Breast Reduction

Breast reduction, also known as reduction mammaplasty, 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.

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

Types of Breast reduction

Vertical or “Lollipop” Breast Reduction

Patients who need a moderate reduction in breast size and have more noticeable sagging are often good candidates for a vertical breast reduction. This involves two incision sites: one is around the edge of the areola, and a second incision running vertically from the bottom of the areola to the inframammary fold, or the crease beneath the breast. This incision pattern allows a cosmetic surgeon to remove excess fat, skin and breast tissue, reshape the new smaller breast internally, and lift the breast into a more youthful position.

While a vertical breast reduction leaves some scarring on the breast, it is limited to the area below the nipple and therefore can be easily hidden beneath a bra or bikini top.

Inverted-T or “Anchor” Breast Reduction

The inverted-T breast reduction involves 3 incisions: one around the edge of the areola, one vertically from the areola to the breast crease, and one made along the crease underneath the breast. Because this technique allows for the maximum degree of tissue removal and reshaping, cosmetic surgeons will typically use this approach if a patient needs a more significant breast size reduction and/or has considerable sagging or asymmetry to correct.

The scars resulting from an inverted-T or anchor breast reduction are similar to those from a vertical reduction, with one additional, thin scar running along the crease beneath the breast. With proper care, scars typically fade considerably over the first year or so after surgery and are easily concealed by clothing, even a bikini top.

Breast Reduction Surgery & Recovery

Breast reduction surgery is typically performed as an outpatient procedure using general anesthesia or intravenous sedation with local anesthesia. After making the incisions using one of the techniques described above, your cosmetic surgeon will remove excess breast tissue, fat, and skin, moving the nipple/areola complex to a higher, more forward position on the chest. The remaining breast tissue and skin will be reshaped and closed with dissolvable sutures. The areolas can be reduced to a more proportional size during the procedure as well.

After spending a brief time in supervised recovery, you will be able to go home that same day to continue your recovery. Your chest will be bandaged, and you may be sent home in a surgical bra. You can expect to feel considerable soreness the first couple of days after your procedure, and your cosmetic surgeon will prescribe pain medication to help keep you comfortable during this initial period. Gently placing ice packs on top of the bandages can help alleviate discomfort as well.

The amount of time you need to recover from breast reduction will depend on your natural healing rate as well as the extent of surgery performed. You will be able to get up and walk around the same day of surgery, although you should have a trusted adult with you during the first 24 hours. While you may be permitted to shower a few days after surgery, you will probably need help getting dressed, as you will not have full range of motion in your chest and shoulders at first.

Most patients feel ready to drive and return to a desk job within 1 week, after they are no longer taking prescription pain medication. Your cosmetic surgeon will likely have you wait a minimum of 3 to 4 weeks before resuming exercise other than walking; this helps to ensure your incisions heal properly. It is essential to follow your cosmetic surgeon’s regarding activity after breast reduction.

Life After Breast Reduction

Because it both alleviates physical and emotional discomfort and enhances a patient’s appearance, breast reduction can be one of the most rewarding cosmetic surgery procedures. Patients note an increase in self-confidence as well as a renewed sense of freedom to wear the clothes they want to wear and participate in physical activities they had previously avoided.

While many patients experience an immediate relief from back and shoulder pain after breast reduction, it is important to understand that it will take some time for your final results to settle in. Swelling, soreness, and tingling are typical after breast reduction, so your new smaller breasts may appear a little larger than you had expected while initial swelling is present. Additionally, the breasts often heal at a different rate, so you may notice some asymmetry during the first few months of your recovery.

After about 2-3 months, your final results will be more or less in place and you can shop for new bras with confidence. However, you may notice subtle changes for the first 6 to 12 months.

Will the Results of Breast Reduction Last?

After breast reduction, you can expect to enjoy smaller, lighter breasts for a lifetime, so long as you maintain a stable weight and do not have any more children. However, nothing can stop the normal aging process. Eventually your breasts will probably begin to sag once again, although not as severely as they might have before breast reduction.

Also, future pregnancies are likely to change the shape, size, and appearance of your breasts, possibly reversing some of the positive changes made during breast reduction. If you are planning to have more children, talk to your cosmetic surgeon. He or she can help you weigh the pros and cons of having surgery now or waiting until you have finished having children.

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 mammaplasty 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