Breast Reduction Surgery

Overview:

Breast reduction is a cosmetic surgery procedure that reduces the size and weight of large, heavy breasts, helping to create a more aesthetically pleasing breast contour that is better proportioned to a patient’s body. By removing excess breast tissue, fat, and sagging, stretched skin, a cosmetic surgeon can not only make the breasts smaller, lighter, and firmer, but also improve breast symmetry and eliminate sagging.

While many patients choose breast reduction to alleviate physical symptoms such as back, neck or shoulder pain, shoulder grooves, or discomfort while exercising, the cosmetic benefits of breast reduction should not be overlooked:

• Your breast will be lifted and firmer, helping you look more youthful
• Bras will fit more comfortably and attractively
• With better proportioned breasts, your overall silhouette will be more balanced and attractive
• Stretched areolas and/or large nipples can be reduced during the same procedure, helping you look better in and out of clothing
• Swimsuits, sports bras, and form-fitting clothes will look and feel better, helping boost your confidence during activity

Who is a good candidate for breast augmentation?

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 the 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

Procedures:

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 individual 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.

Preparation and Recovery:

Preparation: After researching the basics about breast reduction, many patients want to know what to expect before breast reduction surgery.

Prior to breast reduction surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
• Stop smoking well in advance of breast reduction surgery
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

• What to do on the day of surgery
• Post-operative care and follow-up

Recovery:

Immediately after surgery:

• Your breasts will be covered with a gauze dressing or bandages
• A tube might be placed under each arm to drain any excess blood or fluid
• You likely will take medication for pain and antibiotics, to decrease your risk of infection

For the first days or week after surgery:

• Your breasts will probably feel tender and sensitive
• Your breasts might be swollen and bruised
• Your surgeon might recommend an elastic compression bra to protect the breasts

After that:

• You’ll need to limit physical activity for two to four weeks while the breasts heal
• Your surgeon might suggest avoiding underwire bras for a few months after surgery

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

Further information:

Breast Reduction Options

Cosmetic surgeons can use one of several different surgical techniques when performing breast reduction; which technique a surgeon will use for any given patient depends on the patient’s existing breast anatomy, the type and amount of tissue to be removed, and the patient’s desired outcome.

Liposuction for Breast Reduction

In certain cases, breast reduction can be performed using liposuction alone.

The advantages of liposuction for breast reduction are a shorter, less invasive procedure, virtually undetectable scars on the breast, and lasting results. However, this technique will only achieve optimal results in certain patients. The best candidates are those who need or desire a slight to moderate reduction in breast size, have good skin elasticity and little to no sagging to correct, and whose excess breast size is largely due to excess fatty tissue.

If you have sagging, asymmetrical breasts, stretched skin, or a more significant amount of tissue to remove, one of the next breast reduction techniques will probably benefit you the most.

Vertical or “Lollipop” Breast Reduction

Patients who need a moderate reduction in breast size and have more noticeable sagging are often good candidates for a vertical breast reduction. This involves two incision sites: one is around the edge of the areola, and a second incision running vertically from the bottom of the areola to the inframammary fold, or the crease beneath the breast. This incision pattern allows a cosmetic surgeon to remove excess fat, skin and breast tissue, reshape the new smaller breast internally, and lift the breast into a more youthful position.

While a vertical breast reduction leaves some scarring on the breast, it is limited to the area below the nipple and therefore can be easily hidden beneath a bra or bikini top.

Inverted-T or “Anchor” Breast Reduction

The inverted-T breast reduction involves 3 incisions: one around the edge of the areola, one vertically from the areola to the breast crease, and one made along the crease underneath the breast. Because this technique allows for the maximum degree of tissue removal and reshaping, cosmetic surgeons will typically use this approach if a patient needs a more significant breast size reduction and/or has considerable sagging or asymmetry to correct.

The scars resulting from an inverted-T or anchor breast reduction are similar to those from a vertical reduction, with one additional, thin scar running along the crease beneath the breast. With proper care, scars typically fade considerably over the first year or so after surgery and are easily concealed by clothing, even a bikini top.

Risks and Complications:

The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.

Possible breast reduction surgery risks include:

• Unfavorable scarring
• Infection
• Changes in nipple or breast sensation, which may be temporary or permanent
• Anesthesia risks
• Bleeding (hematoma)
• Blood clots
• Poor wound healing
• Breast contour and shape irregularities
• Skin discoloration, permanent pigmentation changes, swelling and bruising
• Damage to deeper structures—such as nerves, blood vessels, muscles and lungs—can occur and may be temporary or permanent
• Breast asymmetry
• Fluid accumulation
• Excessive firmness of the breast
• Potential inability to breastfeed
• Potential loss of skin/tissue of breast where incisions meet each other
• Potential, partial or total loss of nipple and areola
• Deep vein thrombosis, cardiac and pulmonary complications
• Pain, which may persist
• Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
• Fatty tissue deep in the skin could die (fat necrosis)
• Possibility of revisional surgery

You should know that:

• Breast reduction surgery can interfere with certain diagnostic procedures
• Breast and nipple piercing can cause an infection
• Your ability to breastfeed following reduction mammaplasty may be limited; talk to your doctor if you are planning to nurse a baby
• The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
• Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations

FAQ