Breast Reduction

Breast reduction may be necessary for men or women. In women, enlarged breasts are called breast hypertrophy, and in men, enlarged breasts are called gynecomastia. Typically, breast hypertrophy in women occurs in both breasts at puberty or soon afterward, although pregnancy related breast enlargement can persist indefinitely. There is also a rare possibility of women experiencing sudden onset breast enlargement. About half of all men today have excess localized fat and/or excess glandular tissue in one or both breasts. Gynecomastia accounts for more than 65 percent of all male breast disorders, according to the American Society of Plastic Surgeons (ASPS). In most cases, the cause is unknown. Gynecomastia can be caused by an imbalance of the sex hormones estrogen and testosterone, certain endocrine disorders, tumors, chronic diseases, anti-depressant medication, blood-pressure medication, marijuana, steroids, lavender oil, or tea tree oil. True gynecomastia will not improve with diet and exercise because the fat pockets that form will be resistant to these health changes. Rehabilitation from breast surgery, including liposuction, can and should begin even before the surgery itself.

Patients who are to undergo breast surgery, no matter the extent of the procedure, will benefit from a physical therapy program that includes a baseline evaluation before the surgery, followed by physical therapy treatment that begins immediately after surgery – the most critical period of time for rehabilitation.

Why physical therapy before and after reduction? The most common physical problems, pain, and dysfunction that come with large breasts can be improved by physical therapy to encourage better surgery outcomes, faster recovery time, and improved pain management. Many plastic surgeons recommend that activity should be kept to a minimum for 1-2 weeks and that heavy lifting or pushing should not be allowed for 3-4 weeks. We will provide education, guidance, and support so that you can get back into physical activity and your daily activities with less fear and anxiety.

Common Problems

Patients that have breast reduction frequently experience:

• Limited upper extremity mobility (range of motion)
• Arm weakness and swelling
• Fatigue
• Shoulder dysfunction
• Back pain
• Chest pain
• Uncomfortable or painful scars

Patients may not immediately notice these difficulties, as they may have intentionally kept their arms immobile for fear of hurting the incision. It may be only when a patient tries to lift something, perform household chores, drive – or even zip up a zipper – that they realize their arm does not move as it once could. Several of the post-surgical problems are interrelated. The surgery itself and scarring from it can, for example, tighten the skin on the chest wall and form fibrous adhesions, which can cause shoulder joint dysfunction. This dysfunction can lead to improper joint use, in turn causing the joint to contract, or tendonitis to develop. The results are pain, muscle spasms, immobility and the loss of range of motion. Once the stitches are removed and the incisions are closed we will provide and instruct you how to perform gentle scar massage to help improve the shape, movement, and pliability of your scars.

Other Difficulties

Additional difficulties may result from breast reduction surgery may include:

• One of the most significant complications of breast surgery is lymphedema, or swelling of the arm. In addition to causing discomfort, such swelling can produce other complications, including infection as well as changes in posture and musculoskeletal problems related to the increase in the arm’s weight.

• The scapula, or shoulder blade, is susceptible to problems after surgery. Trauma to the long thoracic nerve during surgery can cause temporary or permanent paralysis of the muscle that helps stabilize the scapula (the serratus anterior muscle). This may be first noticed when the patient tries to reach for something, or when headaches, low-back pain or interscapular pain occur.

• Nerve entrapment by adhesions or cutaneous nerve regeneration may cause chest wall pain and numbness. These conditions are often worse for patients who have undergone reconstructive surgery.

• Over-compensating for the loss of breast weight may cause prolonged spasms of the rhomboids or trapezius muscles.

• Abdominal pain often occurs after reconstructive surgery.

Treatment

The degree of difficulty patients encounter with any of these complications varies with the extent of the disease and the procedure, as well as age and prior orthopedic problems.

Recovery from breast surgery – which may take several years – is however, even more directly linked to the timing, intensity and quality of a rehabilitative physical therapy program.

With a preventative goal, a physical therapist will begin treatment before surgery to: