What is breast reduction surgery?

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 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 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 condition, breast composition, amount of reduction desired, your personal preferences, and the surgeon’s advice.

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.

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

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).

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.

Step 5 – See the results

The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.

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

Be sure to ask your plastic surgeon specific questions about what you can expect during your recovery period.

• Where will I be taken after my surgery is complete?

• What medication will I be given or prescribed after surgery?

• Will I have dressings/bandages after surgery? When will they be removed?

• Are stitches removed? When?

• When can I resume normal activity and exercise?

• When do I return for follow-up care?

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 before 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.