Breast Hypertrophy

Breast hypertrophy is defined by excessive breast volume, notably relative to the patient's morphology. This excess volume is generally associated with breast sagging (breast ptosis) and sometimes a degree of asymmetry.

Breast hypertrophy almost always has physical and functional repercussions (neck, shoulder and back pain, difficulty practising sports, clothing difficulties). There is also frequently a notable psychological impact. These disorders justify health insurance coverage under certain conditions.

The procedure removes excess breast tissue. A volume in harmony with the patient's silhouette and consistent with her wishes is preserved. This residual breast volume is elevated, concentrated and reshaped.

The skin envelope must then be adapted, which requires removing excess skin to ensure good hold and good contour for the new breasts. The edges of the skin thus cut are sutured: these sutures produce the scars.

Often these scars take the shape of an inverted T with three components: peri-areolar around the areola between the brown and white skin, vertical between the lower pole of the areola and the inframammary fold, horizontal concealed in the inframammary fold.

The length of the horizontal scar is proportional to the extent of hypertrophy and ptosis. Sometimes, particularly when hypertrophy and ptosis are moderate, a so-called "vertical" method can be used, eliminating the transverse scar in the inframammary fold and reducing the scar burden to its peri-areolar and vertical components.

Breast reduction surgery for hypertrophy can be performed from the end of growth and beyond, throughout life.

A subsequent pregnancy is of course possible, as is breastfeeding, but it is advisable to wait at least six months after the procedure.

The risk of breast cancer is not increased by this procedure. It may even be slightly reduced.

A standard preoperative assessment is carried out in accordance with prescriptions.

• The anaesthetist will be seen in consultation no later than 48 hours before the procedure.
• In addition to the usual preoperative examinations, a breast imaging assessment is prescribed (mammography, ultrasound).
• Smoking cessation is strongly recommended, at least one month before and one month after the procedure (smoking can cause delayed healing).
• Discontinuation of oral contraception may be required, particularly in cases of associated risk factors (obesity, poor venous condition, coagulation disorders).
• No medication containing aspirin should be taken in the 10 days prior to the procedure.

Type of anaesthesia: This is a general anaesthesia, during which you sleep completely.

Hospitalisation: A hospital stay of one to three days is usually required.

Each surgeon adopts a technique of their own, which they adapt to each case to achieve the best results. However, common basic principles can be identified:

• The removed tissues are systematically sent to a specialised laboratory for microscopic examination (histological examination).
• At the end of the procedure, a shaping dressing with elastic bandages in the form of a bra is fashioned.
• Depending on the surgeon and the extent of hypertrophy, the procedure may last from two to four hours.

Postoperative recovery is generally only mildly painful, requiring only simple analgesics. Breast swelling (oedema) and ecchymoses (bruising), as well as difficulty raising the arms, are frequently observed.

The first dressing is removed after 48 hours and replaced by a lighter dressing, creating a sort of custom-made elastic bustier.

Discharge takes place one to three days after the procedure, followed by postoperative follow-up visits.

A well-fitting support bra is then placed. Wearing this bra is recommended for approximately one month following the procedure.

Sutures, if not absorbable, are removed between the eighth and twentieth day after the procedure.

A convalescence and work stoppage of 8 to 21 days should be planned.

It is advisable to wait one to two months before resuming sports activity.

It can only be judged from one year after the procedure: the breast then most often has a harmonious, symmetrical or near-symmetrical, natural contour. Beyond the local improvement, this procedure generally has a favourable impact on weight balance, sports practice, clothing possibilities and psychological state.

The goal of this surgery is to bring about an improvement, not to achieve perfection. If your expectations are realistic, the result obtained should give you great satisfaction.

These essentially concern the scars, which are carefully monitored: it is common for them to take on a pink and swollen appearance during the second and third postoperative months; beyond this, they generally fade progressively to become, with time, barely visible. However, they may remain widened, white or conversely brown.

Regarding scars, it should be understood that while they generally fade well over time, they can never completely disappear. In this regard, it should be remembered that while the surgeon performs the sutures, the scar itself is the patient's doing.

Sometimes, breast asymmetry may persist, whether in volume, height, size or orientation of the areolas.

In all cases, a secondary surgical correction can be performed, but it is advisable to wait at least one to two years.

Breast reduction surgery, although performed for partly aesthetic motivations, remains a genuine surgical procedure, which implies the risks associated with any medical act, however minor.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

• Regarding anaesthesia, during the consultation, the anaesthetist will personally inform the patient of the anaesthetic risks. Having recourse to a fully competent Anaesthetist, practising in a truly surgical setting, means that the risks incurred have become statistically very low.

Indeed, techniques, anaesthetic products and monitoring methods have made immense progress over the past thirty years, offering optimal safety, especially when the procedure is performed electively and on a healthy person.

• Regarding the surgical procedure: by choosing a qualified and competent Plastic Surgeon, trained in this type of intervention, you minimise these risks as much as possible, without however eliminating them entirely.

Fortunately, true complications are rare following a breast reduction performed according to standard practice. In practice, the vast majority of procedures proceed without problems and patients are fully satisfied with their results.

Nevertheless, despite their low frequency, you should be informed of possible complications:

• Thromboembolic events (phlebitis, pulmonary embolism), very rare overall after this type of procedure, are among the most feared. Rigorous preventive measures must minimise their incidence.
• Infection requires antibiotic treatment and sometimes surgical drainage.
• A haematoma may require evacuation.
• Delayed healing may sometimes be observed, prolonging postoperative recovery.
• Skin, glandular or areolar necrosis, rarely observed with modern techniques, may cause delayed healing (risk greatly increased by smoking and in cases of gigantomastia or very significant hypertrophy).
• Sensitivity changes, particularly nipple sensitivity, may be observed but normal sensation usually returns within 6 to 18 months.
• Especially, scar evolution may be unfavourable with hypertrophic or even keloid scars, of unpredictable appearance and evolution, which may compromise the aesthetic result and require specific local treatments, often prolonged.

Thus, in the vast majority of cases, this procedure, well planned and correctly performed, produces a highly appreciable result in terms of comfort, even if the inevitable scar burden remains the main drawback.

Overall, risks should not be overestimated, but one should simply be aware that a surgical procedure, even an apparently simple one, always involves a small element of uncertainty.

Choosing a qualified Plastic Surgeon ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.