My Doctor Online The Permanente Medical Group

How It Is Performed

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We perform breast reduction surgery while you are under general anesthesia. You will be asleep throughout the entire surgery. The techniques for this surgery vary, but all include an incision and scar around the areola.

One of the most common procedures involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breasts. We remove glandular tissue, fat, and skin and move the nipple and areola into their new position. Then the skin from both sides of the breast is brought down and around the areola, creating the new shape of the breast. In most cases, the nipples remain attached to their blood vessels and nerves. However, if your breast is very large or pendulous, the nipples and areolas may have to be completely removed and grafted to a higher position. Grafting always results in the loss of sensation in the nipple and areola area.

There are several other techniques for this surgery. A circular pattern around the areola or a keyhole pattern around the areola and vertically down to the breast crease are some variations. Liposuction is sometimes used along with one of these techniques to remove excess fat. We will work with you to determine the best approach, taking into consideration your health, breast composition, amount of reduction desired, and personal preferences.

Complications

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Breast reduction is not a simple operation, but it is normally safe. As with any surgery, there is the possibility of complications. You can reduce your risk of developing complications by closely following our advice both before and after surgery.

Poor wound healing is the most common complication of breast reduction surgery. It may result in the following:

• Small sores around the nipple.
• Wide or raised scars.
• Permanent loss of feeling in your nipples or breast.
• Rarely, the nipple and areola may lose their blood supply, causing the tissue to die.
  

Some bleeding is normal. Your body can absorb a small amount of blood, and we often use drains to manage the bleeding. In rare instances, you may experience swollen, painful breasts. This is an emergency, and you need to be seen and evaluated by us.

Fat necrosis is the death of fatty breast tissue. This tissue loss can result in significant loss of volume in the breast and asymmetry of size, shape and appearance. It is more common in individuals who are overweight, smoke, or have medical problems.

Keloids are large thick, sometimes painful, scars.

Infection is very rare and is usually associated with wound-healing problems.

Recovery

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After your surgery, you will need to limit some of your activities. Following these limits decreases your risk of developing complications, such as poor wound healing and excessive bleeding. These activity limitations include:

• Do not reach above your shoulders, twist, or lift more than 5 pounds for 3 weeks.
• No heavy activity or exercise for 3 weeks. Any activity that makes your face flush or makes you sweat can cause swelling.
• No soaking your incisions (bathing or hot tubs) until your Steri-Strips and sutures have been removed and all scabs are healed.
• After 3 weeks, you may resume normal activities.
• Do not wear underwire bras for 4 to 6 weeks after surgery.

Scar care

Scar development is a process that lasts up to a year or more after surgery. Scarring can be significant, but with a little care, the appearance of the scars can improve. It is also common to have areas of numbness in your breasts. This may be permanent, but some patients experience improvement with time.

As healing progresses, itching can become significant. Remember, itching equals healing. Sometimes the itching will come from deep inside where no amount of scratching will help, or the nipple can itch a great deal. Be very careful not to damage tender new skin.

Cooling the breasts can soothe them. You can do this with cool air, a cool shower, or ice packs (the blue gel ones are very good because they conform to the breast nicely, are lightweight, and can be reused). When using ice packs, lay a thin towel over the breasts, then the packs, fold the towel over the packs, and gently hug them to your body. Generally, it is a good idea to use the ice packs no more than 15 minutes at a time.

For the first year, avoid sunlight on your scars to keep the areas from developing a darker pigment than your surrounding skin. Use clothing and sunscreen to protect the scars.

Scar tissue does not have the same lubrication glands as regular skin. After 3 weeks post surgery, you can help your scars by keeping them moisturized with lotion or ointment. Massage the length of the scar with a firm circular motion 2 to 3 times a day. This will help organize the scar tissue and help it to be more mobile and soft.

You may notice increased redness in your scars between 3 to 6 months after surgery. This is normal.

If your scars are growing thick or ropelike, are spreading outside their original boundaries, or are itchy, burning, and painful, please call the clinic. If you have a history of keloids or hypertrophic scars, please discuss this with us.

Body image

It may take you a few weeks to become comfortable with your new figure. Your stomach may seem more prominent than before the surgery. It is common to question the decision to have breast surgery and to have temporary regrets in the immediate postoperative period. Usually by 6 to 8 weeks after surgery, most women become comfortable with the new size of their breasts and begin to enjoy the benefits of having smaller breasts.

Before Your Surgery

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Plan to be off work for 2 to 6 weeks, depending on the type of work you do and your recovery. Arrange for childcare, grocery shopping, transportation, and general support during your recovery.

You will need someone to drive you home and stay with you at least for your first night at home.

Purchase a sports bra with the following features:

• Front closure
• Wide side and shoulder straps
• No seams over the front of the breast
• No underwires
• A snug fit to prevent swelling

Medications

Stop all nonsteroidal anti-inflammatory medications (prescription and over-the-counter) 2 weeks before surgery. These include aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), and several arthritis medications. If you are taking a low-dose aspirin, stop it 2 weeks before surgery.

Anxiety as Surgery Approaches

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You may feel anxious around the time of surgery. This is a normal response to any kind of stress. You may experience a range of physical as well as emotional changes, such as feelings of restlessness, agitation, and irritability. You may have emotional outbursts or tearfulness. As your surgery approaches, you may need additional reassurance. It is important for you to be kind and patient with yourself. Being aware and prepared for the possibility of these feelings can lessen any fearfulness that may arise.

The Night Before and Morning of Surgery

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• Do not eat or drink anything after midnight the night before surgery.
• You will be advised if you should take any regular prescription medications with just a sip of water.
• You will probably want to take a shower and shampoo your hair at this time, since you will be unable to shower for up to a week after surgery.
• Do not put any products on your skin such as lotions or perfumes.
• Please allow adequate time to get to the medical center and find the surgery admitting unit so that you arrive on time for your procedure. Bring your Kaiser member card and only enough money for your copayment. Please leave all valuables (money, jewelry, etc.) at home.
• Wear comfortable clothing with an open-down-the-front shirt. You will change into a hospital gown after you arrive in the surgery area.
• You will need a bra for after surgery. It should be soft and comfortable with no underwire. We suggest either a sports bra or a surgical bra.

After Your Surgery

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It is important for you to get up, move around the house, and take some deep breaths 4 to 6 times a day. Plan to sleep on your back with your head elevated, if possible. Some people experience a slight sore throat or mild cough for 2 to 3 days after surgery. This is a side effect of anesthesia and should resolve in 48 to 72 hours.

Pain management

You will be the most uncomfortable the first night and day after surgery. Your pain will stabilize over the next 24 to 48 hours and then decrease each day. You may be able to discontinue prescription pain relievers by the end of the first week. Some people take only a few doses and then use Tylenol. It is important to listen to your body and take medication as you need it. You will heal faster if you are not tense and tired from pain. Pain is also your body's way of asking you to slow down. Plan to rest during the first week after surgery.

We will prescribe a stronger pain reliever for use after surgery. It is usually a combination of acetaminophen (Tylenol) and a narcotic. We recommend that you:

• Take the pills with food in your stomach to avoid nausea.
• Double your fiber and fluid intake while taking these pills, since constipation is a side effect. A stool softener may be helpful for some patients.
• Progress to regular strength acetaminophen as your pain subsides.
• Take nonsteroidal pain relievers, such as ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn), 5 to 7 days after surgery, but not before your drains are removed.

Narcotics will interact with alcohol, so do not drink at the same time you are taking the medication. The medication will also make you drowsy, so do not drive while you are taking it. After the first few days, if you have stopped taking pain medication, you may drink.

Drains

Drains are used in 80 to 90 percent of our surgeries to prevent postoperative swelling and fluid buildup. You will be instructed in drain care before leaving the hospital.

• Wash your hands before and after handling the drains.
• Please check them periodically when you are awake.
• You will need to empty them when they are a third to one-half full.
• It is important not to get the drains wet because of the risk of infection.
• The initial drainage will be bloody, changing to clear red then to clear yellow over the next 3 to 5 days.
• If you observe blood clots in the tube, you can clear the tube by applying pressure and milking the tube toward the bulb. Be careful not to put tension on the tube where it enters the wound.
• Record the amount of drainage and empty the bulb into the toilet. The bulb will need to be squeezed when sealed in order to create suction. 

Keeping your upper body quiet in the first few days after surgery will reduce your drainage.

Wound care

You will not need to change a clean dry dressing for the first 2 to 3 days after surgery. If you have drains, your first dressing change will take place in our clinic. If you do not have drains, we may direct you to remove your dressings at home after surgery.

• Remove the outside adhesive and gauze padding. It is normal to have some dark brown drainage on the gauze.
• You may have paper tapes (Steri-Strips) directly on the suture line and a scab along the Steri-Strip. You will have some bruising as well.
• If you do have Steri-Strips, do not remove them.
• You may shower after the original dressings and drains have been removed. Lather up with a mild soap on your chest above the incisions and Steri-Strips. Allow the suds to wash over the breasts (do not scrub the area; be gentle with yourself), rinse, and pat dry. Place gauze padding or rectangles of clean, soft cotton material (such as old tee shirts) over each breast and hold in place with a front-closing sports bra.

We will give any other wound care instructions to you at the time of your surgery.

Complications

Please call or come into the clinic or to the Emergency Department when the clinic is closed as soon as possible if you have:

• Increasing swelling, redness, or pain in the breasts
• Pus draining from the breasts
• Excessive bleeding after surgery (i.e., extreme pain and swelling associated with bandages becoming soaked with blood)
• Shortness of breath
• Fever greater than 100°F (Fahrenheit) orally

Your Care with Me

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Your personal physician will request a plastic surgery consultation for you for breast reduction surgery. You can be scheduled for an initial consultation with us if you meet the criteria necessary for a medically indicated breast reduction surgery.

Your first meeting with us is usually a 30- to 45-minute consultation. I will address your questions and concerns, review your reasons for considering breast reduction, and assist you with making the best decision for you.

I will take measurements and perform a physical exam. We will discuss the procedure and risks involved. I will make recommendations to help you reach your goal.

You may be asked to complete a medical history questionnaire, which will include your:

• Medical history
• List of medications you are currently taking
• Any allergies
• History of prior surgeries and illnesses

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line, 1-866-454-8855. You will be connected with a nurse who can give you immediate advice. The telephone staff can send me a message or book an appointment with me or one of my colleagues, or your personal physician, if I am not available.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 

• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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