Breast Reduction

What is breast reduction surgery?

Breast reduction, also known as reduction mammoplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia).

Disproportionately large breasts can cause both physical and emotional distress for patients. Patients with macromastia may experience physical discomfort resulting from the weight of their breasts. The resulting pain can make it challenging for some patients to perform common physical activities.

Along with the physical ailments of macromastia, some patients may suffer from emotional distress or more significant mental health problems as a result of their large breasts.

Although breast reduction is often performed to address medical issues, patients who do not have the symptoms of macromastia but are unhappy with the size of their breasts can still pursue breast reduction as an aesthetic procedure. Patients choosing to undergo breast reduction surgery for cosmetic reasons may cite any number of factors, including social stigmas and wardrobe concerns.

What are the steps of a breast reduction procedure?

Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.

In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below.

If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.

The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice.

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Step 1 – Anesthesia

Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

 

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Step 2 – The Incision

Incision options include:

  • A circular pattern around the areola

  • The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.
  • A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease.

  • An inverted T or anchor-shaped incision pattern

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Step 3 – Removing tissue and repositioning

After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.

Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

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Step 4 – Closing the incisions

The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.

What You should know / Frequently Ask Questions

Who is a good candidate for breast reduction surgery?

Overly large breasts can cause health and emotional problems. In addition to self-image issues, you may also experience physical pain and discomfort. The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts can be as important an issue as the physical discomfort and pain.

You may be a candidate for breast reduction surgery if:

  • You are physically healthy
  • You have realistic expectations
  • You don’t smoke
  • You are bothered by feeling that your breasts are too large
  • You have breasts that limit your physical activity
  • You experience back, neck and shoulder pain caused by the weight of your breasts
  • You have shoulder indentations from bra straps
  • You have skin irritation beneath the breast crease

What are the risks of breast reduction surgery?

The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.

Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.

Possible breast reduction surgery risks include:

  • Unfavorable scarring
  • Infection
  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Anesthesia risks
  • Bleeding (hematoma)
  • Blood clots
  • Poor wound healing
  • Breast contour and shape irregularities
  • Skin discoloration, permanent pigmentation changes, swelling and bruising
  • Damage to deeper structures—such as nerves, blood vessels, muscles and lungs—can occur and may be temporary or permanent
  • Breast asymmetry
  • Fluid accumulation
  • Excessive firmness of the breast
  • Potential inability to breastfeed
  • Potential loss of skin/tissue of breast where incisions meet each other
  • Potential, partial or total loss of nipple and areola
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Pain, which may persist
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
  • Fatty tissue deep in the skin could die (fat necrosis)
  • Possibility of revisional surgery

You should know that:

  • Breast reduction surgery can interfere with certain diagnostic procedures
  • Breast and nipple piercing can cause an infection
  • Your ability to breastfeed following reduction mammoplasty may be limited; talk to your doctor if you are planning to nurse a baby
  • The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
  • Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single breast reduction procedure and another surgery may be necessary.

How should I prepare for breast reduction surgery?

After researching the basics about breast reduction, many patients want to know what to expect before breast reduction surgery.

Prior to breast reduction surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
  • Stop smoking well in advance of breast reduction surgery

Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.

What should I expect during my breast reduction recovery?

Many patients have questions about recovery from breast reduction surgery.

When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions for breast reduction recovery that may include:

  • How to care for your breasts following breast reduction surgery
  • Medications to apply or take orally to aid healing and reduce the risk of infection
  • Specific concerns to look for at the surgical site or in your general health
  • When to follow up with your plastic surgeon

What results should I expect after breast reduction surgery?

The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction.

Your better-proportioned figure will likely enhance your self-image and boost your self-confidence.

However, over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.