What is a breast reduction for breast cancer (therapeutic mammoplasty)?

A breast reduction for breast cancer (therapeutic mammoplasty) is a procedure to make your breasts more even in shape or reduced in size. It is normally done at the same time as the surgery to remove breast cancer.

What are the benefits?

The cancer surgery alone may make your breasts uneven in shape and size or your breasts may already be uneven in shape and size (this is common). A breast reduction will aim to make them more even.

A breast reduction combined with removing the cancer may mean your breasts have a more normal shape long term.

If you have large breasts and need radiotherapy as part of your cancer treatment having a breast reduction may reduce your risk of complications from radiotherapy.

Are there any alternatives?

Your surgeon may be able to recommend an alternative to improve the size and/or shape of your breasts.

What will happen if I decide not to have the procedure or the procedure is delayed?

It is your choice to have a breast reduction. You do not have to have it on both sides, and it will not affect the outcome of the surgery to treat the cancer. People who do not have a reduction for breast cancer are at an increased risk of needing another procedure.

You may have asymmetry between your breasts or a less satisfactory breast shape.

If you have very large breasts with a natural droop (ptosis), you may have an increased risk of complications from radiotherapy given as part of your treatment.

If you are booked in for a breast reduction as part of your cancer surgery, you should not have to wait too long. Your breast-care team will talk to you about this.

What does the procedure involve?

The procedure is performed under a general anaesthetic. It usually takes between 90 minutes and 3 hours, depending on whether you are having other procedures at the same time or not.

Your surgeon will make a cut on the breast. They will perform the breast cancer surgery and remove some of your excess breast tissue, fat and skin.

Your surgeon will reshape your breast and lift your nipple (if it can be preserved), so it is in a higher position.

If your breasts are large, your surgeon may also need to make a cut on the crease under your breast.

If your breasts are large or droopy, your surgeon may need to completely detach your nipple and areola and reattach them at a higher position.

How can I prepare myself for the procedure?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help you prepare for the procedure, help you recover and improve your long-term health. Before you start exercising, ask the breast-care team or your GP for advice.

What complications can happen?

Some may be serious and can even be life threatening.

General complications of any procedure

• bleeding
• infection of the surgical wound
• allergic reaction to the equipment, materials or medication
• venous thromboembolism (VTE)
• chest infection

Specific complications of this procedure

• developing lump under your wound caused by blood collecting (haematoma) or fluid (seroma) inside a breast
• developing a hard lump in a breast caused by scarring or damaged fat tissue (fat necrosis)
• numbness or continued pain on the breast or around the scars
• loss of skin, including the areola and nipple
• stiff shoulder
• loss or change of nipple sensation and/or reaction to cold or touch
• reduced ability to breastfeed
• cosmetic problems

Consequences of this procedure

• pain
• scarring of your skin, which can be unsightly

What happens after the procedure?

You should be able to go home the same day or the day after.

You should be able to return to work after a few weeks. It can take 3 to 6 months to get back to your normal energy levels.

You should be able to build up to normal activities after 2 to 3 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the breast-care team or your GP for advice.

Breast cancer reduction surgery scars improve gradually over time. Your breasts should become softer and more natural, and the scars should fade. The combination of cancer surgery, radiotherapy and a breast reduction may mean you develop some asymmetry over time.

Summary

A breast reduction is a procedure to maintain a natural shape of your breasts and improve symmetry with breast cancer surgery. You should consider the options carefully and have realistic expectations about the results.

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