Breast reduction is a surgical procedure designed to reduce the size of overly large breasts. This procedure, performed by a plastic surgeon, removes part of a woman’s breast tissue. Occasionally, the nipples and areola (dark area surrounding the nipple) will be repositioned surgically higher on the breasts for cosmetic reasons.
Over the past 14 years, the number of breast reductions has increased 162 percent, according to the American Society of Plastic Surgeons (ASPS). The ASPS reports that the number of breast reductions performed each year is now over 100,000.
In many cultures, the female breast symbolizes both sexuality and motherhood. But overly large breasts may lead to debilitating neck and back pain. Some of the most common problems associated with overly large breasts include:
Chronic back, neck and shoulder pain
Poor posture
Notching on the shoulders from the bra straps
Restricted activity levels
Heat rashes under the breasts
Self-image concerns
Difficulty finding well-fitting bras and clothing
Most women are pleased with the results of the surgery. The alleviation of pain, the ability to participate in more activities and a boost in self-confidence are among the benefits reported by women who undergo breast reduction.
One disadvantage is that the scars from this type of surgery may be noticeable; however the scars are often hidden from view. Women are usually able to wear a bra or bathing suit without the scars being visible. As with any surgical procedure, there is a potential risk of infection and other significant complications. Full recovery generally takes five to six weeks, but complete healing can take several months.
About breast reduction
Women who have disproportionately large breasts (female breast hypertrophy or macromastia) can elect to have breast reduction surgery (reduction mammoplasty). Some women who develop abnormally large breasts experience significant stress on the shoulders, neck and trunk because of the compensatory need to support the additional breast weight.
Women with large, normal breasts are different from those with macromastia. This condition often starts during or soon after puberty. At times, this condition can arise during pregnancy and persist afterward. In extremely rare cases, a condition known as virginal breast hypertrophy can develop in which breast enlargement progresses very rapidly.
Large, sagging breasts can plague women because they restrict activities and often cause physical discomfort. The symptoms of female breast hypertrophy may result in persistent, debilitating pain. In such cases, the condition can be alleviated or, in most cases, eliminated, through breast reduction surgery (reduction mammoplasty). Some of the most common problems associated with disproportionately large breasts include:
Chronic back, neck and shoulder pain
Poor posture
Breast pain or tenderness
Notching on the shoulders from the straps of bras
Self-image concerns
Bras and clothing that are difficult to fit
Restricted activity levels
Heat rashes under the breasts
Frequent headaches
Positioning for sleep difficulties
Breathing problems
Breast reduction is a surgical procedure designed to reduce the size of overly large, pendulous breasts (larger than a D cup). In this surgical procedure, performed by a plastic surgeon, a significant portion of the breast tissue is removed. For cosmetic reasons, the nipples and areola (dark area surrounding the nipple) may be repositioned higher on the breasts.
Reduction surgery removes a considerable amount of the breast, including the skin and underlying glandular tissue, in an effort to create a smaller breast. The average reduction reduces a woman’s bra size from a DD cup (or larger) to a C cup.
Most often, a woman will elect to have breast reduction surgery for physical relief from pain rather than for aesthetic purposes. A breast reduction in the absence of painful symptoms is considered a cosmetic procedure and is rarely covered by insurance. However, for women who require the surgery for relief of painful symptoms, insurance will usually cover the procedure. In such cases, breast reduction is considered reconstructive surgery because it is correcting a congenital defect.
Breast reduction surgery can take several hours to perform and is usually done with the patient under general anesthesia. Because this procedure involves fairly extensive surgery, it is considered an inpatient procedure, meaning that the patient will need to stay overnight at the hospital.
Breast reduction is a fairly common surgical procedure performed by plastic surgeons. More than 100,000 women each year elect to reduce the size of their breasts, according to the American Society of Plastic Surgeons (ASPS) – making it the fifth most popular reconstructive procedure performed by plastic surgeons. The reasons for these reductions vary, but often include both personal and medical reasons.
One drawback to the procedure is that many insurance companies will not cover the cost of breast reduction surgery unless it is medically necessary. In some cases, a certain amount of breast tissue might need to be removed in order to be covered under insurance. This can range from 250 to 500 grams, which is the equivalent of a half-pound to 1 pound of tissue from each breast. Patients should consult with their insurance company prior to the procedure to determine coverage.
Before the breast reduction procedure
Prior to surgery, the plastic surgeon will most likely take a medical history and perform a physical examination in order to evaluate the overall physical health of the patient. It is important for the patient to share any previous problems relating to the breasts, including any breast pain, lumps or cancer.
Patients may be asked to donate blood prior to the breast reduction procedure in case a transfusion later becomes necessary. The woman should inform her physician about all medications she is taking to ensure that none of them will cause complications. In some cases, the physician may recommend that the woman have a mammogram before the procedure to screen for any signs of disease prior to the reduction surgery.
Patients are typically asked to refrain from eating or drinking for eight to 12 hours prior to surgery. The patient should also abstain from smoking for at least two weeks before and two weeks after the surgery since it can delay healing time. It is also advisable to avoid taking certain vitamins or even aspirin for a period of time prior to surgery.
Prior to the procedure, the plastic surgeon will measure and mark the breasts. These marks will serve as a guide during surgery. During this consultation, the physician will discuss the surgical technique, the type of anesthesia to be used and the patient’s expectations. Other areas for discussion that should take place before the procedure include:
A description of the procedure
An idea of what the scarring will look like
An examination of the patient’s breasts, including taking photographs and measurements of the breasts
Discussion of factors that may affect the outcome, including age, size and shape of the patient’s breasts
Discussion about the position of the nipples and areolas, especially if the patient plans to breastfeed after the reduction procedure
Costs and insurance issues
Possible complications and risks
Pre-operative and post-operative instructions
During the breast reduction procedure
Breast reduction is usually an inpatient procedure, meaning that an overnight hospital stay is required. This procedure is performed with the patient under general anesthesia (the woman is asleep during the procedure). The surgery can take three to four hours and sometimes more depending on the patient’s condition, the extent of the reduction and other circumstances.
To reduce the size of the breasts, the plastic surgeon makes an anchor-shaped incision around the areola (dark area around the nipple), down the breast in a vertical line and then along the natural crease of the breast. During the breast reduction surgery, fat, glandular tissue and skin from the breasts are removed.
For this procedure, the surgeon may use liposuction to remove excess fat from underneath the armpit. In addition, the areola may be reduced in size in certain cases. For many women, the nipple and areola are left intact. However, for some women whose breasts are particularly large, the areola and nipple may need to be moved to a higher position for cosmetic purposes.
Women who are planning to breastfeed their children should discuss this procedure carefully with their plastic surgeon beforehand. Once the nipple and areola are cut and moved, breastfeeding is no longer possible.
After the breast reduction procedure
Immediately following breast reduction surgery, swelling, pain, bruising and tenderness are all normal. These complications can last for several weeks and sometimes longer, but should diminish over time. Most complications can be controlled through medication prescribed by the plastic surgeon.
To help with the healing process, a post-operative bra, compression bandage or athletic bra is often recommended to provide additional support during recovery. However, compared to an athletic bra, the post-operative surgical bra is often easier to put on and take off for changing bandages and to launder. The surgical bra is worn 24 hours a day, seven days a week for the first several weeks after surgery.
The surgeon will usually insert one or more drains (plastic or rubber tubes) into the breast or underarm area. The drains remove blood and lymph fluid that accumulates during healing. At home, patients may need to empty pouches attached to the drains. Women should alert their physician about any problems that arise, such as a large swelling of tissue. This swelling may be due to excess underlying fluid. This is rare, and fluid can be extracted with a needle in a procedure known as aspiration. Drains usually remain in place for several days following surgery. They are then removed once the drainage has subsided.
Symptoms that might indicate an infection, such as fever or redness of the breast, should be reported and evaluated by a physician as soon as possible. Patients should discuss issues such as scarring, pain and recovery time with their surgeon as these vary considerably among individuals. Most patients find that they are able to get up and around within 48 hours.
Although it can take several weeks to fully recover, many women are able to return to work in two to three weeks as long as they are not required to lift more than 10 pounds. Full recovery generally takes five to six weeks, but complete healing can take several months. During that time, a woman who has undergone breast reduction may find that her breasts are tender and sensitive or even swollen and bruised, especially during the initial recovery period.
In addition, for premenopausal women, the first menstruation following surgery may cause breasts to swell and can increase the tenderness or discomfort in the area. Occasional shooting pains in the breasts following reduction surgery is normal and can last for several months after the procedure.
Although much of the swelling and bruising will be gone after the first few weeks, it may take six months or more before a woman’s breasts completely settle into their new shape. However, even after a year, a woman may find that her breasts will change in relation to weight changes or hormonal shifts, such as pregnancy.
Exercise, especially aerobic activity, should be held off a minimum of two to three weeks to reduce the risk of bleeding, swelling and bruising. Other exercise that includes weightlifting or contact sports should not resume for at least four weeks. Breast reduction patients are advised to avoid sex for at least one to two weeks as the sexual arousal of the breasts can cause them to swell and place stress and possibly painful pressure on the incisions.
The scarring from the incisions will be pink and hard for several weeks. Afterward, in a process that may take many months, the scars will begin to fade and possibly even appear to widen (flatten) some. Eventually, most scars will fade but not disappear entirely.
Breast reduction surgery will change the size, shape and amount of breast tissue a woman has. For this reason, women who elect to have this procedure are advised to have a preoperative mammogram as well as a postoperative mammogram within six months to a year following surgery to allow for comparison.
Potential benefits and risks of breast reduction
In addition to the cosmetic and emotional benefits many women experience following breast reduction surgery, there are other advantages to this surgery. For example, some women find that monthly breast self-examinations and mammography are easier following reduction surgery.
One of the most noticeable differences for women is in the area of exercise. Women with large, pendulous breasts (breast hypertrophy) often find it difficult to run or participate in many aerobic activities. Following reduction surgery, exercise is far easier and more comfortable.
However, breast reduction surgery carries with it some degree of risk for complications. Some of the complications or risks associated with breast reduction surgery include:
Infection
The formation of a hematoma, which is an area of clotted blood that forms in the breast often from a broken blood vessel
Excessive bleeding
Delayed healing of the incisions
Fatty necrosis (tissue death) of the breast tissue
Noticeable scarring
Hypertrophic scarring or keloid (thick and excessive) scarring (rare)
Cosmetic imperfections which may require additional corrective surgeries
Aesthetic imperfections of the shape, size or position of the nipples
Impaired nipple sensation, which may be permanent
Elimination of lactation for breastfeeding
Beyond the risks normally associated with surgery, a plastic surgeon may not recommend breast reduction in certain instances. These concerns can lead to possible complications, ranging from excessive bleeding during surgery to slower healing times. Some of the concerns that may prevent a woman from having breast reduction surgery include:
Tobacco use
Steroid use
Anticoagulant use
Plans to breastfeed
Questions for your doctor on breast reduction
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their condition. Patients may wish to ask their doctor or healthcare professional the following questions about breast reduction surgery:
Am I a good candidate for breast reduction surgery?
Can I try other lifestyle changes before considering surgery?
How many breast reductions have you performed?
Will the operation be covered by insurance?
Will I be in the hospital overnight?
What breast reduction technique would be used for my surgery?
Is there a surgical technique that will preserve my ability to breastfeed?
How much scarring will occur on my breasts?
When will my bruises go away?
What type of lifestyle restrictions will I have following surgery?
Is there a chance that the breast tissue may grow back?
