Cosmetic Surgeon Alex D. Karidis offers Rhinoplasty, Breast Uplift & Reduction and Other Cosmetic Surgery

Introduction

Throughout history, large breasts have generally been considered a sign of femininity highlighting a woman's ability to nurture. Yet a woman with significantly larger breasts than the aesthetic standard of her time may be seen as abnormal or deformed. In these cases there is no doubt, that large oversized breasts can be disturbing to a woman by causing a host of both physical as well as psychological symptoms. In the former these can take the form of shoulder, neck and back pain as well as cause distortion of posture and in more severe cases make breathing difficult. Large breasts can dominate a woman's appearance and make her look unbalanced and make exercise difficult or impossible to do. In psychological terms, ungainly stares and rude comments make sufferers even more self conscious which leads them to wear loose clothing to disguise their imbalance.

Surgical correction to reduce the size of the breasts has been performed for many years and in fact the first true surgical reduction of a female breast was probably performed in 1669 in England by William Durston. Although the main aim of the surgery is to reduce the volume and weight of the breast, cosmetic enhancement to fashion a normal shape remains equally important. The techniques have been modified and refined throughout the years in order to improve the safety as well as the aesthetic results.

Breast Reduction

• Am I a suitable candidate?

Only a consultation can assess this. During your consultation Mr. Karidis will ask you about your general medical history including details about any previous breast surgery, and childbirth. While women of all ages can benefit, it's usually never performed before the breasts are fully developed. This is because there have been cases reported where young teenage girls have had the operation only to find 2-3 years later that a significant enlargement occurs again(very rare). As a guideline, we normally wait until after the 18th birthday, although each situation is looked at individually and in more extreme cases the procedure can be performed earlier.

If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications (discussed in DO'& DON'TS section) can cause increased bleeding, so you must avoid these.

If you are significantly overweight then planned preoperative weight reduction is encouraged but this alone does not necessarily rule you out for an operation. In fact many times the achievement of a reduced breast size can become a stimulus for further planned weight loss.

Depending on your age you may be required to have a mammogram prior to surgery. This again will be advised at the initial consultation.

• What does the operation involve?

Before going down to theatre, Mr. Karidis uses a marking pen to draw on the breasts in order to determine the exact position and size of the newly operated breasts. He will then show you approximately where the new breast and nipple position will be. Excess breast tissue, fat and skin are then removed. During the operation, the nipples are preserved on a stalk of breast tissue and repositioned by moving them to a new higher location, all in accordance with the preoperative markings. So although a breast size reduction is performed, all patients will also benefit from a breast uplift as well. The nipple is usually positioned in a line level with approximately the middle part of your arm or your under breast crease. The suture line is situated around the nipple in its new position, and extends vertically downwards to the under-breast crease. Occasionally a small horizontal scar within the crease is also performed. However in general, Mr. Karidis’ technique avoids the older type of unsightly long anchor scars. Mr. Karidis will be able to discuss this with you at the time of your consultation and show you precisely where these will be situated.

Finally some tapes, and a light dressing is applied over the suture lines. All sutures used are of the dissolving kind and will not need to be removed. You will also then be asked to wear a firm sports bra for support.

Mr. Karidis does not use drains routinely. He has deemed these not necessary and has stopped using them for a number of years, without any adverse effects. Patients appreciate the fact that they no longer require any drains to be removed from the breasts after the surgery.

Watch the procedure in Virtual 3d

• What type of anaesthetic is used and how long does the operation take?

Breast reduction is performed under general anaesthesia and usually takes between 90 minutes and 2hours

• How long do I have to stay in hospital?

Most patients only require an overnight stay in hospital

• What happens after the Surgery?

Following your recovery from the anaesthetic you will notice a drip in the back of your hand. This is there so that we may replace fluids lost during the operation. Blood transfusions are not routinely necessary except only in extremely rare situations(extra bleeding). Although it is possible, in fact in Mr. Karidis experience, he has never required the need for any blood transfusions for any of his patients.

After surgery it is important that you maintain good circulation in your legs and thus you will be advised to actively move the joints in your feet, knees and hips quite regularily.

After you recover you will notice bandage dressings around your breasts. You will then be instructed to wear a wireless sports bra for support. Just before your discharge from hospital, you are usually given an appointment for about 10 days to have the dressings changed and wounds inspected.

Post Operative Instructions

• What kind of after effects should I expect?

Following surgery you will experience considerable swelling and bruising of the breasts. The bruising usually lasts about 2-3 weeks. While most of the swelling will have dissipated by this time, some subtle swelling may still be present for up to 4-6 months.

After surgery you may notice that the breasts feel quite firm and taut, particularly along the edges of the incision site. This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing. Occasionally small lumpy areas develop within the breast. This is called Fat necrosis where some small areas of fat cells within the breast tissue do not survive the trauma of surgery and die as a result. In this process, the fat becomes hard before gradually softening over a period of weeks and months. When this occurs, massage as instructed will speed up the recovery.

You should expect the sensation to the skin in the nipples and surrounding skin to be reduced after surgery. This is as a result of surgical trauma to the nerves in the region. Although this usually recovers in a few months, permanent numbness in some areas may ensue.

It is normal for any pair of breasts to be slightly uneven and this is no exception in large breasted ladies. Although every effort is made to make the breasts symmetrical, it is not always possible to achieve this exactly.

Breast reduction surgery is possibly one of the most demanding aesthetic procedures. It is imperative therefore that you talk with Mr. Karidis so that he has a full and proper understanding of your wishes. Try to convey, as much as is possible, how little or large you would like to be following your surgery. This will minimise the possibility of having too little or too much removed.

• Can I get pregnant and breast feed afterwards?

Ideally it is best to have completed your family prior to having a breast reduction operation. Patients therefore who plan to become pregnant should usually postpone the operation until after their family is complete. The reason is that if a pregnancy ensues following a breast reduction procedure, permanent re-enlargement may rarely occur. Thus any decision to perform a breast reduction operation prior to this must naturally be weighed and balanced against this risk and the benefits offered by this type of surgery.

Although the technique used by Mr. Karidis ensures the best possible continuity between the breast and nipples thus increasing the possibility of breast-feeding after breast reduction surgery, this cannot ever be guaranteed.

• What are the scars like?

Scars are not a complication but a normal event after any surgery. Even though in recent years the scars in breast reduction surgery, have become smaller, nonetheless the scars are still somewhat lengthy and may take many months or years to settle. However as the scars are around and below the nipples, these shouldn't be noticeable even in low cut clothing or a bathing suit. You should always expect these to be red, raised, lumpy and even itchy to begin with but with time they should fade and flatten. This is the natural evolution of the healing process. However it is important to keep in mind that this may take up to two years to complete. Daily massage of the scars during this time period is advised to expedite and facilitate this process. You will also provided with scar reducing plasters in order to improve the appearance of your scars. You must understand however that no responsible surgeon will ever be in a position to predict any scars ultimate appearance. Although as mentioned, scars do fade and improve in time it is unlikely however that these could ever be characterised as being mainly only "hairline" in nature.

• Is it painful?

Our surgical understanding, the techniques and instrumentation have improved over the years and Mr. Karidis takes advantage of all these to deliver the best in terms of results. With these new techniques, pain is significantly improved compared to the surgery performed a few years ago. Therefore most ladies, who have breast reduction surgery with Mr. Karidis, complain or only mild to moderate discomfort after surgery. This of course should be well controlled with pain killers. The pain usually improves and dissipates after the first 4-5 days.

• What could go wrong ?

Whilst it is true that when a Breast reduction is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.

As in any procedure the risk of significant infection is always possible. This is minimised by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision sites, but usually subsides over a period of about 2 weeks.

Risks such as leg and lung blood clots are rare. Early mobilisation by moving around as soon after the surgery as possible reduces this considerably. Mr. Karidis regularly deploys anti-clotting measures such as special stockings (TEDS) and compression devices(Flowtron) during surgery to minimise this.

As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very occasionally, increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin)-less than 1% incidence. If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.

As mentioned, during the operation, the nipples are preserved on a stalk of breast tissue and repositioned. In the vast majority of patients they remain natural, with normal contraction and some sensitivity. Very rarely however the stalk of the breast tissue develops inadequate blood supply to maintain nipple viability and some sloughing of part, or even more rarely, the entire nipple can occur. This complication will mean that prolonged dressing will be required over the nipple area until natural healing occurs. It is then possible to reconstruct the nipple as a secondary procedure, should this be required. Thankfully with modern techniques this complication is quite remote (less than 1%).

During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion or even chafing of the skin at any point of the incision sites. One of the most common sites is the point where the vertical scar meets the nipple and or the under-breast crease. This is a temporary complication, which will require regular dressing changes initially. Eventually a scab develops over this, which subsequently separates after 3-4 weeks. A padded dressing for a period of a few weeks decreases the likelihood of this occurring. However some distortion of the skin around the scar may ensue. Further revision surgery may occasionally be required if necessary.

• How many Breast reduction procedures does Mr. Karidis perform?

In accordance with the National Healthcare commission guidelines, according to the last five years (2002 -2006) of annual audit figures submitted to the Hospital of St. John and St. Elizabeth in London, Mr. Karidis performed on average 30 breast reduction procedures per year. In the last 10 years he has performed over 300 breast reduction procedures.

• How long before I get Back to Normal?

With the more modern techniques Mr. Karidis applies to this operation, you should be able to get back to a routine fairly quickly. As a guideline, most patients with office based work can return to their duties after 4-5 days. Of course remember variations do occur in the time individuals take to heal. Others find it more appropriate to take a further 7-10 days to rest. Walking is helpful in the first 3-4 weeks as this improves the circulation and helps reduce the swelling, and the chance of blood clots developing. Heavy lifting or Strenuous activity is best avoided in the first 6 weeks after surgery. Lower body exercise may be commenced after 14 days, with high impact aerobic type of exercises only allowed after 6 weeks. Overall common sense rules in the recovery period. If what your doing is uncomfortable then don't do it!

• Summary

Breast Reduction surgery probably has one of the highest satisfaction rates of all cosmetic procedures. This is because women who had been burdened with the effects of overly large breasts for many years suddenly feel literally "liberated" and able to do things that were difficult or uncomfortable prior to surgery. In many ways these women feel they have been given a new lease of life and are thus able to approach many everyday matters with renewed interest and confidence.