Breast reduction is a surgical procedure that can reduce large breasts by removing both the skin and the mammary gland. This intervention will be taken care of by the social security when the aesthetic surgeon removes more than 300 grams per operated breast. The procedure reduces the volume of the breast and also aims to correct the sagging look of the breast and any pre-existing mammary asymmetry. The position of the areola and the nipple complex are also elevated during the breast reduction intervention. An important phase that many patients want to discuss before scheduling the breast reduction procedure is the appearance and location of the scars after the intervention. Before the breast reduction surgery: A clinical examination of the breast allows the plastic surgeon to see: • The volume of the breasts. • The level of the breast ptosis. • The quality of the skin of the breasts (distended or toned, with or without stretch marks) • The condition of the nipples. Different imperfections of the nipples and areolas can be corrected if the patient wishes to during the breast reduction surgery. A visit to the anesthesiologist, general examinations, and a mammogram are necessary to detect a possible contraindication for the procedure. A mammography is often recommended for women over 35 years of age or with risk factors for breast cancer. Medical photographs of the breast are performed before the breast reduction and then during the various post-operation follow-up consultations. The most important medical instructions before a breast reduction surgery are the following: • Strict cessation of smoking at least two weeks before the surgery, to reduce the risk of skin necrosis and the risk of poor wound healing. • Stop taking aspirin, anti-inflammatory drugs or oral anticoagulants within 15 days before the surgery, to reduce the risk of excessive bleeding during or after the procedure. • It is recommended to avoid pregnancy within the first year after the procedure to avoid deteriorating the aesthetic result of the operation. The patient should know that it is still often possible to breastfeed after breast reduction, but this is never a guarantee. It is important for to remember these details before scheduling the intervention. What happens during a breast reduction surgery? The procedure is always done under general anesthesia, with the patient in a half-sitting position, and lasts between 1-3 hours, depending on the complexity of the case and the amount of mammary gland tissue to be removed. Fasting is required for at least eight hours before the procedure is scheduled. The patient doesn’t usually require hospitalization for more than a few hours after the general anesthesia has worn off. A suction drainage system is usually set up to reduce the risk of breast hematoma. It is usually kept for 1-2 days depending on whether there are fluids draining or not. Having drain tubes installed does not prevent the patient from returning home. The plastic surgeon who performed the procedure will give you all the instructions on how to look after and care for the surgical wound and the drain tubes. Please remember that the drain tubes will only be removed by the plastic surgeon and not by the patient at home. The dressing placed over the chest during surgery is removed the next day after the intervention. A light dressing will be done, and you will need to wear a special post-op bra or a sports bra to compress and support the breasts. This bra should be worn day and night for about a month to hold the chest. Several follow-up consultations are carried out after the procedure. The first one is after a week from the intervention then after approximately one month, three months, six months and one year from the surgery. Then, every five years after and/or in case of an eventual incident. For the first weeks and months following the intervention, it is normal for the patient to experience bruising and swelling of the breasts. Moreover, it can also happen that the breasts do not look very symmetrical immediately after the procedure and during the first stages of the recovery period. This happens because your breasts heal at different times. The final result of the procedure should only be assessed when the swelling and bruising have subsided completely. This usually takes approximately 3-6 months post-operation. The pain at the level of the chest is moderate after the breast reduction surgery and can be easily controlled with an analgesic treatment. Your plastic surgeon may advise you to perform a reference mammogram a few months after the procedure. The resuming of sports activities can be done gradually and can usually start four weeks after the procedure is performed. The patient can return to work usually within the first or second week after the intervention. Results after the breast reduction procedure The procedure reduces the volume of the breasts, corrects breast ptosis by raising the position of the breasts and corrects any pre-existing asymmetry. The position of the areola and the nipple is re-established by the intervention. After the procedure, the patient will have breasts that are not only smaller and less voluminous but also in a better harmony with the rest of the body. The back, neck and shoulder pain often associated and caused by overly large breasts will be eliminated completely. The patient will have more options when it comes to clothing and lingerie. Probably the most important thing for patients undergoing the breast reduction surgery is that they are able to become more active in terms of performing sports or physical activities that were difficult or uncomfortable before the surgery was done. Like with any other surgical procedures, there are also risks involved with the breast reduction surgery. Some of them can be avoided just by choosing a board-certified and experienced plastic surgeon and following his recommendations while the others cannot be completely eliminated. An example of a risk that we can’t get rid of is the scarring after the breast reduction surgery. Scarring after breast reduction surgery There are still some patients who believe that the scars after the breast reduction surgery will disappear in time. It is important to understand and accept the fact that scarring is not only unavoidable after any surgical intervention, but it is also permanent. So if your plastic surgeon promises you that your scars will vanish into thin air sometime after the breast reduction surgery, don’t take his word for it and seek for a second opinion. It is only natural for patients looking for help from plastic surgery to be concerned about the appearance of the scars after the intervention is performed. Many of them undergo the breast reduction surgery for functional purposes; however, being left with a large scar is like a permanent reminder that your breasts were not always this proportionate to the rest of your body. So keep in mind that each time we have a surgical incision, there will be a scar left behind that will be permanent. The appearance of the scars changes in time as the cicatrization process can take up to one year and even more. After this time, the scars left by your breast reduction surgery should look like fine, white lines that are barely visible in the natural folds of the skin. The amount and length of the scars on the breasts vary according to the complexity of each case and the quantity of tissue to be removed. The patient can be left with up to three scars. • A circular scar that goes around the areola’s edges • A vertical scar going from the lower pole of the areola towards the inframammary fold • A horizontal scar positioned in the inframammary fold (inverted T scar). This horizontal scar can often be reduced or even avoided if the breast morphology and elasticity of the patient’s skin allow it. After the breast reduction, scars will appear red and very visible in the first few months. Over the course of the following months, they will flatten until whitening completely, as we have mentioned before. The final appearance of the scars will be evident after a year. To get nice scars after the breast reduction surgery, the plastic surgeon will advise you to avoid sun exposure on the surgical wounds for at least six months to a year after the procedure was performed. Discoloration of the scars can be avoided in this way too. Conclusion The breast reduction procedure involves removing the excess skin and the excess mammary gland from the breasts. It is considered a painless procedure. In some cases, the edema of the mammary gland can reproduce the pain that some women feel after performing intense physical exercises at the gym. An appropriate analgesic treatment will be prescribed by your surgeon or by the anesthesiologist. The scars of a breast reduction surgery vary from one patient to another. Ideally, the scar will look like a thin and white line that is very discreet and hidden in the natural folds of the skin if possible. In all cases, the scars are placed so that they cannot be seen when the patient wears a bra or a swimsuit. Patients who wish to undergo the breast reduction surgery should consider that the healing depends on the quality of the suture performed by the cosmetic surgeon but also on the cicatrization process that is specific to each patient and therefore unpredictable.