Large, heavy or asymmetric breasts can restrict everyday life considerably. Common complaints are neck and back pain, an overloaded spine and postural problems. Some breasts are so heavy that the bra straps cut into the shoulders and leave grooves. Exercise becomes difficult, and the inframammary fold is prone to irritation and eczema.
Breast size alone says nothing about the need for treatment. What matters is the proportion to your build and whether physical complaints are present. When size and weight are out of proportion to the body, the medical term is macromastia. Age-related changes, pregnancy or major weight fluctuations additionally reduce firmness.
A breast reduction (mammary reduction) reduces the volume and reshapes the breast. The procedure takes the weight off the shoulders and spine and is one of the more complex operations in plastic surgery.
Consultation with Dr Özdemir
Dr Özdemir assesses what result can be expected given your physical conditions and whether a reduction, a breast lift (mastopexy) or a combination of both suits your findings. If asymmetries are present, he explains how they can be balanced.
He informs you about the surgical procedure, about risks and possible complications as well as about the costs. The practice is a private practice only; there is no health insurance contract.
Which incision techniques are there?
Three incision patterns are available for breast reduction and breast lift, named after the course of their scars. Which one is suitable depends mainly on how much excess skin there is and how far the areola needs to be raised.
The O-technique (circular method) leaves only a scar around the areola and is suitable for minor excess skin. The I-technique (Lejour method) adds a vertical scar. The T-technique (anchor method) additionally uses a scar in the inframammary fold and can accommodate the largest excess of skin.
The T-incision technique and the internal bra
For pronounced findings and larger reductions, Dr Özdemir preferably works with the T-incision technique. It allows two things that scar-sparing methods cannot achieve to the same degree: precise shaping of the breast and the construction of an internal bra.
For smaller reductions and less excess skin, the I- or O-technique is equally an option. Which incision suits your findings follows from the examination and is discussed during the consultation.
What the internal bra is
Part of your own breast tissue is de-epithelialised: the uppermost layer of skin is removed while the tissue underneath is preserved. This tissue is folded over and sutured at the level of the pectoral muscle. The result is a supporting structure made from your own material that holds the breast shape from within.
The benefit only shows over the years: a breast held by skin alone will sink again over time. The internal suspension counteracts this and contributes to long-term stability of the shape.
Pedicle of the nipple
The nipple remains connected to the tissue beneath it; it is not detached and reattached. Dr Özdemir uses a mediocranial pedicle: the tissue stalk that supplies the nipple with blood and carries its nerves runs upwards and inwards. This is the prerequisite for preserving blood supply, sensation and, as far as possible, the ability to breastfeed.
How much tissue is removed
The amount cannot be determined reliably in advance. What matters is the shaping during the operation: the breast is adapted to the body, not to a predetermined number of grams. Removing too much comes at the expense of the shape, removing too little leaves the complaints in place. Dr Özdemir makes this judgement on the operating table.
Course of the operation
The operation is performed under general anaesthesia in a private clinic in Vienna and takes up to four hours, depending on its extent. You then stay in hospital for at least two nights.
At the end of the operation, two drains are placed, one per breast, to drain wound fluid. When they are removed depends on the amount of fluid: for some patients this happens before discharge, others go home with the drains and have them removed in the following days once the volume decreases.
All sutures dissolve by themselves. There is no need for suture removal.
After the breast reduction
For six weeks you wear a compression bra day and night. It supports the new shape while the tissue heals. Afterwards you can switch to a sports bra, as long as it has no underwire.
The follow-up appointments have a fixed schedule:
- two to three days after discharge, if drains are still in place
- after about two weeks, when the Steri-Strips around the areola are removed
- after six weeks
- after three months
- after one year for the final check
Most patients are fit for work after about ten days. Sauna, solarium and sport are paused until the compression phase is over. The final result can be assessed after six to twelve months, once the swelling has fully subsided and the scars have matured.
Scars
The T-incision technique leaves visible scars. This is part of the procedure and is discussed openly during the consultation. At first the scars are reddened and clearly visible; over months they fade and become flatter and lighter. How well they mature also depends on your disposition and on scar care.
Requirements for a good result
- Stopping smoking before and after the operation. Nicotine impairs blood flow and thus wound healing; for this procedure it is the most important risk factor you can influence.
- BMI below 32 as a guide value; one point above or below is acceptable in individual cases.
- Completed family planning. A pregnancy changes the breast again.
- Stable weight: the target weight reached and held for at least six months. Major weight fluctuations later will change the shape again.
Surgery is not performed in the case of blood thinning that cannot be paused, for example after pulmonary embolism, stroke or heart attack, or in the case of pronounced obesity. In these cases the surgical risk outweighs the benefit.
What are the risks of a breast reduction?
The breast reduction is the most extensive of the breast procedures: up to four hours under general anaesthesia, two nights as an inpatient. Dr. Özdemir discusses the risks with you individually beforehand.
Sensation in the nipple and skin. The nipple remains on its pedicle, so that blood supply and nerves are preserved. Even so, sensation is often altered after the operation. It usually returns over months; in part a reduction can remain.
Ability to breastfeed. The pedicle technique is designed precisely to preserve the milk ducts as far as possible. Still, the more tissue that is removed, the less certain breastfeeding becomes. No assurance can be given.
Impaired blood supply to the nipple-areola complex. The larger the reduction, the longer the pedicle and the more sensitive the blood supply. If it remains disturbed, tissue can undergo necrosis. Nicotine is the most important risk factor you can influence here.
Wound healing at the T-junction. Where the vertical suture meets the suture in the inframammary fold, the blood supply is tightest. Minor wound-healing disturbances at this point are the most common complication of this procedure. They usually heal without consequence but need patience and aftercare.
Post-operative bleeding and infection. Post-operative bleeding can make a further operation necessary. To detect post-operative bleeding early, allow rapid intervention and help prevent a seroma, two drains are placed during the operation, one per breast.
Thrombosis and embolism. As with any longer procedure under general anaesthesia. Preventively, blood-thinning injections are given, and getting up early is encouraged.
Fat necrosis and induration. In deeper tissue layers, fatty tissue can undergo necrosis and remain palpable afterwards as an induration.
Asymmetry and revision. How much tissue is removed is decided during the operation, based on the findings. Differences between the two sides can be reduced but not ruled out.
Are there alternatives to a breast reduction?
Doing nothing. If the breast does not bother you and causes no complaints, there is no reason to operate.
Addressing the complaints differently first. For neck and back pain, physiotherapy, targeted muscle building and a well-fitted, supportive bra can ease the complaints. With pronounced macromastia, however, these measures reach their limit — the weight remains.
Weight loss. Part of breast volume is fatty tissue. With significant excess weight, losing weight also changes breast size. This is also the reason why Dr. Özdemir requires a stable weight before the operation.
A lift instead of a reduction. Sometimes it is not the volume that is the problem but the shape. In that case a breast lift is the smaller procedure with the same effect on the silhouette. What suits your case is determined by the examination.
Why there are no before-and-after pictures
You will not find before-and-after photos on this page, and Dr Özdemir does not show any during the consultation either. The reason is simple: every breast is different. Initial findings, tissue quality, skin tension and body build differ so much from patient to patient that another woman's result says nothing about what to expect in your case. Such pictures raise expectations that cannot be transferred to your own body.
What you receive instead: an examination of your findings and an honest assessment of what result is realistic for you, even if that assessment differs from your expectation.
