BREAST REDUCTION

Breast hypertrophy or having (excessively) large breasts can be a family trait or occur during puberty or as a result of being overweight. It often causes not only personal problems, such as shame or a lack of self-esteem but also functional issues, such as back pain, skin problems underneath the breasts or discomfort while exercising or wearing certain clothes.

Sagging breasts (“ptosis”) are often a result of significant weight loss or having (and breastfeeding) one or more children. If you still want to have children, it is advisable to postpone the surgery on your breasts until after your last (planned) pregnancy.

The procedures to correct the aforementioned problems, i.e. excessively large breasts or sagging of the breasts, are known as breast reduction and breast lifting (or mastopexy), respectively. Both procedures follow roughly the same principle: on the one hand, the shape of the breast is corrected and the nipple placed in a more youthful or higher position and, on the other hand, a certain amount of breast tissue is removed (mostly during breast reduction procedures). Of course, there is no way to do so without cutting into the skin.

There are various ways to perform a breast reduction or lift. Some of these techniques will be more suitable than others, depending on the type of breasts you have.

Tonnard and Verpaele use the technique developed by the Canadian surgeon Elizabeth Hall-Findlay for their breast reduction procedures. To correct sagging breasts (ptosis), they use the technique of the Brazilian plastic surgeon Ruth Graf. In some cases, these techniques are combined with excellent results and minimal side-effects.

When moving the nipple upwards, there will always be a small scar around the areola. In some cases, this procedure is enough to achieve the desired results (figure 1). However, it is usually also necessary to remove a certain amount of skin from the bottom of the breast. This creates a scar that runs from the areola to the underside of the breast (figure 2). Depending on the amount of skin that is removed, there will generally also be a small horizontal scar in the fold beneath the breast (figure 3), which can usually be covered by a bra.

It is up to the plastic surgeon to position the scars in such a way that they are only minimally visible. On top of that, scar tissue tends to become paler over time and assume the same colour as the surrounding skin. That means that any scars will only be visible from up close after some time.

Because the nipple has to be moved, a number of small nerves in the area may be severed. The sensitivity of the nipples may therefore temporarily decrease somewhat after a breast lift or reduction, compared to what it was before. In most cases, the sensitivity of the nipples and areolas is back to normal after four to six months.

This procedure is performed under general anaesthesia and lasts circa 1.5 to 2 hours. The edges of the wounds are covered with a waterproof bandage, so you can take showers in the days immediately after the procedure. You will also receive a sturdy support bra that you will have to wear for four weeks. You can usually go home that same day and we will ask you to return after six days to replace your bandages. A breast reduction or lift is not a painful procedure. The knots tied into the (soluble) stitches are removed in the second week after the procedure.

Check-ups are scheduled for six weeks and six months after the procedure. Final results in terms of the return of sensitivity of the nipples and areolas and the maturing of scar tissue will usually take six to twelve months.