Breast reduction surgery is designed to reduce the size of excessively large breasts, correct sagging breasts and possible asymmetry, with or without reduction in areola size. Breast hypertrophy is defined as when the volume of the breasts is too large, when, compared to the patient’s morphology. This is frequently a genetic issue. This excessive volume can have a physical, psychological and functional repercussions: pain in the neck, shoulders and back, or discomfort while playing sport or even when doing daily activities. There will be two or three scars, depending on the technique used: – either a scar around the areola and another vertical from the lower pole of the latter to the inframammary fold, which is where the lower breast tissue meets the chest wall . This is the so-called “vertical” technique, – or a peri-areolar scar, a vertical scar up to the inframammary fold and a horizontal scar on it. This is the inverted “T” or anchor technique. The length of the horizontal scar, hidden in the inframammary fold, is proportional to the extent of the hypertrophy and ptosis.

Operating Procedure

These procedures are generally covered by insurance. This intervention, which lasts between 1.5–2.5 hours, is performed under general anesthetic, and on an outpatient basis. The patient leaves the operating room with a reinforced bandage. The stitches are absorbable and do not need to be removed. A reinforced supportive medical bra should be worn for three weeks after the operation. The post-operative effects are not very painful, with swelling, bruising, and a slight discomfort when raising the arms are frequently observed. The scars usually heal very well. The removed tissues are systematically sent to a specialized laboratory to be microscopically examined, even if the mammography and / or ultrasound is normal. The final result can only be judged one year after the operation. Although rare, it is important to know of possible complications, such as infections, bruises, delayed healing, etc. Pregnancy after this surgery is possible. Breastfeeding is usually possible but cannot be guaranteed in all cases. Breast sensitivity may also be changed.

A breast augmentation increases the size of the breasts by inserting implants, which are pre-filled with silicone gel. The size is chosen in advance, during consultation, by the patient with the advice of Dr Ratner. Depending on the anatomical characteristics of the patient, several incisions are made through which the implants will be inserted. They will be located either at the level of the lower segment of the areola’s circumference, or where the lower breast tissue meets the chest wall (inframammary fold). Two positions of the implants are possible in relation to the pectoral, pre-muscular or retro-muscular and these choices will be defined during the consultation. The operation lasts about one hour and is performed under general anesthetic.

Post Operation

The patient will leave the clinic a few hours after the procedure, with a secure elastic dressing, which should be kept on for five days, until the first postoperative appointment. A reinforced supportive medical bra should be worn for two weeks after the operation. There may be pain during the first few days, especially when the implants are large and are placed behind the muscles. Pain relief will be prescribed. A feeling of tension, swelling, bruising and discomfort when raising the arms are common in the early stages, as well as minimal swelling of Sun, sea bathing and sport can be resumed after two weeks. The final results will be seen after 2–3 months. For sagging of the breasts, a reduction of the skin can be carried out to elevate the breasts.

*During your consultation, Dr Ratner will show you examples of before and after cases.

Pregnancy / lactation

It is recommended to wait at least six months after having breast implants inserted to consider pregnancy. It is possible to breastfeed in most cases, but this also depends on the patient. Breast augmentation is possible six months after breastfeeding or pregnancy.

Implants and cancer

Breast implants do not increase the risk of developing breast cancer. They do not interfere with the interpretation of breast radiological examinations. However, it is essential to always specify that you have breast implants at these examinations. Dr Ratner only places smooth implants.

Life expectancy of implants

It is not possible to estimate the exact life expectancy of implants as it depends on how each individual reacts to them. Life-long breast implants should not be taken for granted. Their guarantee in the U.S. is 10 years. Women should consider replacing their implants after 10 to 15 years. However, breast implants can often remain intact for 10-15 years and sometimes longer. Replacements are therefore not considered routine but will only be carried out if the implants show signs of pre-rupture, visible on ultrasound or mammography, which should be performed regularly.

Monitoring

After the post-operative check-ups, it is important to continue to attend any regular consultations with the gynecologist. A specific consultation of implants is recommended every 2–3 years. Apart from this follow-up, it is essential to consult as soon as a change is detected or after any violent trauma. Breast ultrasound is a non-irradiating and a very accurate examination that can assess the integrity of the implants.

A breast lift or mastopexy, is a procedure to lifts and shapes the breast. Breasts naturally become droopy over time, and this can be exacerbated following significant weight loss or after breastfeeding. The size of the breasts can also be increased at the same time of the surgery by inserting a silicone or saline implant or by an autologous fat graft. This procedure can be performed from the end of growth of the patient and throughout life. There will be two or three scars, depending on the technique used and depending on the case: -either a scar around the areola and another vertical from the lower pole of the latter to the inframammary fold. This is the so-called “vertical” technique. -or a peri-areolar scar, a vertical scar up to the inframammary fold and a horizontal scar on it. This is the technique called an inverted “T” or marine anchor. The length of the horizontal scar, hidden in the inframammary fold, is proportional to the extent of the volume and drooping.

The scars usually heal well.

Operating Procedure

The operation is performed on an outpatient basis, under general anesthetic and lasts one and a half hours. The patient leaves the operating room with a reinforced bandage. The stiches are removed a week later. A reinforced supportive medical bra should be worn for three weeks after the operation. The post-operative effects are not very painful with slight swelling and bruising. Slight discomfort when raising the arms is frequently observed. The final result can only be assessed one year after the operation. This surgery does not affect the chances of becoming pregnant. Breastfeeding is often possible, but it cannot be assumed in all cases. Breast sensitivity may be changed.