Breast Reduction or Uplift - worries about the op

[Kate]

Hi there - just looking for some advice/reassurance about having a breast reduction. I have been considering a breast uplift for a couple of years now since I lost 3 and a half stone in weight. My breasts were very large when I was overweight - 32H - and are now 32E or F depending on the time of the month. The skin on my breasts was badly stretched by the weight gain and is now very thin with a lot of very thin pale stretch marks - I'm in my mid 40s.

I have seen two surgeons already about having the op but haven't plucked up the courage to do it yet. Both surgeons recommended a slight reduction as well as an uplift to get a better and longer lasting result but having been 'big' all my life I don't really want to go much smaller and wondered if the reduction is absolutely necessary.

I'm also concerned that the reduction is a bigger op than an uplift and will carry more risks.

My biggest fear, apart from the anaesthetic, is the possible loss of sensation in my nipples. I have very sensitive nipples and would be devastated if I lost all sensation. I have heard that loss of nipple sensation is usually down to the skill of the surgeon but I was also told, by one of the surgeons I saw, that it can depend on the nipples and the nerves and isn't something the surgeon can determine before hand.

The other big concern I have is that the surgeon I am considering will not show me any pictures of previous patients. He says the shape of my breasts will be determined by their current shape, tissue and skin. However, I have looked on the internet at before and after pictures and it seems to me that the same surgeons always produce similar shaped breasts whatever the patient. Which seems to contradict what the surgeon has said.

I am really confused about this and would so like to make a final decision and either get the op done or forget about it. I don't think forgetting about it is an option because my breasts are currently destroying my body image confidence, but I'm so worried about choosing the wrong surgeon and not getting the results I want - or even worse losing my nipples and having my love life ruined.

Sorry for the long post - hope you can help.

[Mr James McDiarmid]

Hi Kate,
I can understand that you are in a quandry about whether or not to proceed. The only person who can make the decision to proceed with surgery is you and this decision is mainly influenced by the vibes you got during the consultations you had.

If I were a patient I think a significant part of my decision would be based on the likely result I would be exchanging my current breasts for.
I think you need to see pictures, sure everybody is different, but I think you should be able to see some to get a general idea.

Also it is not unreasonable to ask to speak to a past patient, this may take a little while to organise but is worthwhile from the perspective of increasing your confidence in the decision you are taking or putting you off altogether.

You are right, breast shape is a fairly consistent theme for individual surgeons, certainly in my practice. The same surgeon tends to produce similarly shaped breasts to an extent. However your surgeon is also right - your preexisting breast shape will also have an influence on the final result you obtain.

Finally, IMHO mastopexy is a more technically demanding procedure than breast reduction. Why? Well it is all down to the tension that the tissues are closed under. In mastopexy skin is the only thing that is removed and the same volume of breast tissue is covered with a smaller surface area of skin, hence greater tension of closure. Tension is the biggest cause of nipple circulatory compromise and healing problems in cosmetic breast surgery. During a reduction, not only is the skin surface area reduced but the volume of breast tissue is also reduced thus reducung the tension of closure and reducing the risk of problems.

So... having a slight reduction actually should make the procedure safer.

Nipple sensation is a difficult question. Every technique risks some sensory change. Your surgeon has to warn you of this - if you are lucky you may retain some sensation but you shouldn't bank on it.

I hope this helps.

Most importantly I think if you remain unsure you should not undertake this surgery.

[Kate]

Thanks for your helpful reply. As I haven't felt 100% confident about either of the surgeons I have seen, despite one of them being very experienced/qualified etc, I think I may try somebody else - third time lucky!

I really do want this operation as my breasts are making me so miserable. If I'm honest, they are already affecting my physical relationship with my husband as well as other areas of my life. I had to have some investigations at the breast clinic because of a lump (which fortunately was a cyst) but, unbelievably, the thing I was most worried about, both before and during the ordeal, was that I would have to take my bra off in front of other people. I don't even like my husband to see them!

From my previous research, I had understood that permanently losing all nipple sensation was rare and that, although changes in sensation were common, most women retained some feeling - is this not the case?

[Mr James McDiarmid]

Hi Kate,
The degree of sensory change is very much influenced by the technique used to do the surgery. Although many of us as plastic surgeons are very positive about the benefits that surgery can bring we are legally bound to soberly advise patients about risks and potential complications.
I know patients who have had almost no sensory loss and I also know patients with complete sensory loss. To confuse things further - some patients start off with little sensation in the nipple. Very rarely I have known patients have discomfort after surgery rather than numbness.

I would advise you to assume that you will have significant sensory change and then if you retain most of the sensation it is an added bonus.

I think you should go for a third consultation. My advice would be to choose a surgeon you like and feel you can trust.

[Kate]

Thank you, I will definitely go for a third consultation.

I'm wondering if, as you say, "The degree of sensory change is very much influenced by the technique used to do the surgery", what is the best technique to minimise loss of sensation and how do I find a surgeon who uses this technique?

I feel like this whole thing is a bit of minefield. There are so many surgeons out there and, as I'm learning, there are apparently a number of techniques too. Obviously I want to minimise the risks as much as possible.

I have had somebody tell me they know of a surgeon in Prague who in 28yrs of operating has never lost nipple sensation in any of his thousands of patients. Is this surgeon doing something special or is somebody just spinning me a line?

Sorry for all the questions but this is so important to me and I want to make sure I find the best surgeon and make the right decision for me. I'm based in the North West if you're able to recommend anybody around here? Thanks again.

[Mr James McDiarmid]

I'm wondering if, as you say, "The degree of sensory change is very much influenced by the technique used to do the surgery", what is the best technique to minimise loss of sensation and how do I find a surgeon who uses this technique?

In my hands the technique of choice for an individual patient is based on your preoperative status. I use 3 different techniques depending on nipple to IMF distance, degree of fullness of the breast and the patient's preferences.
Quite honestly the technique of choice is best decided on the basis of safety and some methods are advisable in some patients but not others.

I have had somebody tell me they know of a surgeon in Prague who in 28yrs of operating has never lost nipple sensation in any of his thousands of patients. Is this surgeon doing something special or is somebody just spinning me a line?

That wouldn't be Bangaram up to her old tricks again would it?
Sounds completely unrealistic to me - I don't think the trades descriptions act reaches to Prague!

I'm based in the North West if you're able to recommend anybody around here? Thanks again.[/QUOTE]

I would look for a surgeon who is a full member of BAAPS - this is about the best quality control step you can take.

[Kate]

Thanks again. I really appreciate your help. I'm sure I'll get the surgery done at some point soon - just have to find the right surgeon first.

[Mr James McDiarmid]

No problem Kate. Good luck with your treatment.