What is breast reduction surgery?

Breast reduction surgery entails the removal of skin and tissue from the breast, followed by reshaping and elevating to create a smaller, more proportionate bust size.

Many women struggle with the decision to have a breast reduction, but afterwards consider it one of the best decisions they ever made for themselves.

Women pursue this surgery for various reasons, but all with the goal of enhancing their overall quality of life:

• Improved confidence and self-expression: Many women say that after a breast reduction they are more confident in themselves and more comfortable in their own bodies.
• Easier to shop: Women often report that finding clothes that fit them becomes much easier and they can shop at almost any store they want.
• Back feels better: Women almost always report that having smaller breasts significantly reduces back pain and gives them newfound energy throughout the day.
• Bras don't hurt: By removing weight from their breasts nearly all women experience a significant reduction in bra strap pain.
• Exercise with ease: Women frustrated with the pain and discomfort of having overly large breasts can finally exercise in the way they want.
• Skin feels better: For women with very large breasts, skin irritation under the breasts is common; this is significantly reduced after a breast reduction.
• Easier to breathe: Women find it easier to breathe with smaller, more proportionate breasts.

Overview

Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue, and skin from the breasts. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance.

Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. If you're thinking of breast reduction surgery, talk to a board-certified plastic surgeon. It's important to understand what's involved with breast reduction surgery, including possible risks and complications. It's also important to know what the surgery can and can't do.

Why it's done

Breast reduction surgery is meant for people who have large breasts that cause the following:

• Chronic back, neck, and shoulder pain
• Shoulder grooves from bra straps
• Chronic rash or skin irritation under the breasts
• Nerve pain
• Not being able to take part in some activities
• Poor self-image due to large breasts
• Trouble fitting into bras and clothing

Breast reduction surgery generally isn't recommended for people who:

• Smoke
• Are very obese
• Don't want scars on the breasts

You can have breast reduction surgery at any age — sometimes even as a teenager. But breasts that aren't yet fully grown might need a second surgery later in life.

Reasons to postpone breast reduction surgery include:

• Planning to have children. Breastfeeding might be challenging after breast reduction surgery. However, certain surgical techniques can help keep the ability to breastfeed.
• Planning to lose weight. Losing weight can often result in changes to breast size.

Risks

Breast reduction surgery has the same risks as other major surgeries — bleeding, infection, and a bad reaction to the anesthesia. Other possible risks include:

• Bruising, which is temporary
• Scarring
• Difficulty or inability to breastfeed
• Differences in the size, shape, and look of the left and right breasts
• Not being happy with the results
• Rarely, losing the nipples and skin around the nipples or the feeling in them

How You Prepare

Your plastic surgeon will likely:

• Look at your medical history and overall health
• Discuss what size you want your breasts to be and how you want them to look after the surgery
• Describe the surgery and its risks and benefits, including likely scarring and possible loss of feeling
• Examine and measure your breasts
• Take photographs of your breasts for your medical record
• Explain the type of medicine used to put you to sleep during surgery

Planning breast reduction surgery might require:

• A mammogram
• Not smoking for at least six weeks before and after surgery
• Not taking aspirin, anti-inflammatory drugs, and herbal supplements, to control bleeding during surgery

Usually, you can go home the day of the surgery. Arrange for someone to drive you home from the hospital.

After the Procedure

Immediately after surgery:

• The breasts are covered with bandages and a surgical bra to hold them in place
• A tube might be placed under each arm to drain any extra blood or fluid
• You may receive medicine for pain and medicine to decrease the risk of infection

For the first days or week after surgery:

• The breasts will probably feel tender
• The breasts might be swollen and bruised
• A surgical bra that closes in front is worn to support the breasts

After that:

• Limit physical activity for 4 to 6 weeks while the breasts heal
• Wear an approved surgical bra at all times to allow the breasts to heal and reduce swelling

Scarring fades over time. You will need a follow-up visit with your surgeon to check your recovery.

What You Can Expect

Breast reduction surgery is usually done under general anesthesia, either in a hospital or outpatient surgical center.

During the Procedure

The method used to reduce the size of your breasts can vary. The process might include:

• Surgery through incisions
• Liposuction to remove excess fat in the breasts

The surgeon usually:

• Makes an incision around the nipple and areola and down each breast
• Removes excess breast tissue, fat, and skin to reduce the size of each breast
• Reshapes the breast and resets the nipple and area around it, also known as the areola

The nipple and the area around it usually stay attached to the breast. For very large breasts, the surgeon might need to remove them and add on a new nipple.

Your surgeon will try to make your breasts look alike, but breast size and shape might vary somewhat. The size of the areola also might be smaller. The incision scars will fade over time, but they won't completely go away.

Why the Procedure Is Performed

Breast reduction may be recommended if you have very large breasts (macromastia) and:

• Chronic pain that affects your quality of life. You may be having headaches, neck pain, or shoulder pain.
• Chronic nerve problems caused by poor posture, which result in numbness or tingling in your arms or hands.
• Cosmetic problems, such as persistent bra-strap groove, scar-like lines in the skin (striae), difficulty finding clothes that fit, and low self-confidence.
• Chronic rashes under your breasts.
• Unwelcome attention that is making you feel awkward.
• Inability to participate in sports.

Some women may benefit from non-surgical treatments, such as:

• Exercising to strengthen their back and shoulder muscles
• Losing excess weight
• Wearing supportive bras

Risks

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots, or infection

Risks specific to this procedure include:

• Difficulty breastfeeding, or being unable to breastfeed
• Large scars that take a long time to heal
• Loss of feeling in the nipple area
• Uneven position of the nipples or differences in the size of the breasts

After the Procedure

You may go home the same day or stay overnight in the hospital.

A gauze dressing (bandage) will be wrapped around your breasts and chest. Or, you will wear a surgical bra. Wear the surgical bra or a soft supportive bra for as long as your surgeon tells you to. This will likely be for several weeks.

Drainage tubes may be attached to your breasts. These tubes will be removed within a few days.

Your pain should decrease in a few weeks. Ask your surgeon if you can take acetaminophen (Tylenol) or ibuprofen (Advil) to help with pain instead of a narcotic medicine. If you do use a narcotic medicine, be sure to take it with food and plenty of water. Do not apply ice or heat to your breasts unless your surgeon has told you that is OK.

Ask your surgeon when it is OK to shower or bathe.

Within a few weeks, the swelling and bruising around your incisions should disappear. You may have a temporary loss of sensation in your breast skin and nipples after surgery. Sensation may return over time.

Follow any other self-care instructions you are given.

Schedule a follow-up visit with your surgeon. At that time you will be checked for how you are healing. Sutures (stitches) will be removed if needed.

Results

Successful breast reduction surgery can relieve pain in the upper back, neck, and shoulders. It might also increase the ability to take part in physical activities and promote a better self-image.

Results will show right away, but it can take months for the swelling to completely go down and the surgical scars to fade. The final result generally lasts a long time. But aging, changes in weight, pregnancy, and other factors can change breast shape and size.

Breast Reduction

Reduction mammoplasty; Macromastia – reduction

Description

Breast reduction surgery is done under general anesthesia. This is medicine that keeps you asleep and pain-free.

For a breast reduction, the surgeon removes some of the breast tissue and skin. Your nipples may be moved higher to reposition them for cosmetic reasons.

In the most common procedure:

• The surgeon makes three surgical cuts (incisions) around the areola (the dark area around your nipples), from the areola down to the crease under your breast, and across the lower crease of your breast.
• Extra fat, skin, and breast tissue are removed. The nipple and areola are moved to a higher position. Often the areola is made smaller.
• The surgeon closes the cuts with stitches to reshape the breast.
• Sometimes liposuction is combined with breast reduction to improve the shape of the breast and armpit areas.

The procedure can last 2 to 5 hours.

Before the Procedure

Ask your surgeon if you need a screening mammogram based on your age and risk of having breast cancer. This should be done long enough before surgery so if more imaging or a biopsy is needed, your planned surgery date won't be delayed.

Tell your surgeon or nurse:

• If you are or could be pregnant
• What medicines you are taking, even medicines, supplements, or herbs you bought without a prescription

The week or two before surgery:

• You may be asked to stop taking blood thinning medicines. These include aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin, Jantoven), and others.
• Ask your surgeon which medicines you should still take on the day of the surgery.
• If you smoke, try to stop. Smoking slows healing and increases the risk for problems. Ask your health care provider for help quitting.

On the day of surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Wear or bring loose clothing that buttons or zips in front.
• Arrive at the hospital on time.

Outlook (Prognosis)

You are likely to have a very good outcome from breast reduction surgery. You may feel better about your appearance and be more comfortable with various activities.

Pain or skin symptoms, such as striation, may disappear. You may need to wear a special supportive bra for a few months for comfort and to help with healing.

Scars are permanent. They will be more visible for the first year, but will then fade. The surgeon will make every effort to place the surgical cuts so that scars are hidden. Cuts are usually made on the underside of the breast and around the areola. Most of the time, the scars should not be noticeable, even in low-cut clothing.