Prepare for Your Plastic Surgery Procedure

The day for your surgery has arrived. As exciting as this day is, however, you may find yourself experiencing some anxiety about your procedure. This is normal. Although the thought of undergoing surgery is never without some degree of trepidation, sometimes it helps if you know exactly what the procedure entails beforehand. That way, you can mentally rehearse your surgery day and run through the steps in your head until you feel as prepared emotionally for your surgery as you do physically. Let’s take some time to discuss what happens on the day of your surgery.

Arriving at the Surgical Center
Your surgery will take place either at a hospital or at a surgical center. Some patients prefer a surgical center to a hospital because of the privacy, intimacy and comfort this setting can offer due to its small size. Regardless of your location, upon your arrival the day of your procedure, the medical staff will greet you and lead you into a patient room, where you will change into a hospital gown. You may be asked to undergo a urine pregnancy test to ensure that you have not become pregnant since the last time you were tested.

An intervenous (IV) line will be inserted into a vein in your arm or perhaps in the top of your hand. You will feel the prick of the needle. This IV line will be used to deliver anesthesia and all other medications needed during your surgery.

How Long Wi l l You Be at the Surgery Center?
You can expect to spend the better part of the day here. On average, your procedure will take approximately ninety minutes to three hours. The more breast tissue and fat you are having removed, the longer your surgery will take. Once your surgery is completed, you’ll be in a recovery room until you are awake and alert. If your surgery is to be an out-patient procedure, the medical staff will want to make sure you’re your vital signs are stable and that you are ready to be taken home.

Meeting Your Medical Team
Your surgeon will not work alone. A team, consisting of several healthcare professionals, will be involved in your surgery. This team will likely include an anesthesiologist, your plastic surgeon, a physician technician, and two or three nurses. Just prior to your operation, you will meet with your anesthesiologist who will outline the details of the anesthesia process and answer any questions you may have about it.

You’ll also meet with your plastic surgeon, who will use a marking pen, much like a felt-tip pen, to draw lines on your body, showing where incisions will be made. The surgeon will make these marks while you are standing to make sure that both breasts will be symmetrical.

Once you’ve been wheeled into the operating room, you will be transferred to a narrow surgical table. You will be secured with straps that resemble seatbelts.

Compression Stockings
Just before you receive anesthesia, the medical team will put special compression stockings around your legs to improve circulation to your lower extremities while you’re under anesthesia. These devises, technically known as intermittent sequential compression devices (SCDs), inflate and tighten much like a blood pressure cuff and are intended to prevent the formation of blood clots in the legs. Known as deep vein thrombosis, or DVT, such clots can travel to the heart or lungs and be fatal.

Receiving Anesthesia
Just prior to the surgery beginning, the anesthesiologist will administer general anesthesia through your IV. Within a minute or two, you will gently drift off to sleep. You will not feel any pain at this point. The anesthesiologist will monitor you throughout the procedure.

Monitoring Devices
A nurse will wrap a blood pressure cuff around your arm to monitor your blood pressure throughout the surgery. The nurse will also attach electrodes on your heart to ensure that your heartbeat remains regular throughout your procedure. A pulse oximeter, a device typically clipped onto the forefinger, is an external probe that uses light bounced off the blood vessels under the probe to determine level of “blood gases,” or oxygenation of the hemoglobin in the blood cells.

Breathing Tube Insertion
Once you are asleep, your medical team will insert a breathing tube down your throat. The breathing tube is used to open and protect your airway and is connected to a breathing machine that will breathe for you while you’re under anesthesia. You may notice that your throat feels a little sore after surgery from the breathing tube.

Breast Reduction Surgery
As part of the preparation for surgery, nurses will brush an antiseptic solution across your chest. This process will sterilize the skin’s surface. The medical team will drape your body with cloth, leaving your breasts exposed. You’ll be covered with a warm heating blanket since operating rooms generally are kept quite chilly. Operating suites are kept rather cool because surgeons must perform procedures in “unbreathable” surgery gowns under very bright, powerful, hot lights. Also, cooler temperatures do not promote the growth of bacteria as well as warm environments.

Incision Technqiues
Plastic surgeons have employed a variety of techniques to perform breast reduction surgery over the years. Today, in the United States, the most popular breast reduction methods are the anchor technique and the lollipop technique. The type of incision used to perform the breast reduction will depend on the size and the droop of the breasts. In essence, the larger the breast, the larger the incisions will be.

The Anchor Technique
The anchor technique is the older of the two breast reduction techniques. It’s called the anchor technique because the incisions are anchor-shaped. This approach is typically used with women who have larger breasts.

When executing the anchor technique, the surgeon removes excess breast tissue from the inner, upper and outer parts of the breast. Once the breast is shaped, all incisions are closed. The anchor method is considered what’s called an inferior based pedicle technique because the nipple and areola remain attached to an island of breast tissue based inferiorly—on the lower portion of the breast.

The traditional anchor technique leaves horizontal scars, which run from under the breasts to the center of the chest; this scar may be from ten to twelve inches long. However, some surgeons use a newer variation on this technique, which leaves a horizontal scar that is only one to five inches long. This scar, which is under the breast, is hidden in the inframammary fold.

For your surgery to be considered a true breast reduction (for insurance purposes), you’ll need to have at least 500 grams, close to one pound, of breast tissue and fat removed. Breast reduction surgery may or may not include the use of liposuction to remove fat deposits in the breasts.

The anchor technique is not recommended if you are a woman of color prone to developing keloids because the scarring is even more visible on darker shades of skin than it is on lighter skin.

The Lollipop Technique
This lollipop technique, also referred to as a vertical technique, received its name because the incision pattern resembles the shape of a lollipop. This approach is used for a woman who has smaller breasts. It leaves fewer scars than the anchor technique.

With this technique, the excess breast tissue is removed from the upper, outer and lower parts of the breast. Usually, the lollipop technique includes a very small horizontal incision in the crease at the bottom of the breasts, but sometimes, no horizontal incision is made. This smaller incision minimizes horizontal scarring. The lollipop technique is considered a superior based or supero-medial based pedicle technique because the areola and nipple remain attached to an island of breast based superiorly, on the upper portion of the breast.

Making Breasts Symmetrical

Your surgeon will complete most of the procedure on one breast and then repeat the same process on the other breast. He or she will not fully suture (stitch) your breasts at this time, however. Instead, he or she will tack together each breast at the corners. Although you will be lying flat for most of your procedure, at this point the surgeon will tilt you up to a sitting up position to ensure that your breasts look symmetrical when you are vertical, as well as horizontal.

Because many women have one breast that is larger than the other naturally, symmetry may not have been achieved at this point. If any asymmetry is detected, your surgeon will make the necessary adjustments to make sure both breasts match as closely as possible until the proper balance is found.

Inserting Drainage Tubes
Once your breasts are balanced, your surgeon will finalize the procedure by inserting drainage tubes. These drains are intended to prevent hematomas, the pooling of blood, and seromas, the pooling of serous fluid or serum, after surgery. Serum, a clear fluid, is part of the blood.

Why is there a risk of fluids pooling? Any time the surgeon needs to move or pull the skin, it requires first separating the skin from the underlying tissue structures. This process is called undermining. Before the incision heals and the skin “re-adheres” to the underlying structures, a space is created. The body’s fluids, mostly residual blood and serous fluid seeps into this space. This fluid may not dissipate and may become infected. So, the drains must be left in place until no fluid is collecting under the skin.

The drain tubes themselves are small, rubber tubes about three millimeters in diameter—thinner than a pencil. Rubber “bulbs” attached to the ends of the drainage tubes act as suction devices and will gather excess blood and fluid.

Some surgeons insert these tubes into separate, tiny incisions. Other surgeons may secure the tube at the end of an incision. Your surgeon may secure the tubes with a suture or with steri-strips, commonly called “butterfly stitches.” Steri-strips are pieces of surgical tape designed to hold together and protect incisions. Many patients prefer steri-strips because movement may cause the sutures to pull, creating discomfort. And, sutures need to be removed in the doctor’s office usually with slight discomfort. Steri-strips, on the other hand are removed without any discomfort. After drainage tubes are inserted, your surgeon will suture your breasts together using internal sutures and steri-strips externally. Note, some surgeons still use external sutures that need to be removed in the office.

The length of time you will need the drains depends on the quality and quantity of blood or fluid that drains from the incision site. You may need the drains for as little as 2 to 3 days or as long as 2 weeks. You will be responsible for monitoring the amount of fluid your drains capture and emptying them several times a day when they become full.

After Your Procedure
You will awaken immediately after your procedure is performed but will still be a little drowsy when you are transported to the recovery area. You’ll be wearing a support garment designed to restrict your breasts’ movement until they have begun to recover from your surgery. This garment is a lycra/cotton bra that comfortably supports the breasts. Most likely, your surgeon will request that you stay at the hospital or surgical center for at least a couple of hours post surgery for observation and for your anesthesia to wear off. Remember, you will not be capable of driving a car immediately after surgery and will need to have made arrangements for someone you trust to drive you home and care for you for a couple of days.

Side Effects of Breast Surgery
All surgical procedures carry temporary side effects. These are normal and to be expected. Common side effects include:

• Soreness and discomfort, particularly at and near the incision sites. • Numbness. Some nerves will be affected during surgery. This may cause temporary numbness; it usually disappears within four months. • Bruising, which is very common when your skin is being stretched and pulled. Much of the bruising will fade during the first two weeks. • Swelling, particularly around the incision sites. Swelling will diminish significantly during the first few weeks but can take months to fully resolve.

• Scarring, which is unavoidable. Initially scars will turn brighter red and purple before fading. It will take a full year for scars to fade and blend with your natural skin color. They may continue to fade thereafter, but they will never disappear completely.

• Low mood. You may find feel somewhat depressed the first week after surgery. This may be caused by a number of factors. There is usually an emotional “let down” after the surgery is finally over. Also, anesthesia may be a factor in your feeling down. At the same time, the fact that you are restricted from moving around vigorously is another factor. This type of temporary post-operative depression is quite normal.

Risks and Possible Complications of Breast Surgery
It is important to balance your enthusiasm for the new shape you soon will have with the recognition that every surgical procedure involves some serious issues to consider prior to the operation. Part of your surgeon’s job is to inform you of these factors while you’re deciding whether or not breast surgery is right for you. The chance of breast surgery complications is unlikely, but still, it’s always good to be an informed consumer.

Allergic Reaction or Infection
There’s a slim chance you’ll experience an adverse reaction to anesthesia during surgery or acquire some sort of infection afterward. The American Society of Plastic Surgeons (ASPS) reports that an estimated 1 to 2 percent of breast reduction patients develop some sort of infection after surgery.

Delayed Healing
The ASPS reports that up to 21 percent of all breast reduction patients experience some form of delayed healing, ranging in severity from minor wound separation to actual skin loss. Usually, this condition is treatable. Patients most at risk for delayed healing include smokers, diabetics, obese people and the elderly. The size of the scar can influence delayed healing. There is a decreased incidence of delayed healing in patients whose breast reduction surgery involved techniques which use shorter incisions.

Loss of Nipple Sensation
It’s possible that you could encounter a loss of circulation if a large amount of tissue and fat is removed, although it is unlikely. Some amount of nipple loss from this condition occurs in approximately 4 percent of breast reduction patients, according to the ASPS. Another risk relates to a lessening of nipple sensation. It’s good to know, however, that if you do experience a decrease in nipple sensation, it usually returns fully within a year after surgery. There is, however, a slight possibility that you could be one of an estimated 13 percent (ASPS) of women who undergo breast surgery and report a permanent increase or decrease in nipple sensation. Pigment changes in the breast area have also been reported.

Breast Asymmetry & Shape Complications
Nearly all breast reduction patients experience some sort of discrepancy in size and shape of their breasts after surgery. Remember, though, that this is usually subtle and not much different than the slight irregularities that exist in most women naturally. Because breasts are “living canvases,” plastic surgeons cannot guarantee that your final results will be perfectly symmetrical. Only about 5 percent of breast reduction patients experience asymmetry or shape irregularities significant enough to undergo an additional corrective surgery, according to the ASPS.

Fat Necrosis
Rarely, during the first few days after surgery, some of the fatty breast tissue dies because it receives insufficient blood flow. This can occur anywhere inside the breast, and once this tissue dies, it hardens, like scar tissue. You can feel it when you touch your breast. The ASPS estimates that 2 percent of breast reduction patients experience this complication. This condition likely dissipate over the next few months as the tissues naturally soften. Breast massage may speed the process along. If the hardened tissue does not resolve, your surgeon may remove it with a minor surgical procedure.

Hemotoma and Seroma
A hematoma is the pooling of blood under the skin’s surface. A seroma is a related complication. It is caused by excessive serum under the skin; serum is the clear fluid portion of blood. The pooling of blood or fluid can put pressure on the inside of the skin and interfere with circulation, causing the skin to deteriorate. These conditions are more common when extremely large breasts are reduced, but are rare and would almost never go unnoticed. If a small hematoma or seroma does develop, it may need to be drained. If so, you would need to return to the operating room where your surgeon would open a few of the sutures and allow the accumulated blood or fluid to be drained out. In more extreme cases, skin is repaired with reconstructive surgery. The drainage tubes used in breast reduction surgery greatly diminish the risk of developing these conditions. According to the ASPS, hematomas occur in approximately 4 percent of breast reduction patients, and seromas develop in around 1 to 2 percent. Most of the time, these conditions begin to surface within the 48 hours after surgery.

Hardening of Tissue
It’s also possible that you may experience a temporary hardening of the tissue around and underneath the nipple, but this condition should correct itself with massages and natural softening of the scars. Breast tenderness during the first six months after surgery also is common.

Scarring
A reality of breast surgery is scarring. But, thanks to modern techniques, it’s been minimized quite a bit in recent years. Most scars become unnoticeable in time, but some people may have a tendency to develop thick or hypertrophic scars or even keloids. People prone to keloids (fleshy tumors—large masses of scars) may want to avoid any kind of surgery altogether. The ASPS reports that 2-10% of breast reduction patients suffer from “abnormally heavy scars.”

Healing after Surgery
The final result of your breast surgery won’t be visible for several months. So, don’t judge the success of your surgery on how your breasts look in the days immediately following your procedure. You will have bruising and swelling. The bruises will be red or purple initially, and will turn green and yellow as you heal. Initially, your breasts may have a “boxy” appearance or they may appear somewhat cone-shaped. You may even see some rippling along the incisions, but these side effects will dissipate over a period of months. Your breasts will take on a more shapely appearance as they heal.

How quickly does the healing process occur? This will vary with each individual; however, there are three stages of healing. The first stage is known as the inflammatory phase, which usually lasts three to seven days. During this time, the incision site is swollen, may feel warm to the touch, and is quite red; this color will last for several weeks.

The second phase of healing, known as the metabolic phase, lasts for several weeks. During this time, the body is building new tissues to strengthen the incision site. During this phase, the body’s healing mechanisms often produce scars that are somewhat thick; however, these scars will diminish later, during the third stage of healing, known as the remodeling phase. This is the time during which the body will “remodel” the scar. The collagen that has developed becomes stronger and tissues become more elastic. The incision site becomes smaller and flatter. The color of the scar begins to fade and the scar becomes less thick.

It may take as long one to two years before an incision is totally healed. Such things as smoking and vitamin deficiencies can impair healing.

A Word about Breastfeeding
You may be wondering if breastfeeding is a possibility after breast surgery. A lot of confusion seems to surround this topic. Breastfeeding should still be a likely possibility for you. There is a good chance, however, that you may produce less breast milk than you did prior to your surgery. You may need to supplement your breast milk with formula. Talk to your surgeon more about the specifics.

Table of Contents
Previous: Chapter 4. Preparing for Breast Reduction Surgery
Next: Chapter 6. Breastlifts