Breast Reduction

Breast reduction is one of the most rewarding surgical procedures available to patients who have a large breast size. New techniques and procedures have made it possible to create a more natural looking breast.

Best candidates for Breast Reduction

Women with very large, heavy breasts may have a number of medical and other problems caused by excessive weight. These problems may include:

  • back and neck pain
  • skin irritation
  • skeletal deformities
  • breathing problems
  • indentations in the shoulders from bra straps
  • ill-fitting clothing

Breast reduction, called "reduction mammoplasty", is a procedure to remove extra fat, glandular tissue, and skin from the breasts. This procedure can also reduce the size of the areola, the darker skin surrounding the nipple. The result is smaller, lighter, and firmer breasts that are more in proportion with the rest of a woman's body. The procedure can also help achieve symmetry where breasts are not equal in size.

Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large breasts that restrict their activities and cause them physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breastfeed because the surgery removes many of the milk ducts leading to the nipples.

Risks and complications

Breast reduction is not a simple operation, but it is usually safe. There are risks and possible complications associated with this type of surgery. You can reduce your risk of complications by closely following your physician's advice both before and after surgery.

Some patients may have bleeding, infection, or a reaction to the anesthesia. Others may develop small sores around their nipples after surgery, which can be treated with antibiotic creams.

The procedure does leave noticeable, permanent scars, which are usually covered by your bra or swimsuit. Some patients may experience a permanent loss of feeling in their nipples or breasts.

Your physician will discuss these risks and complications with you. Be sure to ask questions about anything you do not clearly understand.

Planning your breast reduction surgery

Your physician will examine and measure your breasts and will take photographs for reference during surgery and afterward and for your medical records. Your physician will discuss your particular situation which may affect your results such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they will be moved higher during the procedure and should be approximately even with the crease beneath your breasts.

Your surgeon will explain the type of anesthesia that will be used, the facility where the surgery will be performed, and the costs. While some insurance companies pay for breast reduction based on medical necessity, they may require that a certain amount of breast tissue be removed. Please check your policy and ask your surgeon to write a "predetermination letter" if it is required.

Preparing for your surgery

After your initial consultation, your surgeon may also require you to have a mammogram (breast x-ray) to check for cancer or other abnormalities prior to breast reduction surgery.

You will be given specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking cessation, and taking or avoiding certain vitamins and medications. Plan to have a friend or relative drive you to and from the clinic or hospital where you will have surgery.

The day of surgery

Before entering the operating room, the surgeon will ask you to sit upright. While sitting, surgical markings will be drawn on your breasts. The markings outline the "sitting-up" position of your breasts, to make the correct incisions later during surgery when you are lying down.

The most common procedure for breast reduction involves making an incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess tissue, fat and skin, and moves the nipple and areola into their new position. The skin from both sides of the breast is moved down toward the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. For women with very large breasts, however, the nipples may need to be moved and grafted to a completely new location. In these cases, the nipples are removed from the underlying connecting tissues and sensation in the nipple and areola is lost.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. There are ways to eliminate the vertical part of the scar. Occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.

After your surgery

After surgery, you will be wrapped in an elastic bandage or a surgical bra over gauze bandages. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.

For the first couple of days, you may feel pain, especially when you move around or cough. Caring for young children immediately after surgery is not recommended. General discomfort may last for a week or more. Your physician will prescribe medication to reduce the pain.

The bandages will be removed a day or two after surgery, though you will continue wearing the surgical bra around the clock for several weeks until the swelling and bruising subside. The stitches will be removed in one to three weeks. Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more. In rare cases, it may be permanent.

Resuming normal activities

Your physician will give you detailed instructions for resuming your normal activities. Most women can return to work and social activities in about two weeks.

You may be tired for several weeks. Limit your exercises to stretching, bending, and swimming until your energy level returns. You will also need a good athletic bra for support.

A small amount of fluid draining from your surgical wound is normal. If you have unusual symptoms such as bleeding or severe pain, call your doctor immediately.

Your new body

Much of the swelling and bruising will disappear in the first few weeks, but it may take six to twelve months before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.

Your surgeon will make every effort to make scars as unnoticeable as possible. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months. Scars will gradually fade to thin white lines over time.

Breast reduction results in a very quick change to the shape of your body. You will no longer have the physical discomfort of large breasts. Your body will be in better proportion, and your clothes will fit you better. Give yourself, and your family and friends, time to adjust to your new shape. Be patient. Keep in mind why you had surgery and chances are that you will be pleased with the results.