Breast reduction, pregnancy and breastfeeding: what you need to know

Breast enlargement, when the breasts are too big

While breasts that are too small or too flat can be complex, having a large breast is not necessarily the panacea either. A very large breast can also be annoying on a daily basis. Too much breast volume can in fact complicate sports practice, intimate intercourse, but also cause back pain, neck and shoulder pain, or difficulties in finding suitable underwear. Not to mention the looks and comments that a big breast can elicit, and which can, in the long run, have a psychological impact important.

When the volume of the breasts is too large compared to the morphology of a woman, we speak ofbreast enlargement.

This hypertrophy may appear from puberty, after pregnancy, during the natural process of aging, due to a weight gain, or hormonal changes. Note that breast enlargement is often associated with sagging of the breast, which is called breast ptosis.

Breast reduction surgery, which aims to reduce breast volume et possibly correct the associated ptosis or asymmetry, reduces the discomfort and difficulties associated with hypertrophy (back and neck pain, discomfort, etc.). Note that these are these physical repercussions which explain why Social Security covers breast reduction linked to hypertrophy, under certain conditions (see below).

At what age can a breast reduction be done?

It is possible to have a breast reduction from the end of adolescence, around 17 years old, when the breasts have reached their final volume and that the chest is stabilized. Ideally, the chest should not have not changed for one to two years to be able to carry out a breast reduction, the result of which will be lasting.

But as soon as the breast development is stabilized, it is possible to have recourse to breast reduction, surgery which can be of great help from a physical and psychological point of view in a patient suffering from breast enlargement. Because a very generous breast can cause severe back pain, discomfort in intimate relationships, jokes, difficulties in dressing …

Breast volume reduction is also possible at any age in a woman’s life, even if ideally, have recourse to it after having completed your children’s plan seems the guarantee of greater stability of the result. Indeed, pregnancy and breastfeeding can have a more or less important effect on the breast, and increases the risk of ptosis (sagging) and melting of the mammary gland. However, it is quite possible to have breast reduction surgery and then have a successful pregnancy. A period of one year is nevertheless recommended between surgery and pregnancy.

Breast reduction: how is the operation performed?

Several steps are necessary before the surgery itself. It will first be a question for the patient to clearly define what she wants with the surgeon: the desired bra cup size after the operation (the chest circumference remains unchanged), the scars that this induces, the expected operative consequences, the risks and possible complications … The plastic surgeon will also take note of your medical history and your general state of health. 

Un breast assessment will be prescribed, to ensure the absence of pathology of the breasts (cancer in particular). “At a minimum, a breast ultrasound is requested in young women, associated with a mammogram or even an MRI in an older woman.”, Explains Professor Catherine Bruant-Rodier, professor of reconstructive and aesthetic plastic surgery at Strasbourg University Hospital. A consultation with the anesthesiologist is also necessary.

The operation takes place under general anesthesia and lasts 1 hour 30 to 3 hours about. Hospitalization of 24 to 48 hours is then required, as well as a work stoppage of one to three weeks depending on the surgeons and the type of work of the patient.

Breast reduction scars

To reduce a breast scarring is inevitable. The bigger the breast, the longer the scars. They will be at best concealed in the less visible areas.

Breast reduction usually requires pull up the areola, leaving a periareolar scar, an incision between the areola and the inframammary fold (vertical scar), or even a third incision at the base of the breast, in the submammary fold. When the three incisions are associated, we speak of inverted T scar or via marine anchor.

First red and very visible the first months, the scars left by a breast reduction go whiten and fade over time. It is therefore necessary to wait one to two years to see the final result of the surgery, at least with regard to the final appearance of the scars. While knowing that the quality of scars also depends on the way the body heals, which differs between individuals.

Breast reduction: what are the risks?

Like any surgery, breast reduction involves risks and rare complications that must however be taken into consideration. These include thromboembolic accidents (phlebitis, pulmonary embolism), hematomas, infections, necrosis (very rare, and the risk of which is increased in the event of smoking), poor healing.

Bra, support: which bra to wear after the operation?

After breast reduction, plastic and cosmetic surgeons recommend at least wearing a sports bra, such as a brassiere, without frame and preferably cotton, for at least one month, for good breast support. The idea being to hold the bandages, limit edema and facilitate healing. Some surgeons even prescribe a support bra for optimal maintenance of dressings and compresses.

How to sleep after breast reduction?

During the six months following this type of surgery, it is difficult to sleep on your stomach, and it is not even recommended during the first postoperative weeks. You will therefore sleep on your back for a while.

In case of pain, analgesic drugs may be prescribed.

Should you do this surgery before or after your pregnancies?

It is possible to have breast reduction surgery before becoming pregnant. It is nevertheless advisable towait at least six months, and preferably a year after surgery, to get pregnant.

However, it should be kept in mind that pregnancy and breastfeeding lead to a variation in breast volume, which can lead to breastfeeding. ptôse(sagging of the breasts) more or less important, associated or not with a breast melting. Also, the aesthetic result obtained after breast reduction is not guaranteed after pregnancy.

This is why, in the event of moderate discomfort linked to breast enlargement, it may be wiser to carry out her pregnancy plan (s) before to opt for breast reduction. But if you are young and / or are very embarrassed by your large breasts, it may be more beneficial to operate before pregnancy. This is something that can be discussed with the surgeon.

Breast reduction: possible difficulties during breastfeeding

Breastfeeding after breast reduction: not guaranteed, but not impossible

Breastfeeding is usually possible after breast reduction. However, he may be more difficult, because the mammary gland was affected, and part of it was removed. Milk production may be insufficient, and milk ejection more complicated. In some women, breast reduction can sometimes cause decreased sensitivity of the nipples, which can be transitory or definitive.

The success of breastfeeding depends in particular on the surgical technique used (hence the importance of discussing your desire to breastfeed upstream with the surgeon), the quantity of mammary gland removed or the location of the gland. removed. In short, breastfeeding is not impossibleMore not guaranteed either. But given the virtues of breastfeeding for mother and baby, it would be a shame not to try it!

A risk of having severed milk ducts

Breast reduction involves making a periareolar incision around the nipple, which can impact the milk ducts (or lactiferous). Some may have been severed during surgery, which will have consequences for lactation. As the milk cannot flow in some places, it is possible to suffer fromcongestion localized and impossible to drain, that it will be a question of taking charge quickly with painkillers, massages and cold compresses to avoid complications.

Breastfeeding: getting help to successfully feed your baby

When you want to breastfeed after having undergone breast reduction, it is a good idea to use a lactation consultant. After learning about the surgical technique used, it will be able to provide tips and tricks so that breastfeeding goes as smoothly as possible. This will include setting up optimal latching of the baby, through different breastfeeding positions, to consider the use of a Lactation Aid Device, or DAL, if necessary, breast tips, etc. So even if the baby is not exclusively breastfed, it still benefits from breast milk.

Breast reduction: what price and what reimbursement?

Breast reduction is covered by Social Security only in certain cases. Health insurance reimburses this surgery if she aims to remove more than 300 grams per breast. Because she considers that the chest is then very voluminous and that it causes other health problems, in particular back pain. 

It is not necessary to request a prior agreement to be reimbursed. 

Despite everything, it should be kept in mind that reimbursement by Social Security includes only the cost of the medical procedure, and not the additional fees of the surgeon, the anesthetist, or any additional costs (room only, meals, television, etc.). Corn these costs can be covered by the mutual. The price range for a breast reduction therefore varies from zero, which remains payable by the patient if the operation is reimbursed and carried out in a public hospital, to more than 5 euros depending on the clinics and in the absence of reimbursement. It may therefore be wise to establish a quote in advance, and to check well with your mutual upstream.