Dear Doctor: 'I am so sick of my large, ugly boobs'

Dear Doctor, I have very large boobs, always have, but since I have had my children, they have grown even bigger.

I still carry a fair bit of ‘baby weight’, but I don’t think that is the reason that they are so big. I finished breastfeeding my youngest about eight months ago, and I am still producing milk. I know this because I check every now and then in the shower. There are a couple of issues here that I would like some advice on.

The first is about the milk — is it normal to be still producing milk after this long? Could it be a sign of something wrong? The second is the size of my boobs. I am so sick of carrying them around. They look awful — they are so matronly, and also, I think they are giving me a sore back. Is it possible to get a breast reduction?

The Doctor answers: Despite giving up breastfeeding about eight months ago, it is quite normal to notice some drops of breast milk, particularly during a warm shower or the occasional breast-milk stain on your bra. This may go on for a number of years and will eventually stop. Should you notice brown or blood-stained discharge from your breast, then you should attend your GP to arrange a breast ultrasound (if under 35 years of age) or mammogram (if over 35 years old).

In terms of breast cancer, you should also be alert to any change in the nipple (new onset nipple inversion or itchy, flaky, scaly skin on the nipple); any area of the breast that becomes ‘puckered’ or has an ‘orange peel effect’; or a painless (doesn’t hurt when you push down on it) pea-sized lump that is fixed or difficult to move within the breast tissue.

Having very large, pendulous breasts that cause shoulder, neck or back pain is a very valid reason to consider breast reduction surgery. Mammoplasty (breast surgery) involves a surgical procedure to remove excess skin and fat tissue from the breasts in order to reduce their volume and form a more aesthetically pleasing breast shape, position and projection.

We must expect the natural age-related change as skin loses elasticity resulting in some degree of breast ‘sagging’ or falling downwards with gravity. This process is exacerbated post-breastfeeding as the ‘ligaments of Cooper’ that attach the breasts close to the chest wall, become stretched and more lax when breastfeeding ends. Often, women discuss the option of breast reduction with simultaneous breast uplift surgery, known as mastopexy.

There are many surgical options in terms of mammoplasty, mastopexy and the approach to the breast that will determine your residual scars. These breast incisions include the Wise (inverted T) incision, or the periareolar (around the brown area surrounding the nipple) incision or ‘lollipop scar.’

Post-operative pain will occur particularly in the first three to five days. It is important to wear a special support bra for six to eight weeks post procedure. It is likely that you will experience mild–to-moderate levels of pain as the bruising and swelling around the breasts can last for up to two months post procedure. Recovery times vary between patients but, if all goes well, you may be able to return to work within 10 days of having the procedure.

As a general anaesthetic agent is required and the surgery itself takes approximately two to three hours, breast reduction is considered major surgery versus something like a tonsillectomy or a bunion repair. You should ideally be as fit as possible and have a BMI under 30. Depending on the surgeon, patients with BMI between 30-35 may still be considered for breast reduction.

You will be warned about the risk of effectively ‘reversing’ the surgery if you gain a lot of weight in the months to years following surgery. Similarly, if you become pregnant or breastfeed again, then the full benefits of your breast reduction may be lost. You may end up with your original breast size and shape. Much like varicose vein surgery, it is advised to wait until you finish your family before considering breast reduction surgery.

Most surgical procedures carry the same general risks, such as significant bleeding (blood loss), the risk of wound infection, obviously scar formation and the possibility of an adverse drug reaction.

The periareolar incision is fast-healing and tends to leave very little scarring. If you are a smoker, it is strongly advised to quit at least six weeks prior to surgery as this will make the general anaesthetic more safe, and becoming an ex-smoker makes your wound healing far

superior to that of a smoker.

Whatever you decide, you should do your own research and find an excellent breast surgeon in a well-reputed hospital.

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