breast reduction surgery guide

Me at about two months post surgery in 2015
One of the first photos where my boobs weren’t wider than my ribcage.

If you are considering breast reduction surgery there isn’t a lot of proper nuts and bolts information about what it is really like before and after the operation. (It took me over a year to talk about the breast reduction I underwent in April 2015, when I finally wrote a very personal first person essay on living with huge breasts, and why I took the decision to reduce them, for my friends over at The Pool – you can read it here).

I was overwhelmed by the response to the article across the internets. Many, many women wrote to me, begging for the name of my surgeon, and wanting the inside track on what having the operation really involved, so I’ve written my definitive no-holds-barred guide to breast reduction surgery – all 4126 words of it.

It’s definitely a no detail is too small piece, but I know that when I searched and searched the internets prior to my op I found it really hard to find any hard facts about what the actual experience would be like before and after the procedure.

NB. This post was updated in August 2018 to remove some of the parts which are not germane or useful to anyone else contemplating surgery – I never expected thousands of people to read this story each month, and so wrote it as much as a personal record as a general guide. If you want to read the original, much more personal post, then I have re-published it here.

Please also bear in mind that I had my procedure in England as a private patient, and not under the NHS.  This post is my opinion only, and any advice or recommendations should not be taken as definitive. Always do your research before any kind of elective operation, and consult your GP or primary healthcare provider in the first instance.

THE NUTS & BOLTS OF BREAST REDUCTION
I went the private healthcare route: I don’t think I would have qualified for free surgery under the British National Health Service – my breasts were huge, but I wasn’t crippled by them. I thought the NHS had better things to spend its money on than my breasts, and I wanted to choose my surgeon (control junkie).

Please do bear in mind that this first section is geared to choosing a surgeon that is either paid for by yourself, or by your health insurance, although doing due diligence on your surgeon is never a bad idea. (The NHS has some of the top surgeons in the world operating within its portals, so don’t by any means think the NHS is a second-class option: it categorically is not.)

CHOOSING A SURGEON:
Word of mouth is an excellent place to start. If you know anyone who has had the op, talk to them, and if you are given any names then Google them: parts of the Internet may be the digital Wild West but it should give you an overview of how a surgeon is generally perceived.

In the UK check that they are accredited to The British Association of Aesthetic Plastic Surgeons. Known as BAAPS, it’s based at The Royal College of Surgeons and was established for the advancement of education and safety in Aesthetic Surgery.

Regardless of the country in which you are contemplating surgery, check to see if a surgeon is regarded as expert in their field (Do they speak at conferences? Write papers? Conduct research?) and are generally held in respect by their peers. Most important: is breast reduction one of their fields of speciality?

I kept seeing articles recommending consulting with at least three surgeons. Do be aware that in the UK these initial private consultations are usually not free (unless you are searching for a surgeon in the back pages of a women’s magazine, in which case – beware): each visit to a private surgeon can cost around £150. The surgeon I ended up choosing, Mr Bassim Matti, who has rooms on Harley Street, had operated on three friends and colleagues with phenomenal results. When we met I liked his manner and felt comfortable with him, so I didn’t meet with anyone else. (The prospect of interviewing two more surgeons made me feel really nervous.)

THE OPERATION
There are various ways your surgeon can choose to operate. I was both being reduced and lifted, so had the traditional anchor incisions. This involves (look away now squeamish people) completely removing the areola and nipple, whilst keeping them connected underneath, and moving them up several inches.

A vertical incision scar runs down from the bottom of the areola to the ribcage, and then there is a horizontal scar, which runs almost from the armpit to the side of the cleavage, following the curve of each breast. I was really happy with this and, having done my research,  and with quite a large amount to be removed –  I was going from an JJ cup to a D, would not want the operation that does away with that curving incision under the breast, as there is a greater risk of puckering on the vertical scar from areola to ribcage.

My surgeon, Mr Matti, is a perfectionist, and so he also lipo’d under the incision between the curve of the breast and the ribcage, to achieve a clean line, and under the armpit and the axial fold to remove excess breast tissue there. Not every surgeon does this, and I know that in America this is usually considered to be an extra procedure, not covered by health insurance. So this is definitely worth asking about. (I had no idea about this pre-op.)

HOSPITAL
I was originally given a choice of two private London hospitals where my surgeon practiced but, because I was flexible with dates, I was on his cancellation list and ended up taking a slot with just six weeks’ notice. (Mr. Matti has a minimum six-month waiting list as a rule.)

I spent one night at the private BUPA Cromwell Hospital in Kensington. I had a private room and bathroom, and this was where I was examined in the morning pre-op by Mr. Matti, who marked me up, and where I met the anaesthetist. I was Mr Matti’s only op at the hospital that day so I didn’t feel as though I was on a conveyor belt.

Untitled
I took a shower, and selfie-photographed my boobs in the bathroom mirror for posterity before I was wheeled down to surgery. The team was lovely there; the mark ups were checked, and I was put under.

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The op took around four hours, and I came round in my room, rather than downstairs. (I think!) I was dressed in a hospital gown, with oxygen tubes up my nose, there was tight bandaging around my dramatically flatter chest and a surgical drain – long rubber tubes ending in plastic bulbs, hanging off each breast. I felt woozy but actually fine, all things considering.

No great pain.

I was wearing compression stockings and, because Mr. Matti knew I was paranoid about blood clots, I had these funny electric compression blood pressure balloon things on my legs, which constantly tightened and released to keep my blood flowing.

Before you go down to the operating theatre check that the nurse call button will be within reach of your pillow when you return, and keep your cellphone within reach of the bed. Because of the leg balloons, wooziness, and drains post-op, I couldn’t get up unaided, and was left for quite some time post-op in bed desperate for the lavatory because the nurse call button had been looped over the back of the bed where I couldn’t reach it (you can’t lift your arms for some time post-op). In the end I managed to hook my cellphone over to the bed to make an external call to the hospital switchboard to get help. I was deeply unamused.

I spent that night in hospital. I was so hungry I ordered supper, and spent the evening WhatsApp-ing friends pics of my newly flattened chest – well, what I could see of it from over a hospital gown.

My father arrived to pick me up around noon the next day and drive me to the clinic. I had been in hospital for just over 24 hours in total.

LEAVING HOSPITAL
It doesn’t matter what you wear on your bottom half, but make sure you pack a shirt with front buttons and a cardigan, as you won’t be able to pull anything over your head. I found a cashmere shawl v useful, both in hospital instead of a bed jacket, and for wearing outside to save faffing about trying to get my arms into a jacket. Likewise a cashmere or wool poncho is an excellent idea as, although it goes over the head, there are no sleeves, so it’s a doddle to get on, fits over your bandages and doesn’t rub against your poor sore boobs. (This one is good.)

AFTERWARDS

PAIN
It’s actually okay. If you bear in mind that they are chopping off glandular tissue and fat as opposed to muscle then it’s really not such a big thing. Post-op I was just given NSAIDs and standard over-the-counter painkillers. However, if you start trying to lift your arms, try to wash your hair, or sleep in any other position that lying propped up on your back then you will fiercely regret it. And long for ALL OF THE DRUGS.

CONVALESCENCE:

(I have created an Amazon shopping list with the things that I found essential for my recovery, from nursing pillows to scar gel, which you can find here. The items are all detailed below)

Hospitals in the UK must release you into someone’s care anyway in order to leave after a general anaesthetic and they strongly advise not to spend the first night home alone.

Clinic? I hear you say. Someone I know died of a blood clot at home on their own a few days post a breast reduction operation.  I was understandably freaked out by this. I wanted to be very near doctors for at least three nights in case any thing happened, which ruled out the parental homes in the middle of the countryside, and my sister has MS so I didn’t want to lean on her. Not fair.

I live in a one-bedroom apartment so anyone staying with me would be on the sofa, so I didn’t want to ask a friend to help me, so I booked into a convalescence home in Surrey, just outside London, for three nights. It took a while to find somewhere suitable – most convalescent homes cater for longer stays, and for more, erm, geriatric, patients. There are a couple that I found in Essex, but my hospital was in West London and, bearing in mind that going over speed bumps is f*cking painful post op, I didn’t want a lengthy journey through the city, stop/ starting through traffic.

The Surrey clinic was a truly excellent decision, not least because they had electric tilting beds – it’s hard to lever yourself up to a sitting position when you can’t more your arms because of PAIN, so the ideal scenario is sleeping propped up. When we booked they weren’t used to having such short-stay patients, but they had the space for me, so thought why not?

As I didn’t really need actual nursing, and my pain relief was just normal over the counter meds, they pretty much left me to my own devices, bar checking regularly that I hadn’t died, which was perfect – I am very anti-social.

I had a pretty room, with a sash window overlooking rolling grass lawns, and an en suite bathroom with a shower. Three meals a day were delivered to my bed (I shall draw a veil over the school dinners food – suffice to say I was happy I wasn’t having to cook, or think about meals beyond ticking menu boxes, and thankful that I had packed all the snacks), and the nurses were cheery and kind.

AFTER-CARE – MEDICAL
After about a week (in my case, six days) you will see your surgeon in his clinic, where he will check that nothing has fallen off, and that everything is healing as it should. He will remove the bandages and you be mildly revolted by the huge stitched together incisions in your boobs (the so-called anchor scars) which are waiting to mesh together. He will produce a roll of surgical tape and proceed to tape over the stitched together and as-yet unmeshed incisions. Groo.

You will then be able to go home with a big roll of said tape, and have a proper shower that will feel like the best shower in the world ever. You will also be extremely revolted when you discover that you need to peel off the tape to wash properly. This whole exercise gave me the serious heebs. You can’t just whip the tape off like Elastoplast: you have to gently lift and peel to avoid stretching the stitches. Erk.

There is a LOT of sticky surgical tape on your boobs. It will take bloody forever to remove. All around your areola, which have been repositioned, then down to the rib cage on each boob, and then along the entire under curve of each boob to the armpit. This de-taping was hands down the bit I hated most about the entire breast reduction exercise. Boak.

Then you can wash your boobs gently with non-perfumed soap or body wash (SkinFix is very good), and then, after patting dry with a very clean towel, you can re-tape the scars. Joy.

HOW LONG WILL I BE OFF WORK?
A friend in New York had the op and was back at work after a week. Likewise my English friend UL told me that after a week she was back doing appointments. I am not that hardcore. Although to be honest, if I was an American with only ten days vacation a year, I’d probably have gone back to work too.

Thankfully I work from home, so there was no real pressure to get up and about. I think you need two full weeks off work, but three would be the ideal (I took two). The first week is all about dealing with the woozy after-effects of general anaesthesia, getting your head around the op, and trying not to flinch in horror at the blood, scabs, and general grim around your bandaged chest area.

Week two is dealing with not much sleep, (so a lot of napping during the day), general grogginess, working from bed in between napping, and plucking up the courage to wash your boobs. I was in a breakfast meeting up The Shard two weeks to the day after my operation, and on site at the Chelsea Flower Show interviewing garden designers three days after that. With hindsight that was a mistake. Three weeks taking it easy at home would have been better, although I doubt it made much difference in the long run.

WILL I BE ABLE TO MOVE AROUND OR LIFT THINGS POST OP?
HAHAHAHA in your dreams. There will be no lifting of the arms more than 20 degrees from your side for at least a fortnight. Forget doing The Birdy Song. Or brushing your hair.

So if you have kids, you won’t be able to lift them or wheel a pushchair/buggy for quite some time. Think about how you will manage this, because you will really screw up your recovery otherwise. Dog walking is not possible on a lead for at least three weeks. Arrange walkers.

Get all your heavy dry goods shopping for at least a month done before the op, and, top tip, rearrange the kitchen so that everything you use regularly is on the counter. You will not be lifting your favourite coffee mug out of the eye level kitchen cabinet for a while. And forget about making cups of tea, because you won’t be able to lift the kettle – empty or full. Fill the fridge and freezer with microwave meals and nutritious snacks.

Put snacks, tissues, facial goop, hand cream, phone chargers, laptop, books, mags, iPad, scented candle & matches next to your bed, or in a basket next to you – you really don’t want to bend down to get anything that falls on the floor. This will really f*cking hurt.

BED AT HOME
You won’t be able to turn over at all, not even a tiny bit, and will need to sleep on your back, propped up on pillows, back and sides. Quite a lot of Americans who have blogged about their breast reduction experience seem to have spent a fortnight sleeping in a reclining chair, or a La-Z-Boy. Sadly one-bedroom London apartments do not fit poufy leather reclining chairs, so I stayed in my bed.

This is ESSENTIAL: The very first thing that I bought on coming home was a V-shaped boppy or nursing pillow which wedged me into a good sleeping position, and finally allowed me to get some sleep without waking up screaming because I’d inadvertently squished a boob in my sleep.  You will also need to buy a removable pillowslip for said pillow. Preferably two because you will be in bed ALL the time, and quite likely dribbling in your sleep. Nice.

WASHING
Not a lot of fun in the first week, or actually for a while. Buy baby wipes and dry shampoo. You will thank me.

You will be beyond desperate for clean hair by day two. Because I was in a clinic, the nurse was able to help me do this the first time without getting my dressings wet, which was like angels descending from heaven, because there was no way I could have done this on my own, least of all because I couldn’t either reach up to or hold the shower head. (Owwwww).

If you are at home, you’ll need someone to help you. We did mine with me kneeling on the floor and tipping my head over the side of the bath. If you have a fixed shower head then you may want to consider one of these inexpensive rubber attachments for the bath taps to save having jugs of water tipped over your head.

I was also very grateful for those beauty apps (Blow Ltd in London was excellent) that send people to your home to blow out your hair – I rang up before I booked to beg that the stylist wash my hair  (usually you wash your hair yourself before they arrive) and then tipped lavishly. In week two I also simultaneously booked a pedicure as I couldn’t bend to paint my toes and I was fed up with looking at my manky feet.

DRIVING
Not impossible. I had to take Lettice, my miniature sausage dog, to the vet to be neutered fourteen days after my op because I forgot to ask anyone to do it for me. I couldn’t face walking, so I drove the 1.5miles, and it was fine. But then I didn’t have to do any flashy manoeuvres, reverse parking, or three point turns. I don’t think that would have been fun. I didn’t get back in a car for a fortnight after that – but then I didn’t need to. Speed bumps are the devil. Top tip: Sit on the tip up seat in a black cab for a while after the op, as the axle is directly under the back seat and this makes for a bumpier ride.

BRAS
Everyone online bangs on about wearing sports bras immediately post op. All I can say is that they must be on crack. There was zero way I was putting a compressing sports bra anywhere near my very sore chest, six days after my bandages were removed. Not only could I not do one up behind my back, the whole point of a sports bra is to be tight to the body. Just thinking about stretching a sports bra over my body post–op makes me flinch a year down the road. (I also didn’t have the strength to pull it.) I burst into tears (post-op over emotion) when I got out the sports bra I had bought in advance and realised it was a non-starter.

What you need is a lovely soft bra without an underwire, and ideally front loading, as you won’t be able to move your arms to do up a bra from the back, especially if you live alone like I do.

My favourites after buying over twenty bras online post sports bra debacle (and sending most of them back) was the Silver Post Surgery Bra from Royce, which contain X-Static silver fibre to aid the healing process. They are seam free at front and sides to avoid irritation to incisions and scarring, and have a lower band so they are not snug under the breasts where your incision scars will be. Most importantly they are front-loading and front-fastening, and are drop cup for easy access to surgery areas.  I bought two and thought they were fantastic but not cheap at £33 each. Lifesavers, honestly.

The bras I ended up wearing for six months post op once I could move my arms behind my back were the Smooth And Comfort Non-Wired Bra from Marks & Spencer, which annoyingly they have discontinued. In its place I would recommend their Cotton Rich Zip Front Non-Padded Bra, and the Cotton Rich Non-Padded Full Cup, both of which have nice wide bands under the cup so they won’t irritate stitches. (Zip fronts are particularly good as so easy to get on over dressings and when it hurts to move your arms.)

Wacoal Embrace Lace Soft Bra, Black
(You won’t be wearing an underwire wire for six months whilst your breasts settle into their new shape. Instead you can fantasy shop online. I also got some beautiful soft lace bras to wear once my scars were healed. Heaven. I cried when a lovely PR sent me the pretty Wacoal bra above as a post op present in the post. I’d never worn a pretty delicate bra in my life.)

CLOTHES
I realised a few days before I went into hospital that I didn’t own any suitable nightwear, or dressing gowns. Of the items that I panic bought (most of them are in this post), the shorty pyjamas were the lifesavers, because I hadn’t thought about the fact that I wouldn’t be able to pull a nightie over my head. What you need is a button through nightdress, or a pyjama jacket.

Sasha Wilkins

The shorty set from Rosie at Marks & Spencer’s that I am wearing above was perfect for me, as it didn’t feel too lingerie-ish when I was receiving visitors at home, washed and dried like a dream, didn’t need ironing, and the shorts meant I didn’t get too hot in bed. (There’s a floral satin version at M&S here, and these lovely cotton H&M shorty pyjamas are perfect – and a bargain.)

(Nice crisp white shorty sets like these Next ones do look very beguiling but trust me when I say that wearing white and eating all your meals in bed is asking for trouble.)

CODEINE AND YOUR BOTTOM
Sorry guys, but this important. I had the worst codeine-related constipation you could possibly imagine post op. It was a nightmare of pain, whilst I was in the clinic, worse than any torture they can come up with in Game of Thrones. Forget bloody useless senna which you are usually given post-op – it had zero effect. I wish I had known about glycerin suppositories back then. They can be bought over the counter at any chemist, and they are life changing. Pop them in, and five minutes later bobs your uncle. Do not forget them or there will be tears. Proper snotty, gasping tears. (Who knew that constipation-pushing would make your sore boobs hurt even more?)

SCARS
A year later you can barely tell I’ve had the operation. Use silicone gel once the scars have closed up: HealGel is the most magic product in the whole world ever. I also used SilGel. These two products will stop you having angry red scars, and are essential. Don’t even think about not using them. They  help fade the appearance of all post surgery scars, soften scar tissues, and flatten raised scars. (Edited to add: three years later you wouldn’t know I had had the procedure. I have the boobs of a twenty-something. They’re bloody marvellous.)

STITCHES
You may also want to look away from this point: there are stitches under the skin as well as on the surface holding together the surgical work. Some of them float up to the surface of the skin during the healing process. This will be very disconcerting. I didn’t know about this and it wasn’t until I saw a friend who’d had the same procedure that I realised that the little stiff dark hair thing poking up was a stitch. My surgeon just pulled it out during a post op appointment. The final floater I found myself: I’d had a scab on one of the vertical scars way past the point when my other scars had closed. Eventually I flicked it off to discover a looped floating stitch hiding underneath. I tweezered it out, and the tiny hole that was left closed within days.

COST
I didn’t want to use the National Health Service for all the reasons above. But private breast reduction isn’t cheap, and I saved up for four years to afford my operation which, when I include transport, the clinic, after care, new bras, cabs, meds, takeout etc etc, clocked in at over £10 000. I still gulp when I see that figure. And I’m still paying it off.

A lot of specialist cosmetic surgery clinics that do every kind of procedure do all-in fees, and will cost maybe half what I paid. But I didn’t want to go to one of those clinics that advertise in the back of mags, travel abroad, or blag a freebie in return for press coverage. And I wanted to choose my surgeon, one who specialised in breasts.

If you go the Harley Street or private surgeon route remember that the surgeon’s fee will not include the cost of the hospital stay, the anaesthetist or the post-op pathology tests. However the practice manager gave me all these costs simultaneously at my first appointment, so there were no surprises later on down the line. The only surprise was on my first visit because I had budgeted £6k for the lot, so I had to wait another year to be able to realistically be able to afford to manage the debt I would incur.

THE TOTAL COST
My surgeon cost around £6000. The anaesthetist was around £1750. The hospital was around £2750. Path was £150.

The convalescent clinic was approx. £750 for three nights, all inclusive of meals, and 24hour on-call nursing care.

(The pathology tests are to test for breast cancer or any other diseases in the removed post-surgery tissue.)

Notes:
My surgeon: Mr Bassim Matti
Address: Suite 2, 30 Harley St, London W1G 9PW
Telephone: 020 7637 9595
www.aestheticrhinoplasty.co.uk

The Convalescent Clinic:
Lynden Hill Clinic, Surry
www.lynden-hill-clinic.co.uk

This post is my opinion only, and should not be taken as definitive. Always do your research before any kind of elective operation, and consult your GP in the first instance.

Some, if not all, links in this post may contain commission-bearing affiliate code

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34 comments

Reply

You are still one of the bravest gal’s I know!

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Thank you for sharing. I am a big booby girl and you explained exactly what it is like. The agony of dress shopping, the stares, the discomfort. I am so happy for you Sasha. Beyond my wildest dreams financially and I’m really not sure I would be brave enough but I appreciate all the information and honesty. Now can we have someone design beautiful affordable, comfortable bras for the thousands like me. Many thanks xxx

Reply

The only reason why I haven’t done it is cost. But the freedom associated with it afterwards must be amazing…

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I think you’ve been very wise to take this step as boobs seem to get even bigger as you get older – I was Twiggy size once , not now . The medical folk should issue your advice in an information leaflet . It must have been a real comfort for you & Lettice to be convalescing together .

Reply

Thank you for this. My surgery is in 3 weeks and all tips are so welcome. Have purchased more pyjamas and gowns than I’ve ever owned and obsessed with researching scar creams etc. Can’t wait to get some pretty, delicate bras

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As always, I hugely admire your honesty and integrity. This post must be so useful to very many people searching on the Internet.

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Although I have no need of breast surgery I think this post is truly brilliant and must be of enormous (!) help to people contemplating it. As ever, honest, insightful, witty, and beautifully written.

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Hi Sasha – I was just wondering how you used the two creams for scar reduction – what it one on the morning and the other at night? Or did you find out about the HealGel after you had used the SilGel?

In your opinion was the HealGel better? Just asking asking using SilGel at the moment but was curious if this other product is better. Thanks

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I love this article and wish you’d written it sooner! My sister had breast reduction surgery last summer and encountered so many complications. I had no idea how to support her because I didn’t research the op myself and wish I had. This is so bloody honest and refreshing! Plus I shall be ordering the gels for sis pronto!

P.S. Totally agree with your views on NHS. It f**king rocks.

Reply

Thank you so much for writing this blog entry. I will be making a big shopping list based upon your suggestions. I am having my reduction on 16 December (hoping I can have a celebratory glass of fizz or two on Christmas Day!?). I have waited around 15 years for my surgery (money, life, etc) so I am very excited!

Reply

Good for you! Do not forget the glycerin and the HealGel – both vital! I’m really excited for you: it is hands down the best thing I have ever done with my money. Worth every single penny. And I see no reason why you can’t drink a bottle (should you so wish!) on Christmas Day. I wish you all the success with your op.LLGxx

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