Therapeutic mammoplasty is a form of breast conserving surgery that is a modified breast reduction operation. Therapeutic mammoplasty reshapes the breast and raises the nipple higher. It may be suggested if you either have large breasts that you would like to be smaller, or if the area that needs to be removed is large compared to the size of your breast.
There are more scars after therapeutic mammoplasty and it is more complex surgery that takes longer to carry out than standard breast conserving surgery. Your Surgeon will explain to you where the scars are likely to be on your breast, but in general these will be going around your areola (the dark skin around your nipple) and then straight down and possibly also along in the fold underneath your breast. There is a greater chance of problems with wound healing and infection after therapeutic mammoplasty and this can delay your additional treatments as chemotherapy and radiotherapy cannot be given until wounds are healed. Sometimes the blood supply to the nipple may be insufficient following therapeutic mammoplasty and part or all of the nipple can die off. This happens in around 1 in 100 cases, but the risk is increased if you are a smoker, diabetic, and/or have very droopy breasts. Your surgeon will explain if your risk of this is very high and may suggest that you have the nipple removed as part of your surgery. If your nipple is removed or dies off it will be possible to consider nipple reconstruction in the future if you wish.
There may also be problems with lumpiness after surgery caused by reduced blood supply to the fatty tissue of the breast (this is known as ‘fat necrosis’). Fat necrosis can also causes flecks of chalk (‘microcalcification’) in the breast tissue which show up on a mammogram. If either lumpiness or microcalcification occur you may need to have investigations to be sure it is only due to fat necrosis, and rarely additional surgery may be required to remove lumps. If you have large breasts then having them made smaller with a therapeutic mammoplasty can make it easier for the postoperative radiotherapy to be given to you, which may lower the chance of breast lymphoedema after radiotherapy.
Breast reduction surgery to the other breast may be required after therapeutic mammoplasty; particularly if it has been done to deliberately make your breast smaller. Sometimes this surgery to the other breast can be done at the same time as your therapeutic mammoplasty, but sometimes it is left until all of your cancer treatment is complete. Having both sides operated on at once avoids you being too asymmetrical after surgery, but sometimes the treated breast can change in size particularly after radiotherapy and delaying surgery to the other breast can make it easier to get a better size match. Also, if we know you will be needing chemotherapy after surgery we may suggest you have this before you return for surgery to the other side to lower the chance of wound complications delaying your chemotherapy starting. If you only have surgery to one side to start with you will be given a prosthesis to put in your bra to match you up until the other side is operated on.