Dr Nicholas Lotz (FRACS) Specialist Plastic Surgeon
Dr Nicholas Lotz
MBBS BSc(Med) FRACS
Specialist Plastic Surgeon
Main Rooms
Level 1 357 Military Rd
MOSMAN, NSW 2088
Appointments & Enquiries
info@drnicholaslotz.com.au
Ph: 1300 304 209
Fax: 02 9904 0166
BREAST SURGERY

Breast Reduction

The following information sheet is intended to assist patients preparing for breast reduction surgery with Dr Nicholas Lotz.

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Overview

Breast Reduction

Excessive size of the breasts can cause many problems including neck ache, back pain, difficult exercising and rashes in the skin creases under the breasts.

Breast reduction surgery to reduce the size of the breasts may help to alleviate some of these problems as well as improving your ability to exercise without discomfort from your breasts.

This is one of the most common procedures performed in our practice, and is associated with one of the highest degrees of patient satisfaction following surgery.

The reduction in size to put your body back into proportion can also enable you to wear clothes that do not need to hide the size of your breasts. As well as reducing your breast size, your breasts will also be lifted so that they sit in a better position relative to your torso.

Timing of Breast Reduction Surgery

Breast reduction surgery can be performed at any time once your breasts have finished developing.

If you are a young patient there is certainly no need to wait until after you have had children as the surgery is performed in a way which aims to preserve your ability to breast feed later. It is important to know however, that some women are unable to breast feed regardless of if they have had surgery or not. Similarly, it is never too late for breast reduction surgery, as with age your body will find supporting the weight of large breasts even more difficult.

Breast Reduction

Before the
surgery

During your initial consultation, Dr Lotz will spend time with you discussing your general health, current problems, and what breast size you would ideally like to be. All patients have slightly different requirements, and will require breast reduction surgery to be tailored to their needs. Dr Lotz will explain in detail what is required in your case, and the relevant risks and expected recovery will be discussed. You will be shown photographs of other patients who have undergone similar surgery, so you have an idea what to expect with respect to results.

You will be sent an information pack further explaining the procedure, along with a detailed, personalised quotation which explains all the relevant costs pertaining to the procedure as well and any heath fund or Medicare rebates applicable.

It is important that you stop any blood thinning medications at least 10 days prior to surgery in order to reduce the risk of bleeding.

You should also cease smoking a month before and a month after your surgery to reduce the risk of skin healing problems.

You will have a second consultation a week or two prior to your surgery to answer any final questions you may have, and photographs will be taken to aid planning your breast reduction surgery.

Breast Reduction

The surgery

Breast reduction surgery is performed under general anaesthetic and takes approximately three hours. Dr Lotz always performs this procedure in an accredited hospital and uses qualified and experienced anaesthetists.

You will usually be in hospital for one night, although some patients prefer to stay for two nights.

Prior to the surgery you will be seen by Dr Lotz to mark the planned incisions on your breasts. Dr Lotz does not use any surgical assistants, so you can rest assured that the entire operation and all of the stitching will be performed solely by him, and there will be no surprise charges from an assistant.

Surgical Procedure

In the surgery the excess breast tissue and loose skin will be removed and the breast will be lifted and reshaped. A drain to remove and fluid that may accumulate is placed into the breast and this is usually removed after one or two days. The final scars will be shaped like a lollipop, with an incision around the areola and straight down to the breast crease. There will usually be a short horizontal scar which sits in the breast crease, although in very large patients this incision may be longer. Waterproof dressings are applied and you are placed into a specially designed bra.

Breast Reduction

After the surgery

Post-operative Recovery and Care

Dr Lotz will see you the morning after the surgery, and the drain may be removed if there is not much fluid coming out. You will be able to shower once the drain is out as the dressings are all waterproof. The surgery is not usually painful but you will be sent home with pain killers to use if needed.

The recovery period is usually about two weeks following breast reduction.

It is important to rest for the first week following the surgery, and it will take up to six weeks until you are back to completely normal activity.

You are able to drive when it is comfortable to do so.

Follow-Up Care

You will be seen a week after surgery to remove the dressings and check all the wounds. Dr Lotz uses all internal, dissolving stitches, so there are usually only about three small stitches to remove from each side. The scars will be covered with surgical tape and you will be able to continue showering normally.

You will be seen again a week or two later to check everything is continuing to heal normally and to answer any questions.

You will continue to wear the surgical bra for two weeks, after which time you can wear any bra that is comfortable.

Additional follow up appointments are usually at 6 weeks and at around 4 months following surgery.

The final result in terms of breast size and shape is usually achieved a few months following surgery. Scars will take about 12 months to achieve their final appearance.

Risks of breast reduction surgery

Fortunately, severe complications from mastopexy are unusual, and most problems do not impact the final long-term result. Dr Lotz will explain the risks in detail during his consultation, which include:

  • Unfavourable scarring
  • Infection
  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Anaesthesia risks (nausea, vomiting, clots in the legs)
  • Bleeding (hematoma)
  • Poor wound healing, including parts of the nipple and areola
  • Breast contour and shape irregularities
  • Skin discoloration, permanent pigmentation changes, swelling and bruising
  • Breast and nipple asymmetry
  • Fluid accumulation which may need to be aspirated
  • Excessive firmness of the breast
  • Potential inability to breastfeed
  • Pain, which may persist
  • Allergies to tape, suture materials.
  • Fatty tissue deep in the skin could die (fat necrosis)
  • Possibility of revision surgery
  • Your ability to breastfeed following reduction mammaplasty may be limited – Dr Lotz will discuss this in detail
  • Significant weight fluctuations, future pregnancy and menopause can affect the breast shape and require further surgery

These risks will all be explained in detail to you during the consultation.

Case Example 1:

20 year old patient with large breasts.
Final result 2 years after breast reduction surgery with removal of 400g from each side.

Case Example 2:

21 year old. 425g R, 470g L reduction. 5 months after surgery.
Before After
Before After

Case Example 3:

37 year old. Breast reduction.
400g removed from right breast and 500g from left breast.

Case Example 4:

19 year old. Reduction with correction of breast asymmetry.
350g removed from right breast, 250g removed from left breast
Before After
Before After

Case Example 5:

48 year old. Marked breast asymmetry.
Shown 5 months after breast reduction surgery.
595g removed from the left breast
1.115kg from the right breast

Case Example 6:

21 year old. Breast reduction
Shown 5 months post op
600grams removed from right breast
650grams removed from left breast.

Case Example 7:

61 year old. 3 months following breast reduction.
385g removed from R side, 210g from L side to correct asymmetry.

Case Example 8:

57 year old before and after breast reduction surgery.
550g removed from each breast.
After images taken 6 months post surgery.

Case Example 9:

This 41 year old lady has undergone a breast reduction and correction of her breast asymmetry. She has previously has a right reduction by another surgeon (note the scars around the nipple) to attempt to correct the size difference. She is shown post operatively following reduction and with much better volume and nipple symmetry.
Breast Reduction Surgery

Frequently Asked Questions

What will the scars look like following a breast reduction??

The extent of scarring after a breast reduction surgery will depend on how large your breasts are and how much tissue needs to be removed.

In cases where not too much breast tissue needs to be removed, and if your skin is good quality, then a shorter scar that runs around the areola and vertically down to the breast crease may be possible (a “lollipop” style scar).

For larger breast reductions where there will be lots of skin to remove an incision that runs horizontally in the fold under the breast will also be needed (leaving an upside-down T-shaped scar).

The type of scar you would most likely to expect following your individual breast reduction surgery will be discussed during your consultation with Dr Lotz.

Can I breast feed after a breast reduction?

The technique I use for breast reduction surgery aims to preserve the ability to breast feed. Studies have shown that 20% of women in the general population are not able to breast feed even without surgery, and some women have a limited ability to breast feed.

Following surgery you should retain whatever breast feeding potential you had, but some studies show that with extensive surgical dissection (ie very large reductions) the amount of milk produced may be less.

When is the right age for breast reduction?

You are never too old for a breast reduction. If you have large, heavy breasts, the ability of your musculoskeletal system to support them will decrease with time, and you can develop worsening pain and posture. A large number of the reductions I perform are in women in the 55-70 year old age group, and most of these women report afterwards that they wish they had had breast reduction surgery earlier.

For young patients, you ideally want to wait until your breast growth is finished so that the surgery does not need to be repeated. Given that breast reduction aims to preserve your ability to breast feed, there is no reason to delay surgery if you are suffering.

Can you have a second breast reduction?

Following a breast reduction your breast size may again increase with weight fluctuation, pregnancy or menopause. It is possible to have a repeat breast reduction if required.

Is breast reduction surgery covered by my health fund?

This depends on your level of insurance. As there is an item number for breast reduction surgery (45523), the hospital and theatre fees are usually covered by your fund, but there may be an excess payment. This will all be outlined in your detailed quotation provided after your consultation.

Do I need a referral for a breast reduction surgery consult?

No you do not need a referral, but it will allow you to claim some of the consult fee back from Medicare. If you decide to go ahead with breast reduction surgery you will need a referral so that some of the surgical procedure will be covered by your fund or Medicare.

How long will I be in hospital?

You will need to spend one night in the hospital following the surgery. This is to monitor you following the surgery, measure how much fluid is coming out the drains, and ensure your pain relief is adequate. Some patients from further away opt to spend 2 nights.

How long will I be off work?

Most patients require 1-2 weeks off work following a breast reduction. This depends upon how much is to be removed, and the nature of your job. You will be back to full activity at about 6 weeks.

What cup size will I be following the surgery?

Your goals for the surgery will be discussed during the consultation. Whilst it is never possible to predict exactly what final cup size your breasts will be, Dr Lotz has years of experience with this surgery and will assist you in deciding how much voloume needs to be removed to meet your expectations.

When will I see the final result?

There is some settling of the breasts following breast reduction surgery, and you will have a good idea of the result after a few weeks. Final results, including fading of the scars, takes about one year.

Considering cosmetic breast surgery?

If you would like further information or if you wish to make an appointment to discuss breast reduction surgery with Dr Nicholas Lotz, please contact our rooms.

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