The Office Visit
Dr Lista prefers to see all his patients at least twice before surgery. In the consultation process we spend considerable time obtaining a careful history and physical examination. We also spend a long time discussing the patient’s desires, goals and expectations. It is important that the patient discuss with the plastic surgeon her desired size and shape of breast. Not all expectations can be accomplished with surgery and it is important that these issues are carefully discussed before surgery. Photographs can be helpful in this regard and at The Plastic Surgery Clinic we have computerized digital imaging, which allows Dr Lista to show the patients examples of how she may look after the operation.

The Operation
Breast reduction surgery usually takes about 2 hours. The most common procedure involves an anchor-shaped incision which goes around the edge of the areola, straight down into the bra crease and then along the bra crease. Dr Lista is a pioneer of a new operation which eliminates the long scar in the bra crease. This leaves the patient with much less scarring. This operation is often called the “stop sign” or “lollipop” procedure because the only scars are around the edge of the areola and straight down to the bra crease. Dr Lista has performed over 1200 of these operations and has given lectures describing this technique to other plastic surgeons in Canada and the United States.

Scars in most breast reductions around the nipple, down to the crease and then along the bra line crease

In new reduction surgery there is no scar under the breast

During the operation, excess skin is removed and the nipple is moved to the higher position. The nipple is not removed but rather is slid up to its new, elevated position. Breast tissue is removed to make the breast lighter and smaller. Often liposuction is performed at the same time to further reduce and refine the breast.

Dr. Lista has written an article on breast reduction surgery which appeared in a recent issue of the medical journal Plastic and Reconstructive Surgery. Click here or on the Journal icon to read his article.

How Breast Reduction is performed
Breast reductions are performed at The Plastic Surgery Clinic or at the Trillium Health Center (The Mississauga Hospital) where Dr Lista is the Chief of Plastic Surgery. Dr Lista performs all of the procedures personally. Dr Lista ensures that all anesthetics are administered by specialist physicians who are board certified in the specialty of anesthesia. These doctors give the anesthetic, stay with the patient during the entire operation and are with the patient while they are waking up. The operation takes about two hours. A friend or relative will need to come and pick you up and stay with you for 24 hours.

After your surgery
After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a few days, but the pain shouldn't be severe. Any discomfort you do feel can be relieved with medications prescribed by Dr Lista.

Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You'll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.
Patients need to take one week off after surgery. This means staying at home and no driving. During this week off, the patient should stay fairly quiet keeping arm movements at a minimum. We suggest sitting around the house watching television, enjoying videos or reading. Patients with small children will need help at home. While this sounds excessive to some, staying quiet in the first week, actually speeds healing and helps obtain a good result from the surgery. Pain pills are prescribed to help reduce post-operative pain. Patients can gently exercise in about 2 weeks. This means walking, stair-master or treadmill walking is allowed but no upper body workouts, running or high impact working out for one month.You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

All surgery carries some uncertainty and risk
A breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast reduction are uncommon and may necessitate further surgery. You can reduce your risks by closely following Dr Lista’s advice both before and after surgery.

Breast reduction does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts. The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)

Your new look
Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.

Dr Lista will make every effort to make your scars as inconspicuous as possible. Dr Lista leaves scars which are much less obvious than those left by most commonly performed breast reductions. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

You should also keep in mind that a breast reduction won't keep you firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again.

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.

However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be pleased with the results.