Dr Lisa Friederich

1300 375 472

Dr Lisa Friederich

1300 375 472

Breast Reduction

Breast reduction surgery not only reduces the size of overly large breasts, it reshapes and lifts them.

Common problems with large breasts

Back pain, neck pain and shoulder pain are common problems experienced by women with large breasts. This is exacerbated by bras – tight around the chest, with thick shoulder straps transmitting the weight of heavy breasts to the shoulders, neck and back. Shortening the straps to lift the breasts higher and to a more youthful position increases the transmitted forces and pain.

Chafing, rashes and pain in the infra-mammary fold. 

Difficulty exercising not only the movement of breasts, but finding adequately supportive sportswear.

Social anxiety, unwanted attention and self consciousness often leads to hunching and poor posture, exacerbating neck, shoulder and back pain.

Feeling top-heavy and out of proportion

Aim of Surgery

The primary aim of Breast reduction surgery is to remove excess breast tissue.

In doing so, the breast diameter is narrowed and the whole breast lifted.

The areola is reduced in diameter and the nipple areola complex(NAC) is repositioned to an ideal position at the point of maximal breast projection.

Surgical options

Liposuction: This is a suitable option for women with primarily fatty breasts and good skin tone. This does not involve the excision of skin or breast tissue and will not lift the breast or change the position of the nipple and areola.

Surgical Reduction: This is the standard recommended operation for breast reduction. Breast tissue and excess skin are removed and the NAC is repositioned. There are two main variations commonly used with regard to the pattern of skin excision- a vertical and inverted T pattern.

How it's done

There are a few components to the operation;

In the pre-op bay the breast are marked up – the skin excision pattern new NAC position and pedicle are drawn as well as standard landmarks: the midline, the superior extent of the breast and the infra mammary fold.  Ancillary areas on the lateral chest wall may also be marked if they require liposuction.

The blood and nerve supply to the NAC are preserved on a cuff of breast tissue carrying these vessels. This is called the pedicle. The most commonly used is a superior or supero-medial pedicle as this retains the tissue in the “social” area of the breast. Historically, an inferior pedicle was the most commonly used, but this emptied out the upper and medial parts of the breast, whilst retaining the tissue in the heavy dependent part of the breast. This led to bottoming out and often a boxy appearance to the lower part of the breast.

Once the pedicle has been determined and isolated, the parenchymal (breast tissue) resection is performed. With a supero-medial pedicle the lateral and inferior parts of the breast are debulked.

**All breast tissue resected is sent for histopathological examination to screen for abnormalities.

The breast have a very good bloody supply so after all tissue has been resected a careful check for any remaining bleeding vessels is done before the pedicle is rotated and inset to it’s new position. The lateral and medial parts of the remaining breast tissue are brought together.

In a vertical scar reduction the skin is closed along this resection line. If this distance is too long, a horizontal wedge of tissue is removed (converting to an inverted T pattern)allowing control of the distance between the NAC and the new infra-mammary fold. If this distance is too long, the NAC will appear too high as the breast settles with time and gravity. 

Liposuction is performed in areas surrounding the breast as needed. This is most commonly done on the lateral chest wall.

Drains are usually placed on each side before closure is completed. These are used to deliver local anaesthetic into the wound at the end of the operation and later placed on suction. This helps the surfaces stick together and removes any excess tissue fluid and blood.

The wounds are dressed and a supportive bandage or surgical bra are fitted. 

Limitations

Definite cup sizes are impossible to promise, there is great variability between manufacturers and an individual’s cup size is determined from the ration of their chest circumference to the chest and breast circumference. So the breast size alone won’t determine the cup size.

Having said that, it is possible to give you a general estimate.

Many patients want as much tissue as possible removed, this is limited only by needing to maintain enough tissue for a healthy pedicle, enough tissue to retain blood supply to the remaining skin and retaining enough tissue to maintain enough shape to make an attractive breast. 

Hospital stay and Follow-up

This surgery is performed in an accredited hospital under general anaesthesia.  An overnight hospital stay is recommended.

The operation takes 3-4 hours including anaesthetic time. You will often spend another 30minutes in the recovery bay before going back to your hospital room.

Dr Lisa will see you in hospital before discharge to check your dressings and discuss the surgery with you. 

It is usual to be swollen the day after surgery, don’t worry, they will settle within 2-4 weeks to their new size.

We will see you in the office 7-10 days after surgery. If you have any concerns beforehand, you can email or phone us.

Breast Reduction

Breast reduction surgery not only reduces the size of overly large breasts, it reshapes and lifts them.

Common problems with large breasts

Back pain, neck pain and shoulder pain are common problems experienced by women with large breasts. This is exacerbated by bras – tight around the chest, with thick shoulder straps transmitting the weight of heavy breasts to the shoulders, neck and back. Shortening the straps to lift the breasts higher and to a more youthful position increases the transmitted forces and pain.

Chafing, rashes and pain in the infra-mammary fold. 

Difficulty exercising not only the movement of breasts, but finding adequately supportive sportswear.

Social anxiety, unwanted attention and self consciousness often leads to hunching and poor posture, exacerbating neck, shoulder and back pain.

Feeling top-heavy and out of proportion

Aim of Surgery

The primary aim of Breast reduction surgery is to remove excess breast tissue.

In doing so, the breast diameter is narrowed and the whole breast lifted.

The areola is reduced in diameter and the nipple areola complex(NAC) is repositioned to an ideal position at the point of maximal breast projection.

Surgical options

Liposuction: This is a suitable option for women with primarily fatty breasts and good skin tone. This does not involve the excision of skin or breast tissue and will not lift the breast or change the position of the nipple and areola.

Surgical Reduction: This is the standard recommended operation for breast reduction. Breast tissue and excess skin are removed and the NAC is repositioned. There are two main variations commonly used with regard to the pattern of skin excision- a vertical and inverted T pattern.

How it's done

There are a few components to the operation;

In the pre-op bay the breast are marked up – the skin excision pattern new NAC position and pedicle are drawn as well as standard landmarks: the midline, the superior extent of the breast and the infra mammary fold.  Ancillary areas on the lateral chest wall may also be marked if they require liposuction.

The blood and nerve supply to the NAC are preserved on a cuff of breast tissue carrying these vessels. This is called the pedicle. The most commonly used is a superior or supero-medial pedicle as this retains the tissue in the “social” area of the breast. Historically, an inferior pedicle was the most commonly used, but this emptied out the upper and medial parts of the breast, whilst retaining the tissue in the heavy dependent part of the breast. This led to bottoming out and often a boxy appearance to the lower part of the breast.

Once the pedicle has been determined and isolated, the parenchymal (breast tissue) resection is performed. With a supero-medial pedicle the lateral and inferior parts of the breast are debulked.

**All breast tissue resected is sent for histopathological examination to screen for abnormalities.

The breast have a very good bloody supply so after all tissue has been resected a careful check for any remaining bleeding vessels is done before the pedicle is rotated and inset to it’s new position. The lateral and medial parts of the remaining breast tissue are brought together.

In a vertical scar reduction the skin is closed along this resection line. If this distance is too long, a horizontal wedge of tissue is removed (converting to an inverted T pattern)allowing control of the distance between the NAC and the new infra-mammary fold. If this distance is too long, the NAC will appear too high as the breast settles with time and gravity. 

Liposuction is performed in areas surrounding the breast as needed. This is most commonly done on the lateral chest wall.

Drains are usually placed on each side before closure is completed. These are used to deliver local anaesthetic into the wound at the end of the operation and later placed on suction. This helps the surfaces stick together and removes any excess tissue fluid and blood.

The wounds are dressed and a supportive bandage or surgical bra are fitted. 

Limitations

Definite cup sizes are impossible to promise, there is great variability between manufacturers and an individual’s cup size is determined from the ration of their chest circumference to the chest and breast circumference. So the breast size alone won’t determine the cup size.

Having said that, it is possible to give you a general estimate.

Many patients want as much tissue as possible removed, this is limited only by needing to maintain enough tissue for a healthy pedicle, enough tissue to retain blood supply to the remaining skin and retaining enough tissue to maintain enough shape to make an attractive breast. 

Hospital stay & Follow-up

This surgery is performed in an accredited hospital under general anaesthesia.  An overnight hospital stay is recommended.

The operation takes 3-4 hours including anaesthetic time. You will often spend another 30minutes in the recovery bay before going back to your hospital room.

Dr Lisa will see you in hospital before discharge to check your dressings and discuss the surgery with you. 

It is usual for your breasts to be swollen the day after surgery, don’t worry, they will settle within 2-4 weeks to their new size.

We will see you in the office 7-10 days after surgery. If you have any concerns beforehand, you can email or phone us.

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