Reference Library

Breast Surgery

Tuesday, Apr 22, 2008

DEFINITION

There are several forms of Breast Surgery available. Breast Surgery may be performed to increase the size or enhance the shape (augmentation) of the breasts, reduce the size (reduction) of the breasts, lift sagging breasts or reconstruct the breast after a mastectomy.

DESCRIPTION

BREAST AUGMENTATION (ENLARGEMENT)
Saline implants are currently being used to improve the shape or increase the size of breasts. Liquid silicon implants are no longer used. These are thought to be the cause of autoimmune disease and other diseases in some women. Water-based gels called hydrogels are being used as an alternative.
The surgery may take up to two hours and is performed under general anaesthetic. In most cases the patient can go home on the same day. One surgical technique involves the surgeon making a cut inside the rim of the areola (pink area around the nipple). This creates a pocket behind the pectoral muscle for the implant. After surgery, tubes may be inserted to help drain away any blood or excess fluid. Scarring is usually minimal and the curve of the breast usually conceals other scarring.

Some of the risks involved with this type of surgery are listed below:
- Breast implants may cause nipples to lose some sensitivity or the nipple may become over sensitive due to nerve damage. There are thought to be fewer risks associated with these implants compared with the previous use of silicon implants.
- Infection may occur after the Breast Surgery.
- Scar tissue which forms after surgery may press into the implant causing it to change shape. This condition is known as 'capsular contraction' which gradually results in a loss of normal breast shape and causes excessive firmness of the implant. This is the most common reason for people with breast implants requiring reoperation.
- Rupture (bursting) or malfunctioning of the valves of the implant.
- Haematoma formation is a risk associated with Breast Surgery. Bleeding into the tissues where the surgery was performed forms a hardened clot which is often quite painful to the patient. Further surgery may be required to treat the haematoma.

BREAST REDUCTION
Very large breasts may be physically and socially uncomfortable for some women.
The surgery can take up to four hours to complete and is usually performed under general anaesthetic. An overnight stay in hospital is usually required. The most common procedure involves the surgeon making an incision around the areola, a verticle line from the nipple downwards and a horizontal line from the nipple towards the side of the body. Tissue, fat and skin is removed in proportion to form a smaller, well-shaped breast.
There may be bruising or tenderness after the surgery. It is best to avoid playing sport or lifting heavy objects. Supporting the breasts well with a comfortable bra is recommended during the recovery period. A Physiotherapist may be able to suggest suitable exercises to help promote a speedy recovery.
Some of the risks involved with this type of surgery are listed below.
- Not being able to breast feed after the Breast Surgery is a factor to consider before the operation. Fat in the breast may congeal into lumps preventing the flow of breast milk and may take months to disappear.

BREAST LIFTING (MASTOPEXY)
This procedure helps reshape sagging breasts without necessarily changing the size of the breasts. The procedure can take up to four hours and usually involves an overnight stay. The procedure is performed in a similar way to the breast reduction, though no fat or tissue is removed. There will be some swelling and discomfort after the surgery.
The risks involved are similar to those experienced after breast reduction. Since the nipple is rarely detached during the procedure, there are fewer associated problems such as loss of sensation.

BREAST RECONSTRUCTION
Breast reconstruction involves implanting a saline implant or using tissue taken from other parts of the patient's body to reconstruct the breast after a mastectomy. A breast reconstruction can be performed at the same time as the mastectomy or at a later date.

TREATMENT OPTIONS

Ensure that your Doctor has a thorough understanding of the changes you wish to make to your breasts. Have your Doctor explain all the risks involved with the surgical procedure you are having performed.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) It is important that your Pharmacist is informed about the history of the surgical scars.
2) Does the wound look clean? If it is excessively red and swollen, smelly or weeping a yellowish thick fluid then an infection which requires medical attention may be present.
3) Post surgical wounds should be covered to protect the wound from damage and to absorb any fluid. Ask your Pharmacist about a non-adherent wound pad.
4) The pad should be secured in place using tape or a retention bandage. Make sure that the correct tape is used. See the topic on Wounds and Tapes.
5) Change the wound pad daily or more often if fluid seeps through the pad.

INTERACTIONS

Some herbs are not recommended in the weeks before and after surgery. Advise your Doctor before surgery if you are taking any of the following supplements.
1) Echinacea. Although it is often used to improve the immune system, it may also interfere with normal cell responses and can delay wound healing. Discontinue as far in advance as possible before surgery.
2) Garlic. Can reduce blood clotting and increase the risk of bleeding. Discontinue at least seven days before surgery.
3) Ginkgo biloba. Can interfere with blood clotting and increase the risk of bleeding. Discontinue at least 36 hours before surgery.
4) Ephedra. Increases heart rate and blood pressure, and may increase the risk of stroke or heart attack during anaesthesia. Discontinue at least 24 hours before surgery.
5) Panax Ginseng. Lowers the blood sugar level and can affect blood clotting. This may cause hypoglycaemia and increased bleeding. Discontinue at least seven days before surgery.
6) St. John's wort. May interact with other medications used during surgery. Discontinue at least five days before surgery.
7) Valerian. This may cause increased tolerance to the anaesthetic, resulting in a need for higher doses. Gradually decrease the dose over several weeks before surgery.