Türkçe 
Large breasts may be desirable at a younger age, but they are also more exposed to the downward pull of gravity. The effect is accelerated by large weight gains and losses, and by pregnancies. Large breasts out of shape give women a more sturdy, plump and older appearance. Young girls, on the other hand, may feel embarrassed about the large size of their breasts, and try to hide them under wide clothing or through a stooped posture. They avoid sports which in turn may result in weight problems. It may adversely affect their social relationships, in particular with the other sex.
Large breasts cause back and shoulder pain and, over time, may lead to permanent deformation of the spine. The bra straps deform the shoulders. Heat and sweat in the breast crease can cause skin problems.
The goal of a breast reduction is to balance the body-to-breast ratio. Breast reduction surgery comprises three distinctive steps: reduction and shaping, excision of excess skin, re-placement of the nipple-areola complex.
Frequently asked questions about breast reduction:
Who is a good candidate for breast reduction?
Breast reduction is recommendable for all women with (too) large breasts. They include women whose breasts have lost their shape after childbirth or massive weight loss, or women who have gained in weight and breast size after the onset of the menopause.
What is a good age for breast reduction?
As a rule, we wait until breast development has stopped, and therefore only operate on adults. However, in cases of uncontrolled breast growth, so-called virginal hypertrophy, intervention at a young age is advisable. Under normal circumstances, all healthy women can have their breasts reduced.
Does the surgery leave any scars?
After every surgery there are scars. Depending on breast size and the extent of drooping prior to surgery, there will be scars around the areolas, in the breast crease, and vertically between areola and breast crease. The vertical scar is the most obvious; the others are hidden in the skin texture or under the breast. Over time, the scars fade and become even less conspicuous.
Under what circumstances does the scar look like a “reversed T”?
In the classic procedure, an incision is made from the bottom of the areola vertically down to the breast crease, and then inside the crease, following its natural shape. It is still the most widely used method. Because of the size of the incision and its visibility, it is less suitable for young women. The reversed T incision is usually reserved for very large and pendulous breast, when skin elasticity is very low due to massive weight loss, and in case of asymmetries. Most patients are women at an advanced age.
What is vertical mammaplasty?
That is the name for the most modern breast reduction and tightening technique in use today. The incision is made around the areola and vertically to it, causing only a small scar. With this procedure, the breast basis is more easily reduced, and at the same time a very satisfactory breast lift is achieved. The result is aesthetically pleasing and more lasting then with other methods.
What to do and what not to do before treatment?
Three weeks before an invasive / surgical treatment patient must stop smoking and taking aspirin. In the last week, patients must stop taking any anticoagulant (“blood-thinning”) medicine.
The following substances are also prohibited:
- pain killers such as Apranax, Voltaren and Vermidon (alternative brand names are Minoset and Novalgin)
- multivitamin tablets containing ginseng, ginkgo biloba and coenzyme Q,
- green tea, herbal products containing linseed, sour cherry stalks, tomato seeds
- all diet products.
Before breast surgery, a mammogram / ultrasound scan must be taken. It is important for postoperative examinations. A year later, another mammogram / ultrasound scan is taken.
Does the procedure require anaesthesia?
The surgery is performed in a clinic under general anaesthesia.
How long does the operation take?
Surgery takes about 2-3 hours; the larger the breast, the longer it takes.
Is the procedure painful?
Breast reductions count among the least painful plastic surgeries. In the first few days after the operation you may experience some pain, but it is easily controlled with simple pain medication.
What happens after the operation?
After 3 hours, patients can eat and get up. After 6 hours, they can be discharged. A dressing is placed on the incision. After 2 days, patients can take a bath. On the 3rd day, they have to return to the clinic for a check-up; afterwards they can return to their normal life. In the first three week all physical exercises, except walking, must be avoided. During this time, the patient must wear a sports bra at all times. After 3 weeks physical exercises are permitted, except arm and chest movements. After 6 six weeks, you are free to exercise as you please.
In the first 3 weeks, the breasts lie higher than normal and the appearance is unnatural. Also, the vertical scar under the areola looks rippled. After week three, the breasts begin to sink into their final position which they reach after 3 months. Further check-ups follow after 3 weeks, 3 and 6 months and one year after the operation. At that time, a control mammogram / ultrasound scan must be taken as well.
Does breast reduction surgery adversely affect breast-feeding?
Scientific studies have found no difference between comparable groups of women with and without breast reduction. With the exception of women with very large and pendulous breasts, their breast-feeding capability is as good as that of regular-sized women without reduction.
Does breast reduction surgery cause sensation changes?
The feeling in the nipples may be temporarily reduced or they may become over-sensitive. Reduction of very large and pendulous breasts may, in individual cases, result in permanent loss of sensation. Normal sensation usually returns after a few months. Some women have reported increased sensitivity in their nipples.
Is there any connection between breast reduction and breast cancer?
No. Rather the opposite is true because breast mass is reduced. According to studies, cancer risk is reduced in the order of 27-70%. By a rough estimate, the risk is reduced by half. The excised breast tissue is examined for any signs of pathological developments. The results constitute an important data base for future preventive check-ups. Any pathological changes in the breast tissue would be detected at the time of the surgery.
What are the main problems after breast reduction?
The most frequent complaint concerns scars, still too large breast even after surgery, and asymmetries of breasts and nipple-areola complex. All these problems are avoidable if the operation is carried out by an expert surgeon. A specific complication associated with vertical mammaplasty is a slight bulging of the skin at the lower end of the incision. This requires correction which is usually performed 3 months later under local anaesthesia. The wound healing process may take longer than expected; this affects smokers in particular. However, the proverb that “time heals all wounds” applies here as well. Until that time, a dressing must be placed on the wounds. This complication does not affect daily activities.
