Breast reduction

While many women wish to increase the volume of their breasts, others may suffer from overly large breasts. This breast hypertrophy can have both genetic causes (breast hypertrophy sometimes visible as early as adolescence) and acquired causes such as weight gain or various hormonal surges such as pregnancy or breastfeeding, or on the contrary, during the menopause.

Breast hypertrophy or overly large breasts can have multiple consequences on the body, which may justify breast reduction surgery:

• aesthetic repercussions, as overly large breasts can upset the balance and lightness of the figure and bust.
• psychological repercussions, with discomfort when undressing, in private or social life, or when dressing.
• medical repercussions, as overly large breasts alter the center of gravity, and encourage spinal pain in the neck, back and shoulders.

In some cases, these medical causes may justify partial reimbursement of breast reduction surgery by the health insurance scheme. After a clinical and aesthetic examination, Dr Christelle Santini will be able to tell you whether or not your surgery is eligible for reimbursement. To be eligible for reimbursement by the French health insurance system, excess breast tissue removed must weigh at least 300 g per breast. As Dr Christelle Santini's practice is not covered by a convention, you should expect to pay a higher fee.

Two surgical consultations are recommended before any cosmetic or plastic surgery procedure. Dr. Christelle Santini performs a clinical examination, to suggest the best surgical response for your morphology.

Pre-operative mammography and ultrasound are systematically performed prior to breast plastic surgery.

An anesthesia consultation is mandatory prior to breast reduction surgery. You must bring the results of the blood test prescribed during the consultation.

Medical photographs are always taken prior to surgery to facilitate the surgical procedure and postoperative follow-up.

A non-wired medical support bra, made of elastic fabric and opening from the front, is prescribed for the post-operative period and must be worn for 6 weeks, day and night.

Dr. Christelle Santini also always gives you the most important medical instructions, including :

• Smoking cessation 1 month before surgery.
• Stop taking aspirin, anti-inflammatory drugs or oral anticoagulants for 15 days prior to surgery.
• Oral contraception stopped 1 month before.

Reduction mammoplasty, whether unilateral or bilateral, always takes place under general anaesthetic, and lasts between 1.5 and 3 hours. The patient is admitted to hospital the day before or the morning of the operation, and returns home the day after the reduction mammoplasty.

You must fast on the morning of the operation from midnight the night before (no drinking, eating or smoking) and wear a medical bra on the day of the breast reduction procedure.

Dr Christelle Santini chooses the approach according to the patient's morphology and expectations, within the limits of technical possibilities. She will also determine the type of scar to be produced during the operation, with three possibilities:

• A circular mammoplasty scar around the areola, constant ;
• A vertical breast surgery scar located between the lower pole of the areola and the submammary fold is common;
• A horizontal scar in the submammary fold (sea anchor scar). This horizontal incision is not made if breast morphology and skin elasticity allow. The length of the scar depends on breast morphology: the more voluminous the breast and the wider its base, the longer the scar. The scar will also be longer if there is a lot of fat in the axillary extension.

In cases where scars are a source of discomfort, Dr Santini offers UrgoTouch laser sessions to significantly reduce their appearance.

In the second stage, Dr Christelle Santini removes the excess breast volume, with two main requirements:

• ensure perfect hemostasis to minimize postoperative pain and the risk of hematoma;
• achieve sufficient glandular resection to ensure a natural, harmonious and symmetrical result, with a well-positioned nipple.

The excess skin is then resected, as in the case of breast ptosis.

Finally, the incisions are closed, usually with absorbable thread, and a drain is placed for 24 hours. The drain is used to evacuate any effusion and blood that may stagnate in the surgical site, and helps to limit pain, speed recovery and reduce the risk of complications. It is checked the following day, and removed if production is low.

After the procedure, monitoring takes place first in the recovery room, then in your room. The suction drainage system is usually kept for 1 to 2 days, depending on production. The dressing is redone the day after the operation, and will need to be changed every day for 10 days.

A light dressing will be applied, and you will need to wear the non-wired compression bra prescribed prior to surgery. This bra must be worn day and night for 6 weeks to two months.

Hospitalization lasts between 1 and 2 days maximum. It is recommended that someone accompany you home.
You may shower for the first time the day after the operation, and every day thereafter, as you renew your dressings.
Swelling disappears after 2 to 6 weeks, but the final result in terms of breast volume and shape is not seen for 6 months.

We need to wait at least 12 to 18 months to judge the final appearance of the scars.
Sports activities must be stopped for about 2 months.

Vertical scar-only breastplasties often look very ugly for the first few weeks. This is nothing to worry about, however, as the breast takes on its natural shape in about two months.

Several follow-up consultations are carried out: one within seven days of the operation, then at 6 weeks, 3 months, 6 months and 1 year after the operation to monitor the evolution of the shape and scars.

Breast reduction surgery can lead to a reduction in areola sensitivity, which can be permanent, although this is rare.

It's important to know that any cosmetic surgery procedure can also carry the risk of complications. Don't hesitate to discuss this with Dr. Santini during your consultation: she will be able to explain the benefits and risks associated with this procedure in general, and in your case in particular, depending on your medical history.

Breast monitoring by mammography as part of routine breast cancer screening is little or not affected by breast reduction surgery. However, it is advisable to perform a baseline mammogram a few months after the operation.

However, it is essential to protect breast scars from the sun for 6 to 12 months.

Pregnancy should also be avoided for 1 year after the operation, to avoid damaging the aesthetic result of reduction mammoplasty. Breast-feeding is sometimes possible after the operation, but cannot be guaranteed.

If breast reduction is not covered by social security, you should expect to be off work for around 10 days after the operation, as no sick leave will be prescribed. On the other hand, in the case of significant breast hypertrophy, sick leave and other expenses are covered by the health insurance fund.

• Breast volume reduction and correction of breast ptosis (sagging breasts)
• Procedure covered by social security under certain conditions (removal of 300 g per breast operated on or more)
• High patient satisfaction with aesthetic and functional improvements (back pain)

Breast reduction relieves physical discomforts such as back and shoulder pain, while balancing the figure. Results are visible immediately after the operation, but post-operative swelling gradually diminishes, with final results visible in 6 months.

The results of this procedure are long-lasting, but can be influenced by factors such as weight gain or pregnancy.

What to do before a breast reduction?

• 1 to 2 plastic surgery consultations with a quote and medical photographs.
• A mandatory 15-day cooling-off period, unless covered by social security.
• Consultation with anaesthetist, blood test, mammogram +/- breast ultrasound as appropriate

How is a breast reduction performed?

• Breast reduction under general anaesthetic
• 2 to 2.5 hours for bilateral breast reduction
• Anatomopathological analysis of the removed gland
• Return home the day after breast reduction.
• A medical support bra is fitted at the end of the operation, to be worn for 2 months.

What is the post-operative course of a breast reduction?

• The sutures used are absorbable.
• Follow-up consultation with Dr Santini 7 to 10 days after breast reduction
• No sport for 6 to 8 weeks after breast reduction
• Allow 10 to 15 days of professional downtime
• Final result of breast reduction after 12 months
• Medical follow-up for one to two years after breast reduction