Do I need to wear some form of support at all times or can I go without a bra?

Once you have recovered from surgery there is no reason why you shouldn’t go without a bra on occasions. As long as you feel comfortable it will not have a detrimental effect. In the long term, however, breast tissue will be more susceptible to droop if you do not wear a bra most of the time.