Breast surgery: Options

Overview

Breast surgery is a procedure that alters the appearance or structure of a person’s breasts, and it can be performed for a range of reasons. Some surgeries are cosmetic, aiming to enhance breast size or restore a youthful appearance. Others undergo these procedures for medical reasons, like reducing breast size to alleviate back pain or removing tissue affected by cancer.

Types

There are various types of breast surgeries, performed for either medical or cosmetic reasons.

Breast surgery for cosmetic purposes include:

• Breast reconstruction: Often performed following breast cancer surgery.
• Breast reduction: This is performed to decrease breast size.
• Breast augmentation: Performed to increase breast size.

Breast surgery for medical purposes include:

• Surgery for breast cancer: To eradicate the malignancy, all or a portion of the breast as well as any adjacent lymph nodes may be removed. Common surgery include mastectomy and lumpectomy. 
• Removal of breast lumps that are non-cancerous: Removal of certain non-cancerous breast masses may be necessary.
• Preventive surgery (mastectomy): To prevent breast cancer, breasts are removed. 
• Breast reduction: This is performed to reduce breast size.

Reasons for undergoing the procedure

Breast surgery is done for two main reasons:

• Medical: It may include treating breast cancer, removing non-cancerous lumps, or reducing breast size to alleviate back pain.
• Cosmetic: Surgery can be done to change the size, appearance, or shape of the breasts to meet personal preferences. 

Risks

Potential risk include:

• Anesthesia
• Excessive bleeding
• Infection
• Discomfort, or intense pain
• Modifications to breast or nipple feeling
• Scarring
• Leakage or rupture of the implant
• Requiring corrective surgery

Breast augmentation surgery can complicate the detection of breast cancer, posing a significant health concern. Additionally, breast implants may not be permanent and could require future surgical interventions.

Before the procedure

Consultation to determine candidacy: Assessing suitability for the procedure typically involves a comprehensive consultation. This includes discussing the reasons for surgery, any allergies to medications, past medical treatments, current medications, use of vitamins or supplements, alcohol, tobacco, or drug consumption, family history of breast cancer, existing health conditions, and prior surgeries. 

Eligibility for optional cosmetic breast surgery typically requires being in good physical health, not pregnant or breastfeeding, having fully developed breasts, and making the decision for personal reasons rather than external pressures, which is an important consideration in cosmetic procedures.

Prior surgery, necessary preparations may include:

• Undergoing a blood test
• Taking recommended vitamins
• Avoiding or adjusting intake of certain medications
• Refraining from recreational drug use
• Ceasing smoking and nicotine use

During consultation, it’s also important to inquire about the healthcare provider’s credentials, expected recovery time, potential risks and side effects, likelihood of future surgeries, impact on breastfeeding, long-term appearance of the breasts, and options available if the patient is dissatisfied with the surgical outcome.

Before breast augmentation, reduction, or reconstruction, the healthcare provider will measure the breasts and discuss the desired size with the patient. Photographs will also be taken for before-and-after comparisons.

For breast surgery related to cancer, the provider will assess the size and location of the cancer to determine the appropriate procedure, either a lumpectomy or mastectomy.

During the procedure

Breast surgeries involve several steps tailored to the specific procedure. 

• Breast reduction surgery: During the procedure, one will be under general anesthesia. The healthcare provider makes incisions around the nipple and downward, removes excess skin, tissue, and fat, relocates the nipple, and closes the incisions, possibly with drainage tubes and dressings.
• Breast augmentation surgery: In this procedure, often performed under intravenous sedation or general anesthesia, incisions are made depending on implant type and placement preference (areola, breast fold, or armpit). The implants are inserted either under the muscle or behind breast tissue. The incisions are closed with sutures and adhesive, and results are visible immediately post-surgery.
• Breast reconstruction surgery: This procedure may be an option if there has been trauma to the breasts or nipple, or if a change in appearance is desired. However, this procedure will not restore the ability to breastfeed or recover sensation in the nipple. Reconstruction can be performed using implants or with tissue from other areas of the body, such as part of the abdominal wall.

After the procedure

Healthcare providers will closely monitor the patient’s recovery. Pain medication will be prescribed to alleviate discomfort. Gauze dressings, along with a support bra or elastic bandage, will be provided to reduce swelling and support the healing process of the breasts. Following breast surgery, comprehensive post-operative instructions will be provided, and a follow-up appointment will be arranged. 

Outcome

Recovery time after breast surgery typically ranges from one week to six weeks or more, depending on the specific type of surgery. Soreness can persist for weeks afterward, although it varies case by case. 

Recovery time depends on the type of breast surgery:

• Lumpectomy: One may return to work around two weeks
• Mastectomy: Recovery takes four to six weeks.
• Breast reduction or augmentation: One may return to work/school in about one week

Bruising, numbness, or tingling around the surgical site, upper arm, and armpit is also commonly felt after breast cancer surgery. Scar tissue from breast reduction surgery can sometimes lead to discomfort or pain as well.

Use pain relievers, take warm showers after a week, and perform gentle exercises. Applying vitamin E lotion or pure lanolin to the incisions can aid in reducing scarring.

It is also important to be on lookout for potential complications, such as:

• A fever that reaches 101 degrees Fahrenheit or above
• Swelling in the arm, hand, underarm area, or near the incision site.
• Increased drainage
• Pain that is unresponsive to standard painkillers.
• Damaged sutures
• Coughing or breathlessness
• Digestive issues
• Headaches, blurred vision, or dizziness
• Appetite loss

Regular blood tests, physical exams, and mammograms are essential for ongoing health monitoring. Future surgeries may be required due to cancer recurrence or the need to replace implants.