Though we can't tell you every single detail of what happens in the operating room, we can describe the general techniques of breast reduction surgery as well as some things to expect on the day of surgery.
Before the Anesthesia
When you arrive at Rexford Surgical Institute, our Surgical staff will ask you to register and complete some necessary paperwork. Your companions, including family members, will not be able to accompany you to the surgery or recovery areas, and they will be asked to wait in the waiting room. They will be asked to join you as needed. After changing into a patient gown in the pre-operative area, you will be examined and evaluated by Dr. Golshani, and Avosant's anesthesiologist and registered nurses, to confirm that you are ready for surgery. Dr. Golshani will also measure and mark your breast incisions and the new positions of your nipples. To properly receive necessary fluids during surgery, an intravenous catheter (IV) will be inserted in your hand or arm veins and to monitor your heart, patches will be placed on your skin. If needed, intravenous medications will be used to prevent anxiety. When you finally get to the operating room, the anesthesiologist will put more medications into your IV, and soon you will fall asleep listening to soft music.
Many of our breast reduction patients have little or no memory of the time immediately before and after their surgery. They are peacefully asleep during the approximately four hours of the surgical procedure and they are usually resting during the average two hours in the recovery area.
Dr. Daniel Golshani and the Avosant Surgical Associates have been performing breast reduction surgery for more than 12 years. During these years, they have acquired much experience and been able to further refine their surgical techniques. The main goals of the surgery are to remove breast tissue and excess skin as well as correct ptosis (droopy breasts) by moving the nipples up to a higher position on the chest. Though the same exact operation is usually performed on both breasts, asymmetries and/or reconstruction of one breast after a mastectomy may require different incisions or surgical techniques to be used on one breast versus the other. In addition, breast reduction can be performed unilaterally (on one breast) or bilaterally (on both breasts).
Depending on the overall shape and size of your breast, Dr. Golshani will choose the best incision technique for you in order to minimize scarring and maximize results.
Incisions are made in the middle of the breast as a circular pattern around your areola (darker skin around the nipple) and excess skin, except the nipple - areola complex, is removed from the lower part of the breast. Different incision options include an upside-down "T" (anchor-shaped pattern), an upside-down "L" pattern, or a keyhole pattern where the incision is made around the areola and vertically down to the crease of the breast only.
Managing the Nipple (Areola Complex)
In order for the nipple to survive and maintain its rich nerve and blood supply, it is left attached to its tissue and the breast. In addition, leaving the nipples attached to their glandular component allows most patients to breastfeed in the years after surgery. This breast tissue attachment is called the nipple pedicle and it is specifically designed based on the surgeon's experience and patient's surgical needs. Patients who have extremely large or long breasts or certain medical risks, such as a history of smoking or gigantomastia (extreme growth of the breasts), may require the nipple to be treated like a skin graft rather than leave it in a pedicle that would be too long and too wide to properly reduce the breast. With free nipple grafting, the nipple and an appropriate amount of areola are completely removed from the breast to be attached later during the surgery.
Reducing the Breasts & Repositioning the Nipples
After the breast incisions are made and the nipple pedicle is separated, it is time to reduce your breasts and reposition your nipples. Breast tissue is removed, weighed and sent to a laboratory for analysis by a pathologist to evaluate normalcy. Excess skin and fat are also removed to sculpt the breasts and the nipple while the areola is moved into its new, higher position. Some women have enlarged areolas that can be reshaped and made smaller during surgery.
Dr. Golshani uses several techniques to shape the breasts. The Inferior Pedicle Technique, which uses the upside-down "T" or keyhole incisions, is the most commonly performed technique and produces the most predictable outcomes especially for women with extremely large or droopy breasts. However, modified variations may be used in different patients on an individualized basis.
Occasionally, breast liposuction (suction lipectomy) is used to help contour the chest and the sides of each breast. This technique utilizes small stainless steel tubes, called cannulas, which are connected to a suction pump and inserted through very small incisions into the fat tissue. Excess fat is sucked out to help shape the area. Recently, liposuction is being used as the main breast reduction technique to reduce breast size without any major incisions. This surgical technique is best suited for a patient with minimal or no ptosis (droopy breasts), good skin tone and fatty, non-dense breast tissue. Though the results of this technique are not drastic, there is a quicker healing time, less risk of damage to the nipple, and little scarring. In addition, laser or ultrasounds assisted techniques may be used in some cases as needed.
Shaping the Breasts & Closing the Incisions
Dissolvable (absorbable) and removable (non-absorbable) sutures are used to create, support and anchor the remaining breast tissue to each other and to the deep chest tissue while closing the surgical incisions. Drains are usually left in for one to two days to help remove excess blood and tissue fluid, and dressings consisting of gauze are placed with bandages and/or a surgical bra.
Breast Reduction Versus a Breast Lift
Breast lifts, also known as a mastopexy, use some of the same surgical techniques as a breast reduction. However, a breast lift deals mainly with breast sagging (ptosis) and not with its weight. Because very little volume is removed in a breast lift, it is not generally covered by insurance companies who require a minimum amount of breast weight to be removed in surgery. Breast augmentation and concomitant lift, also known as augmentation mastopexy, are also procedures very commonly performed by Dr. Daniel Golshani. Both surgeries require significant surgical experience to be performed correctly and safely.
Breast Augmentation After a Breast Reduction
There are a few breast reduction patients who actually benefit from a breast augmentation. Women who have heavy, flat and long breasts may have very little breast volume and projection, and a breast augmentation with implants can create a fuller look. However, insurance does not usually cover this procedure.
Recovery & Surgery Aftercare
Learn more about the next stage in the process, visit the breast surgery aftercare section.