Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Breast reduction is typically performed under general anesthesia. This ensures the patient is completely unconscious, feels no pain, and the airway is protected throughout the procedure. A board-certified anesthesiologist or a nurse anesthetist continuously monitors vital signs.
In some specific cases or minor revisions, deep intravenous sedation (twilight sleep) might be an option, but general anesthesia is the standard for safety and control during tissue manipulation. The anesthesia team manages fluids and medications to prevent nausea upon waking.
Once the patient is asleep, the surgical team preps the chest with sterile antiseptic solution. The surgeon follows the pre-drawn markings to make the incisions. The choice of incision (anchor, vertical, etc.) dictates the exposure.
The nipple-areola complex is typically circumscribed and left attached to a pedicle (mound of tissue) to preserve the blood supply. The skin around it is removed. Then, the surgeon excises the predetermined amount of glandular tissue and fat from the lower and lateral parts of the breast.
After the bulk is removed, the remaining breast tissue is reshaped and molded into a more miniature, lifted mound. The nipple-areola complex is moved to its new, higher position. If the areola was enlarged, it is reduced in diameter.
The skin is then brought together and sutured. This is the “tailoring” phase, where the cone shape is created. Deep sutures support the breast tissue, and fine sutures are used on the skin surface to minimize scarring.
In many cases, surgeons place small drainage tubes under the skin to remove excess blood and fluid that accumulates after surgery. This helps prevent hematomas (blood clots) and reduces swelling. The drains usually exit through a small hole near the incision.
The incisions are covered with sterile dressings, tape, or surgical glue. A surgical bra or compression bandage is placed on the patient while they are still on the operating table to provide immediate support and reduce edema.
The patient is moved to the recovery room (PACU) to wake up. Nursing staff monitor vital signs and manage pain. Patients may feel groggy, experience chest tightness, and have some soreness.
Once the patient is stable, alert, and pain is controlled, they are discharged to the care of their designated driver. Instructions are given regarding drain care (if applicable) and medication schedules.
The first few days are the most uncomfortable. Patients should rest with their upper body elevated on pillows to reduce swelling and throbbing. Getting up to walk around the house is encouraged to prevent blood clots in the legs.
Pain is generally manageable with prescribed narcotic medication for the first few days, then transitioning to over-the-counter pain relievers. Patients should avoid reaching overhead or lifting anything heavier than a milk jug.
If drains were placed, they are typically removed within 2 to 5 days, depending on the fluid output. The removal is a quick, generally painless procedure done in the surgeon’s office.
Patients are often asked to record the amount of fluid drained daily. Once the drains are out, the patient can usually shower more freely, though scrubbing the incisions is prohibited.
Swelling and bruising are expected and peak around day 3 or 4. The breasts may initially appear square, high, or boxy due to tight skin closure and swelling. This is normal and not the final shape.
Asymmetry in swelling is also common. One breast may be more swollen or bruised than the other. Patients are reassured that this resolves with time. The compression bra should be worn 24/7 (except for showering) to help manage this.
Pain management shifts from narcotics to non-narcotic options like Tylenol and muscle relaxants. Avoiding aspirin and NSAIDs (ibuprofen) is often recommended for the first week to prevent bleeding risks.
Ice packs should generally not be placed directly on the breast tissue or nipple, as the cold can constrict blood vessels and compromise the blood supply to the healing nipple.
Patients are instructed on how to care for their incisions. This may involve changing gauze pads, applying antibiotic ointment, or simply keeping the area clean and dry if surgical glue was used.
Any signs of infection, such as increasing redness, heat, fever, or foul-smelling discharge, must be reported immediately. Keeping the incision lines dry helps prevent wound breakdown.
Strict activity restrictions are in place for the first 2-4 weeks. No heavy lifting, no strenuous exercise, and no raising arms high above the head. This protects the internal sutures and the blood supply to the nipple.
Most patients can return to a desk job within 1 to 2 weeks. Driving is permitted only after the patient is off narcotic pain medication and has a full range of motion to drive safely.
Numbness or hypersensitivity in the nipples is common in the weeks following surgery. This is due to nerve stretching and manipulation. Sensation typically returns gradually as the nerves heal.
In rare cases, the nipple may appear dusky or pale, indicating a problem with the blood supply. This is a medical emergency requiring immediate contact with the surgeon. Most healing proceeds uneventfully, with the nipple regaining pink color quickly.
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You must sleep on your back, propped up on pillows or in a recliner, for at least 2 to 4 weeks. Sleeping on your stomach or side puts pressure on the incisions and can distort the healing breast shape.
Most surgeons allow showering 24 to 48 hours after surgery, once you feel stable. You should let the water run gently over your shoulders and chest, avoiding direct spray on the incisions. Do not soak in a bath.
A hematoma is a collection of blood inside the breast. It causes sudden swelling, pain, and bruising on one side. If it is large, you may need to go back to the operating room for a quick procedure to wash it out and stop the bleeding.
The “boxy” look is very everyday immediately after surgery. The surgeon sutures the bottom of the breast tightly to prevent it from bottoming out later. As the skin relaxes and gravity takes over in the coming months, they will round out into a natural teardrop shape.
You cannot lift anything over 5-10 pounds for at least 4 weeks. This includes babies and toddlers. You can hold them if someone else places them gently in your lap while you are sitting, but you cannot pick them up.
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