THE PROCEDURE

I usually have my patients check into the hospital the morning of the surgery, usually between 6:00 and 6:30 a.m., as these surgeries are often scheduled at 8:00 a.m. I meet them in the holding area before the operation and draw some markings on the breasts with a purple surgical marking pen. The markings remain permanent on the body throughout surgery and for a few days postoperatively. Then these markings quickly fade.

Symmetry is a critical aspect of this procedure. Frequently, a patient will exhibit asymmetry between the two sides, with one breast being larger than the other. If the left breast is a bit larger than the right, this is taken into consideration, and the procedure is modified appropriately (see Fig. 13-2). The nipples will be repositioned. (The normal nipple position from the point at the base of the neck is anywhere from nineteen to twenty-three centimeters, depending on the height of the patient.) If breasts are ptotic, or droopy, the nipple has to be repositioned to a higher point. The surgical markings done before the operation are probably the most aesthetically critical part of the entire operation. When the markings are done correctly, the patient will have beautiful results.

Following this, the patient is brought into the operating room, placed on the operating table, and given general anesthesia. During the operation, the patient is positioned symmetrically on the operating room table. I will often have a second plastic surgeon work with me during the operation in order to save time on anesthesia and to allow for improved symmetry between the right and left breasts. We usually operate simultaneously with two teams of nurses assisting us.

Following the breast reduction, the incisions are closed with sutures. I usually use dissolving sutures that are buried underneath the skin and dissolve on their own (a subcuticular closure), although I will occasionally use some sutures that have to be removed in one to two weeks following the procedure. Most patients prefer sutures that dissolve because they leave very few stitch marks.

In addition, I use drains that are removed the following day; however, some plastic surgeons do not use drains. This decision depends on a surgeon’s experience and personal preference.

I also use a breast wrap consisting of gauze wrapping that looks like a mummy wrap around the breast area and is changed daily for about two weeks. Each surgeon has his or her own preferences for postsurgery dressing, some using gauze and some suggesting the use of a bra immediately after surgery. We recommend avoiding an underwire bra, as this can cause unnecessary irritation to the incision line. We also recommend a support bra, with support needed most on the outside of the breast, near the arm, as breast tissue will continue to mold and form for the next four to six months.

The final shape of the breast is not evident for up to six to eight months postoperatively. Following the surgery, the incisions will be red and noticeable for up to one year.