Breast Reduction Surgery | Medbelle Q&A with Mr Adel Fattah

Mr Fattah is a Medbelle surgeon based in the North West. He specialises in all areas of plastic surgery, including breast surgery.

He enjoys performing breast reduction surgery because it has phenomenal benefits for patients. Not only positively affecting how they look but how they feel, and, in his own words: “that’s what being a doctor is all about”.

In this Medbelle Q&A, Mr Fattah answers patient-submitted questions about breast reduction surgery, covering questions about surgical techniques, recovery and aftercare.

What is possible to achieve with breast reduction surgery?

Well, I’ve seen pretty much the whole spectrum. I remember performing breast reduction surgery on a woman and taking four kilograms off each breast. So that’s a really large breast! It needed three people to hold it while we did the procedure.

So is there a limit to what we can do? Not really. The question is how we do things differently to get those results. With the vast majority of breast reductions, they can all be done in the standard way with what we call an anchor-shaped scar. You can take anything from 100 grams (which is roughly a cup size) to 500 or 600 grams. That’s like going down from a double G-cup to a C-cup.

You can make yourself virtually flat-chested if you want. But after a certain size of breasts, there may be a limit as to how far we can “move” the nipple. People often get quite scared when they hear about people “moving” you’re nipples. But it isn’t literally moved. The skin is lifted up off the breast tissue itself, the excess is removed, and then the remaining breast is pushed up in while the skin is brought around it. As a result of that, the nipple appears to “move” up the chest. It is certainly not taken off the chest! That goes for most procedures.

There is, however, a limit to what size breast you could do that surgical technique with. So for patients with very, very large breasts, we have a different surgical technique. If we actually have to take away a huge amount of breast tissue, we can take the nipple off like a skin graft and then put it back in we call a free nipple graft. I’ve done it once in my career, so it gives you an idea of how unusual that is. I would usually try to do a ‘normal’ breast reduction technique. But people care about the nipple being taken off and put back on. I think it sticks in people’s minds because it’s so dramatic. But it’s not a common thing.

What is the ‘normal’ breast reduction technique?

So what we try and do is take away the lower parts of the breast tissue, leaving the nipple and the part around the nipple on. Then the remaining breast tissue, the upper two-thirds of the breast, is brought around and under. It’s almost like putting a waistcoat on and truing up the buttons which pushes everything up. By doing that it gives a bit of lift by allowing us to remove the breast tissue.

The amount that we remove is a decision made between myself and the patient in the consultation. Some patients want just a bit of uplift and they don’t particularly want a significant reduction - sometimes just taking out maybe a small half-cup with giving them a better lift and better shape in the long run. Other patients want a huge amount removed, in which case it is a more radical change for them.

Many patients want to know how soon they can resume exercise. Is the point at which they can get back to the gym or running different between different types of breast surgery?

So I would say six weeks is pretty much standard for every operation across the board. Sometimes more minor reductions can be less time. With running I would also say six weeks. But why six weeks? Well, six weeks is the time when the scar healing is strong enough to withstand moderate blows or tensions. Sometimes patients can be pleasantly surprised. With smaller reductions, some patients are almost fully healed after four weeks. But I would suggest that you should build up a kind of exercise tolerance.

What I say is “your body will tell you”, then you’ll know. If it’s uncomfortable or painful, you know that you’re pushing yourself too much. So most people have a lot of common sense and they are the best judge of what to do. So let you body guide you.

How is the nipple affected by breast surgery? Does it actually have an effect on sensation around the nipple?

I’d say to patients to expect several months of not having sensation or sometimes hyper-sensation - which can be irritating when wearing a bra. But it’s quite common to have altered sensation after surgery. So do expect some changes.

How long can you expect to be in the hospital for following breast reduction and breast uplift procedures?

Usually, I do it as a daily procedure, apart from patients who have either had a very large reduction or may have other medical problems that might keep them in. Or perhaps if the surgery is performed later in the day or you’re just feeling a bit sick afterwards, I’d rather keep the patient in. It’s always best to be safe.

I always aim to get people out of the hospital and into their home environments where they’re comfortable to recover, provided it’s safe to do so.

How long do patients have to wear a support bra after breast surgery?

I usually say six weeks. For breast reduction surgery, the scars are where the underwire is. So always wear a non-underwire bra, something supportive that stops your breasts jiggling around. That’s the bottom line.

Some patients might get to the point where they’ve had enough of wearing it after a week. Fair enough. I have a protocol for a reason, because on average, for most people, six weeks is standard.

Surgeons use local and general anaesthetics, so the immediate post-operative period is not particularly painful for the patients. But, do they need to take medication afterwards?

We normally give patients a codeine type medication at first, and recommend simple things like Nurofen and paracetamol, which might sound like pretty lightweight pain relief! But when you start adding all that together, it’s incredibly effective. You continue to take it probably for about a week without really experiencing the pain ‘breaking through’. Then, after a few more days, you can maybe miss a couple of doses and see if the discomfort comes through and then tail it off as you see fit.

Of course, some people are allergic to certain drugs. So it is always tailored to the individual. Also, it may be sometimes necessary to take some small laxatives to counteract the blocking effects of any codeine-type drugs.

What is the recovery time for a breast reduction?

Many breast surgeries have similar recovery times, even though they’re quite different operations. Normally, most breast reduction patients can go back to an office-based job between the end of the first week or the second week, after the procedure. Of course, this depends on the patient. But the patient will know best what their job is like.

With driving, I recommend giving it a few days. Also, contact your insurer and let them know you’ve had a procedure. Make sure there are no exclusions on your insurance policy that they can use if you have an accident soon after surgery.

Then, as I mentioned earlier, getting back to the gym might take six weeks. But go for walks in the meantime!

Most patients can shower and bathe usually by the next day. I do encourage patients to shower but sometimes they get told by nurses not to, but that is traditional teaching for non-plastic surgery patients. But I encourage patients to get any bacteria off the surface of the skin and keep the wounds nice and clean.