Overly large breasts can cause health and emotional problems as the weight of excess breast tissue can impair one’s ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large breasts can be as important an issue as the physical discomfort and pain.

Breast reduction, also known as a reduction mammoplasty, removes excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with a patient's body, while also alleviating discomfort. If a breast reduction is right for you, a physician will perform an initial consult and physical exam to take breast measurements and discuss goals and expectations. It is important to discuss current medications, vitamins, herbal supplements, alcohol, tobacco and drugs, previous surgeries, family history of breast cancer and results of any mammograms or previous biopsies.

The physician will also discuss possible risks from a breast reduction, which include general risks of surgery as well as:

• Changes in nipple or breast sensation, which may be temporary or permanent
• 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
• 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
• Death of fatty tissue (fat necrosis)

Should I get a breast reduction?

Breast Reduction is a good option for patients who:

• Are physically healthy
• Have realistic expectations
• Don’t smoke
• Are bothered by feeling that their breasts are too large
• Have breasts that limit physical activity
• Experience back, neck and shoulder pain caused by the weight of their breasts
• Have shoulder indentations from bra straps
• Have skin irritation beneath the breast crease

Breast Reduction Surgical Procedure

Patients will get a baseline mammogram before surgery and another one after surgery to help detect changes in the breast tissue.

Breast reduction surgery is usually performed under general anesthesia through surgical removal of the excess fat, glandular tissue and skin via incisions on the breasts. In some cases, excess fat may also be removed through a combination of incision and liposuction, or even liposuction alone if breast size is largely due to fatty tissue and excess skin is not a factor.

There are several incision techniques for breast reduction surgery such a circular pattern around the areola, a keyhole pattern around the areola with a vertical line or an inverted anchor shape pattern. The size and shape of the breast, along with the preoperative discussion with the surgeon will determine which pattern will be used.

Whichever pattern the surgeon chooses, the incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra. 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 in a free nipple graft.

The incisions are then 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.

Recovery Time for Breast Reduction

After a breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra can 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.

Most breast reduction patients can go home the same day as surgery, but some may be kept overnight for observation and pain control. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing.

Many health insurance plans cover breast reduction surgery. The plastic surgeon may need to obtain authorization from an insurer for the surgery. This may require a letter and the submission of photographs.