Too generous breasts can be a real handicap on a daily basis. Beyond a certain volume, we speak of breast enlargement and a reduction is similar to reconstructive surgery and no longer cosmetic. How is the operation going? Are there any risks? The answers of Dr Massimo Gianfermi, plastic surgeon in Paris

Breast reduction can lighten a breast that is too heavy, suffering from an excess of mammary gland associated or not with an excess of fat.

“We speak of breast reduction when the volume removed from the patient is at least 300 g per breast, and 400 g per breast if the patient is overweight” specifies the surgeon. Below 300g per breast, the operation is no longer for restorative purposes but for aesthetic purposes, and is not covered by social security.

Difference from breast enlargement

Breast enlargement is often associated with sagging breasts, called breast ptosis. The reduction is then accompanied by a breast lift to lift the breasts and rebalance the posture.

Women affected by breast reduction are all those who are embarrassed on a daily basis by the weight and volume of their breasts.

The most frequent causes

“Patients who consult for breast reduction generally have three types of complaints” explains Dr Gianfermi:

• Back pain: they suffer from back pain, or pain in the neck or shoulders, caused by the weight of the breasts;
• Difficulty dressing – especially finding underwear that fits their size, which does not compress their chest – and discomfort in certain daily activities;
• The aesthetic complex: in even young women, a large breast can sag and cause significant complexes. And even when she stays firm, it’s not always easy to come to terms with a big bust and the interest it can spark.

In young women, it is important to wait until the end of breast development – ie around 18 years – before performing a reduction.

After pregnancy

Likewise after pregnancy, it is recommended to wait 6 to 12 months after childbirth, or after breastfeeding if it has taken place, before carrying out this intervention, in order to give the young mother time to find her. form weight.

Breast reduction is an operation that is always performed under general anesthesia, and most often on an outpatient basis. “It happens that we recommend a night of hospitalization if the reduction is particularly important, or if the patient lives far from the place where she is going to be operated” specifies the surgeon.

The operation lasts between 2 hours and 2 hours 30, depending on the technique used.

The three surgical techniques for breast reduction

There are three main surgical techniques for breast reduction, employed depending on the volume of breast removed:

• If it is small, without associated ptosis: a simple incision around the areola is sufficient;
• If it is medium, with mild ptosis, two incisions are made: one around the areola and another vertical, between the nipple and the lower part of the breast;
• If it is large associated with a significant ptosis, three incisions are necessary: ​​one peri-alveolar, one vertical and one under the breast, hidden in the infra-mammary fold. The scar is said to be in the shape of an inverted T.

The mammary gland removed during the operation is systematically sent for anatomopathology, to be analyzed and weighed precisely.

There are several contraindications to performing breast reduction.

“It is first of all imperative to do a prior mammogram in order to rule out any abnormalities, and in particular breast cancer” insists Dr Gianfermi. Here are the most common contraindications:

Tobacco

Tobacco is one of the contraindications to breast reduction: “Heavy smokers present a much greater risk of complications and healing problems” explains the surgeon, who refuses to operate on patients who smoke more than one pack daily, and which requires, even for small smokers, complete weaning at least 3 weeks before the operation and 2 weeks after.

obesity

Obesity also increases the risk of complications. A woman whose Body Mass Index is greater than 35, will first need to lose weight before undergoing breast reduction.

History of pulmonary embolism

A history of pulmonary embolism or phlebitis is also a contraindication to this surgery.

Healing takes about two weeks, and the patient must wear a compression bra day and night for a month, then only during the day for a second month. Postoperative pain is moderate and is generally relieved with conventional analgesics. Convalescence will be observed for one to three weeks depending on the case.

The patient can resume sports activity after 6 weeks.

Scars should be protected from the sun for at least a year. “As long as the scars are pink, it is essential to protect them from the sun at the risk of them turning brown and always remaining darker than the skin” insists the practitioner. It is therefore necessary to wait for the scars to whiten before considering exposing them to the sun.

After the operation, the breast will initially be very high and round, it will not take its final shape until about three months later.

“It is important to specify that, if the architecture of the breast can be modified by a breast reduction, this in no way affects the surveillance for breast cancer” reassures the surgeon.

Operative risks or complications are relatively rare, but must be mentioned by the practitioner during prior appointments. Here are the main complications:

• delayed healing, when the scar opens slightly on the base of the T ”explains the surgeon;
• the appearance of an expansive hematoma can occur in 1 to 2% of cases: bleeding occurs in the breast, causing significant swelling. “The patient must then go back to the operating room so that the bleeding can be stopped” indicates Dr Gianfermi;
• cytosteatonecrosis is one of the serious complications: part of the mammary gland can die, disintegrate and form a cyst, which must then be drained.

As with any operation, healing can be unfavorable: with hypertrophic or even keloid scars, the latter then hampering the aesthetic appearance of the result.

In some cases, the milk ducts are altered during surgery, compromising future breastfeeding.

Finally, an alteration in the sensitivity of the nipple is possible, although it usually returns to normal after 6 to 18 months.

In the event of real breast enlargement, with at least 300g removed from each breast, hospitalization and access to the unit are covered by social security. When the operation is performed by a private surgeon, his fees as well as those of the anesthesiologist are not reimbursed, and can range from 2000 to 5000 euros.

Complementary mutuals can cover part, or even some, of all of these fees.

When the operation is performed in a hospital environment, on the other hand, it is fully reimbursed by social security because the surgeon and the anesthetist are paid by the hospital. However, the delays are very long before obtaining an appointment in a hospital environment.