In this Article
Breast Reduction
What Is Breast Reduction Surgery?
Breast reduction surgery is a procedure to reduce the size of very large breasts. Breast reduction surgery is done to relieve physical discomfort associated with large sagging breasts. It is not performed for appearance only.
The aim of surgery is to make the breasts smaller and to improve their shape so they are in proportion to the body. The surgery removes excess tissue, fat, and skin from large, often sagging breasts. At the same time, the areola (the circle of dark skin around the nipple) may be made smaller. Sometimes the nipple and areola are moved to a higher position.
The technical name used for the procedure is reduction mammaplasty .
Breast reduction surgery has among the highest patient satisfaction rate of any cosmetic procedure.
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Facts about breast reduction surgery:
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Who Is A Good Candidate For Breast Reduction Surgery?
Breast reduction surgery is not usually done for appearance only. It is done to relieve medical problems and physical discomforts caused by unusually large breasts. These discomforts include:
- Back and neck pain
- Poor posture and deformities of the skeleton
- Grooves and scars on shoulders from bra straps
- Rashes on the skin under the breasts
- Breathing problems
Overlarge breasts can also cause inconveniences in daily life.
- Many women find it difficult or impossible to find clothing and bras that fit.
- Women with big breasts often draw unwanted stares and comments and can feel limited in the social and physical activities in which they can participate.
- They sometimes find sports or vigorous activity painful.
- Large breasts can make many women, especially adolescent girls, extremely self-conscious.
In most cases, breast reduction surgery cannot be done until the breasts are fully grown, usually by age 18.
A woman who intends to breast-feed a baby probably should not have the procedure. It’s preferable to delay the procedure until she has had all her children.
Women whose breasts are sagging but not too large might receive more benefit from a breast lift, also known as mastopexy.
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Need To Know: It is important to know that breast reduction surgery can reduce the size of the breasts and relieve the discomfort caused by very large breasts, but it can’t create perfect breasts. |
What Are The Risks Of Breast Reduction Surgery?
The breast reduction procedure is normally safe. But as with any surgical procedure, there are risks relating to the procedure itself or to the anesthetic. Any early sign of infection will be vigorously treated, and if bleeding occurs postoperatively, it will be immediately dealt with.
Some people who have breast reduction surgery experience:
- Delayed wound healing.
- Noticeable, permanent scars on the breasts. The breast reduction procedure will leave scars, but some women have a greater tendency to produce scar tissue than others do. Women who smoke are more likely to heal slowly and develop prominent scars.
- Small sores around the nipples following surgery. These sores can be treated with antibiotic cream.
- Breasts that are slightly mismatched or nipples that are unevenly positioned.
- Inability to breast-feed because most of the milk ducts leading to the nipple are removed.
- Permanent loss of feeling in the nipples or breasts.
- Loss of blood supply to the nipple and areola, which can lead to tissue death. This complication is rare, and the nipple and areola can usually be rebuilt from skin grafts taken from other parts of the body.
- Infection, which in very rare cases can lead to death if it is not effectively treated.
Who Should Not Have Breast Reduction Surgery?
Breast reduction surgery is not recommended for women with:
- Breast cancer
- Uncontrolled diabetes
Cellulitis (infection of the soft tissue of the breast)- Hardened breast skin
- Dry or broken breast skin
What Is The Procedure For Breast Reduction Surgery?
How To Prepare For Breast Reduction Surgery
A woman who is considering breast reduction surgery should consult a plastic surgeon. She should talk openly with the doctor about her reasons for wanting a breast reduction and what she expects from the operation.
The surgeon will describe the procedure in detail, and discuss the possible complications, as well as what surgery can and cannot achieve. Breast reduction surgery does leave scars, but they can usually be covered by clothing or a bathing suit.
First Consultation With The Surgeon
At the first meeting in the office, the plastic surgeon will
- conduct a complete physical examination and take a medical history
- examine and measure the breasts
- photograph the breasts (These photographs can be used for reference during and after the operation. They may also be useful in placing a health-insurance claim.)
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Nice To Know: Q. Is breast reduction surgery covered by insurance? A. If the procedure is deemed medically necessary because of neck or back pain, some insurance plans will cover it. They usually require that a minimum amount of fat be removed to qualify, often in the range of 500 grams (the equivalent of 1.1 pounds), depending on height and weight. The doctor usually must write a “predetermination letter” to the insurance company beforehand to confirm that it will be covered. |
A woman whose breasts become tender just before her period should be careful not to schedule her consultation appointment at that time.
Most women are advised to have a mammogram or breast x-ray before the surgical procedure. Because the size, shape, and mass of the breast will be changed, it is also advisable to get another mammogram six months to a year after the procedure.
The doctor should also discuss individual factors that might influence the decision to have the procedure, such as age, previous plastic surgeries, and the condition of the breasts. The doctor will explain where the surgery will be done and what kind of anesthetic will be used.
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Nice To Know: Q. I am thinking of having breast reduction surgery but I’m not sure how to go about finding a good surgeon. How do I find a qualified plastic surgeon? A. Professional organizations, such as the American Society of Plastic Surgeons, can provide a list of certified plastic surgeons practicing in your area, but word of mouth is sometimes best. Ask women who have had breast reduction surgery how they found their surgeon and whether they were happy with the results. Primary care physicians can also make recommendations. Check a surgeon’s experience and credentials. Most public libraries carry the Directory of Medical Specialists, a reference that can be used to check the credentials of any referred physician. It is also acceptable to ask surgeons directly about their qualifications, the number and complication rates of breast reduction surgeries they have performed, and the cost of the surgery. These questions should be addressed at the first consultation. |
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Nice To Know: Q. I’m thinking of having breast reduction surgery, but I’m worried about breast cancer. Will breast reduction make it more likely that I will develop breast cancer? A. No. The operation does not increase the risk for cancer, nor does it interfere with routine screening techniques for finding breast lumps later. In fact, some women may find that having mammograms is easier after breast reduction, and lumps may be easier to find when breasts are less massive. The tissue removed during reduction surgery will be examined under a microscope for signs of cancer, so in some ways, the operation itself is like a giant Coincidentally, the same study found that women who had the operation also had somewhat lower rates of lung, cervical, and digestive cancers. |
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Nice To Know: When a woman is thinking of having nose surgery, the cosmetic surgeon often uses computer imaging to show her what her nose will look like after the procedure. This type of computer imaging isn’t used with breast reduction surgery. Instead, the desired size of the breast and |
Preparing For The Operation
Breast reduction surgery is usually done in the hospital, and the patient is usually asked to arrive about an hour before the procedure is scheduled. She will be given a general anesthetic, which means that she will sleep through the entire operation. The procedure usually takes from two to four hours and requires an overnight stay in the hospital.
- Patients are usually given guidelines about eating and drinking before the surgical procedure. They are generally asked not to take aspirin, ibuprofen, vitamin E, gingko biloba, or other medicines and supplements that thin the blood during the two weeks before the operation.
- A patient who smokes may be asked to stop for a period of time before the operation. Smoking reduces the amount of oxygen available to body tissue and, as a consequence, slows healing and increases scarring. Women who are heavy smokers are sometimes advised not to have the procedure because of poor blood supply to the skin.
- On rare occasions when a great deal of breast tissue is removed, blood transfusions may be required during or after the operation. Some patients may be advised to have their own blood drawn and “banked” before the operation in case a transfusion is needed.
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Nice To Know: If you intend to lose weight, it may be best to do it before having breast reduction surgery. Weight loss after the procedure may cause the breasts to lose mass and droop. |
The Operation
The most frequently used breast reduction procedure is performed through an incision that circles the areola and passes down the lower central part of the breast; then curves sideways in the natural skin crease at the base of the breast. The incision is shaped somewhat like an anchor, so it is called an “anchor shaped incision”
- Excess tissue, fat, and skin are removed through this incision.
- The nipple and areola are moved into their new position.
- The skin that was once above the nipple on both sides of the breast is brought down and around the areola, giving the breast a new shape and contour.
In most cases, the procedure leaves the nipples and areolas attached to their blood vessels and nerves. But if the breasts sag very low and the skin and tissue supporting them is stretched, the surgeon may have to remove so much tissue that it will be necessary to cut the nipples and areolas completely away from the breast. After the removal, the nipple and areola are grafted back onto the breast in a higher position. When the nipple and areola have to be moved in this way, the patient is likely to lose feeling in them.
The incision is closed with stitches. Depending on the amount of bleeding, a small drainage tube may be left in the wound that will be removed in a day or two.
- The operation is usually performed with general anesthetic, which means it takes place in an operating room while the patient is unconscious.
- Usually an overnight stay in the hospital is all that is necessary.
- Some cases may require as long as five days in the hospital.
- Some patients will be able to go home the same day.
If the breasts are not too stretched, reduction can sometimes be done by liposuction, a technique in which fat is sucked out of the breast through a tube attached to a vacuum. Liposuction, which can be done through tiny incisions, causes very little scarring and allows faster recovery. However, because the breast is not repositioned, it may sag more after fat is removed.
Sometimes liposuction is used along with reduction surgery to remove fat from around the armpits.
What To Expect After Breast Reduction Surgery
Once the stitches are in place, the incision will be covered in gauze dressing and then wrapped in a bandage or surgical bra to hold them in place. A surgical bra is somewhat like a sports bra with a front opening. It is constructed in such a way that the seams don’t hit the incision sites, and it is very adjustable.
There may be some pain in the first day or two after the procedure and some discomfort for about a week. Moving around and coughing may make the pain worse. The doctor will prescribe medication to control pain and discomfort.
- Women are advised not to shower for at least the first several days after the operation.
- The bandages and drainage tube are removed a day or two after the operation, but the surgical bra should be worn 24 hours a day for about a month.
- Stitches are usually ready to come out one to two weeks after the operation.
It is normal for the area around the nipple and lower breast to feel different after the surgery. It usually returns to normal in a couple of months, though in some patients can take much longer. If the nipples were moved, the loss of feeling on the nipples will likely be permanent.
- A small amount of fluid draining from the wound, and even some crusting around the incision, is normal. However, if there is severe pain or bleeding, contact a doctor.
- Breasts will ache and feel tender for a couple of weeks. The first menstruation after the operation may cause pain and swelling in the breasts.
- You can usually get back to light work in 2 to 3 weeks. Your surgeon will discuss this with you. The stress and strain of surgery leaves most people feeling fatigued for several weeks.
- Exercising should be limited to stretching, bending and swimming for the first few weeks until stamina returns. A good athletic bra is recommended for support.
- It is best to avoid heavy lifting or pushing for at least a month.
- Surgeons often ask women to refrain from having sexual intercourse for a week or so after the reduction procedure because becoming sexually aroused can cause the wound to swell. Anything but gentle contact with the breasts should be avoided.
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How To Information: How should I prepare for the recovery process? Plan to spend about two inactive weeks at home engaging in light activities such as reading and watching television. It might be a good idea to gather a supply of your favorite books, magazines, and videos. In addition, it might be helpful to:
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How Long Until Full Recovery?
The breasts don’t usually achieve their final shape immediately after surgery. It takes up to six months for everything to settle down. The scars from breast reduction surgery are noticeable and usually permanent, and they can remain lumpy and red for months. Most scars will become less noticeable over time and may fade to thin white lines. The scars are limited to the lower part of the breast and therefore will not show under low-cut tops and bathing suits
It may take a while to adjust to the new look. Women who have undergone this procedure should give themselves, their families, and their friends time to adjust. Be patient. Breast reduction surgery has the highest patient satisfaction rate of any of the cosmetic procedures. Nearly every woman who has this procedure is pleased with the outcome.
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Nice To Know: Some surgeons are working to develop new techniques, such as vertical mammaplasty, that reduce the amount of scarring, especially under the breasts. These techniques are not often used for breast reduction because it can be somewhat difficult to control the outcome. However, in some cases, these new techniques can be used. If a woman is concerned about scarring, she should discuss newer techniques with her doctor. |
Frequently Asked Questions: Breast Reduction
Here are some frequently asked questions related to breast reduction.
Q: I’m thinking of having breast reduction surgery, but I’m worried about breast cancer. Will breast reduction make it more likely that I will develop breast cancer?
A: No. The surgery does not increase the risk for cancer, nor does it interfere with routine screening techniques for finding breast lumps later. In fact, some women may find that having mammograms is easier after breast reduction, and lumps may be easier to find when breasts are less massive. The tissue removed during reduction surgery will be examined under a microscope for signs of cancer, so in some ways, the operation itself is like a giant
Q: Is breast reduction surgery covered by insurance?
A: If the procedure is deemed medically necessary because of neck or back pain, some insurance plans will cover it. They usually require that a minimum amount of fat be removed to qualify, often in the range of 500 grams (the equivalent of 1.1 pounds), depending on height and weight. The doctor usually must write a “predetermination letter” to the insurance company beforehand to confirm that it will be covered.
Q: My daughter is 16 and wants to get breast reduction surgery. Is that too young?
A: Surgeons generally require that breasts be fully developed before they will consider performing a reduction procedure. Breasts are usually fully grown by age 18. In some cases, if the discomfort is very bad, reduction surgery can be done at a younger age.
Q: Will I be able to nurse my baby after I have breast reduction surgery?
A: In many cases the milk ducts leading to the nipple are cut during breast reduction surgery. However, some women find that they can breast-feed after surgery, at least partially. Most need to supplement their breast milk with formula.
Q: Will my breasts grow again after the reduction surgery?
A: Unless the operation is done at an age when the breasts are still developing, they will not grow large again after the operation. However, the breasts will increase in size with weight gain or pregnancy. Conversely, they get smaller with weight loss. As a result, doctors recommend that women have the operation only after finishing any weight-loss diet or regimen.
Q: I am thinking of having breast reduction surgery but I’m not sure how to go about finding a good surgeon. How do I find a qualified plastic surgeon?
A: Professional organizations, such as the American Society of Plastic Surgeons, can provide a list of certified plastic surgeons practicing in your area, but word of mouth is sometimes best. Ask women who have had breast reduction surgery how they found their surgeon and whether they were happy with the results. Primary care physicians can also make recommendations. Check a surgeon’s experience and credentials. Most public libraries carry the Directory of Medical Specialists, a reference that can be used to check the credentials of any referred physician. It is also acceptable to ask surgeons directly about their qualifications, the number and complication rates of breast reduction surgeries they have performed, and the cost of the surgery. These questions should be addressed at the first consultation.
Putting It All Together: Breast Reduction
Here is a summary of the important facts and information related to breast reduction.
- Breast reduction surgery is done to relieve physical discomfort associated with large sagging breasts. It is not performed for appearance only.
- Breast reduction surgery will leave permanent scars but they may fade with time. They can also be camouflaged by clothing and will not keep a woman from wearing a bathing suit or a low-cut top.
- Breast reduction surgery does not increase the chances of developing breast cancer.
- Breast reduction surgery is sometimes covered by health insurance. It is best to check with the insurance carrier before having the operation.
- Breast reduction surgery has the highest patient satisfaction rate of any of the cosmetic procedures.
Glossary: Breast Reduction
Here are definitions of medical terms related to breast reduction.
Areola: disk of darker tissue surrounding the nipple on the breast.
Biopsy: removing tissue from a part of the body to be examined under a microscope for signs of disease.
Cellulitis: an infection of the tissues under the skin. Cellulitis sometimes occurs as the result of a surgical incision or a wound or a suppressed immune system.
Reduction Mammaplasty: the medical term for breast reduction surgery. A “plasty” is a surgical procedure undertaken to rebuild or reconstruct a part of the body. “Mamma” is the Latin word for breast.
Additional Sources Of Information: Breast Reduction
Here are some reliable sources that can provide more information on breast reduction.
American Society of Plastic Surgeons
Phone: 1-888-4-PLASTIC
www.plasticsurgery.org
The ASPS maintains a web site for both consumers and plastic surgeons. Information can be found there about plastic surgery in general and about specific procedures. A surgeon referral service is also available.
American Academy of Cosmetic Surgery
Phone: 312.527.6713
http://www.cosmeticsurgery.org
MEDLINEplus Health Information Breast Implants/Breast Reconstruction page
http://www.nlm.nih.gov/medlineplus/breastimplantsbreastreconstruction.html
Medline Plus is a website offered by the United States National Library of Medicine as a tool for the consumer and the medical professional to find the latest information about any disease or procedure. This site offers links to reliable articles and to a search engine, MEDLINE, for searching the professional periodical literature. Links to medical dictionaries are also offered. Although they currently have more links to information about breast implants than about breast reduction, the site is frequently updated and should contain links to the latest information.