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Breast reduction surgery, more accurately termed reduction mammoplasty/mastopexy, is not as widely discussed as procedures like breast augmentation or enlargement.
There exists a group of women who require a breast reduction surgery. Unlike breast enlargement, this procedure is a medically-indicated treatment than a cosmetically driven one.
The medical condition which afflicts these women is termed macromastia, where the women’s breasts are disproportionately large and heavy since teenage years. Often, this happens to women who are not obese or large-built, but average-sized with disparately large and heavy breasts.
Many a time, these women have been suffering quietly with macromastia before seeking treatment because they are not aware of the good surgical options that are available now.
I typically divide the symptoms into 2 major categories - physical symptoms and psychological symptoms. The physical symptoms of this condition include:
The psychological symptoms, which may not be as apparent as the physical ones, include:
Many of my macromastia patients come to me with a collection of some or all of the above symptoms. Unfortunately, the symptoms do not go away with age. In fact, some progressively get worse with age, such as the upper back and neck pain, as well as the rashes which may result in abnormal skin pigmentation or scarring.
Furthermore, they do not get a good understanding from others, even from other women, on their degree of suffering with this condition. Many people, especially men, do not comprehend how having large breasts can be a problem, much less a medical one.
The breast reduction patients that come to see me are usually in the younger age group, between 20 to 40, with the youngest patient I have treated for this condition being 16. For the younger patients, they are accompanied by their parents (usually the mom), which is important, as this procedure is a permanent, life-changing one. The typical bra cup size of my patients that seek this procedure range from DD to H cup.
Physiological macromastia [1] (the most common kind) occurs usually from teenage years after puberty, due to the increased sensitivity of the breast gland receptors to the circulating hormones. They usually do not grow much more after 16-18 years of age.
After a reduction surgery where the breast glands are removed, they do not grow back, hence the condition does not recur. If the patient puts on weight, the breasts will enlarge but with fat rather than breast gland tissue; fat being much lighter would not result in much increased strain on the neck or upper back, therefore, symptoms do not usually recur.
The first thing I do during the consultation is to assess their fitness and suitability for the procedure. This means that I screen through the patients to ensure that they are medically and psychologically fit to undergo this procedure.
Firstly, I emphasise that this procedure, unlike other procedures I perform such as double eyelid surgery and breast augmentation surgery, is a permanent irreversible procedure. Therefore, the patient must consider and be aware of all the factors and consequences before making the decision to undergo a breast reduction.
Secondly. I then ascertain the various symptoms that they may be experiencing due to the macromastia (listed above). This is followed by determining the patient’s current bra cup size as well as their target bra cup size. The most common refrain I hear from all my patients is to make their breasts “as small as possible”. While I can understand why, I do not encourage as in my opinion, there are 3 targets of this procedure:
All 3 of these goals are equally important.
I then discuss the important aspects and risks of the breast reduction surgery [2], which will fall into the various sub-categories:
I will usually send my patients for a simple pre-operative screen, such as a mammogram or a breast ultrasound, so as to exclude anything suspicious. On the patient’s side, they would have to avoid certain foods, medications and/or supplements about 1 week prior to the surgery to reduce the chance of bleeding and blood clots.
The surgery is performed under general anaesthesia (GA) with an anaesthetist present to administer it. It is however, a modified version termed total intravenous anaesthesia (TIVA), which means my patients are not paralysed and breathing on their own. There is no breathing tube in their airway. This allows for a greater safety margin for my patients and a much more pleasant recovery period.
The entire procedure takes 4-5 hours, depending on the size of the breasts being reduced. I reduce between 600gm to 1.8kgs total in breast tissue for my patients. The important thing is how much I leave behind, as that determines the final size and shape of the breast, as well the resolution of the symptoms such as back and neck pain. In my experience, with reduction of 3 cup sizes or more, there should be almost complete resolution of symptoms.
The surgery is performed as a day surgery procedure in my centre. I do not put drainage tubes; my patients only need to wear a compression bra, for around 3-4 weeks. In terms of pain, my patients only require oral painkillers, of which a significant number do not even require or take. It is usually far more comfortable than breast augmentation for example.
In terms of return to work, my patients are given hospitalisation leave of around 1 week, although many go back even sooner. Return to the gym, pilates/yoga and strenuous physical activity typically is after a month from surgery.
In order for the surgery to fulfil the criteria for Medisave and insurance claims, there is a minimum criteria in terms of weight - either 250gm from 1 side or 500gm in total from both breasts. The breast tissue would need to be sent to the laboratory for the pathologist to examine and weigh.
My surgical fee starts from $12 000. The cost of surgery is also dependent on the following factors: anaesthesia fees, facility fees, medication, garment and the equipment/medical consumables. GST is of course the last factor.
