Breast Reduction (Reduction Mammoplasty)
Breast reduction, also known as reduction mammoplasty, is a surgical procedure that reduces the size of overly large breasts.
Patients who undergo breast reduction surgery frequently are seeking relief from physical symptoms caused by the excessive weight of large breasts.
Breast reduction usually can solve these problems as well as improve the size and shape of your breasts. Following breast reduction, your breasts will be more proportional to the rest of your body, and clothes will fit you better.
Am I a good candidate for breast reduction?
You may be a good candidate for breast reduction if you have one or more of the following conditions:
- breasts that are too large in proportion to your body frame
- heavy, pendulous breasts with nipples and areolas that point downward
- one breast is much larger than the other
- back, neck or shoulder pain caused by the weight of your breasts
- skin irritation beneath your breasts
- indentations in your shoulders from tight bra straps
- restriction of physical activity due to the size and weight of your breasts
- dissatisfaction or self-consciousness about the largeness of your breasts
Breast reduction can be performed at any age, but surgeons usually recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this with your surgeon. During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.
How will my surgeon evaluate me for breast reduction surgery?
Your surgeon will examine your breasts, taking measurements and perhaps photographs for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.
You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. It is important for you to provide complete information.
You should tell your surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss. Your surgeon may recommend that you stabilize your weight before having surgery.
How Breast Reduction is Performed
Individual factors and personal preferences will determine the specific technique selected to reduce the size of your breasts.
Where are the incisions placed?
The most common method of reducing the breasts involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision follows the natural curve of the breast crease.
After the surgeon has removed excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, also is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.
Usually, the nipples and areolas remain attached to underlying mounds of tissue, and this allows for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed.
One common breast reduction technique removes excess breast tissue, fat and skin through the incisions shown. The nipple and areola remain attached to the underlying tissue but are shifted to a higher position. The size of the areola is often reduced at the same time. Skin that formerly was located above the nipple is brought down and together to reshape the breast.
What are some variations to the common breast reduction technique?
There are many variations to the design of the incisions for breast reduction. The size and shape of your breasts, as well as the desired amount of reduction, are factors that will help your surgeon determine the best technique for you.
In some instances, it may be possible to avoid the vertical incision that runs from the bottom edge of the areola to the breast crease or the horizontal incision underneath the breast.
Rarely, if your breasts are extremely large, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In such a case, you will need to have made the decision to sacrifice sensation and the possibility of breast-feeding in order to achieve your desired breast size.
Fortunately, significant complications from breast reduction are infrequent. Every year, many thousands of women undergo successful breast reduction surgery, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and the risks.
I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?
The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon’s office.
Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Rarely, a patient may require a blood transfusion during the operation. This usually can be anticipated in advance, and your surgeon may, under certain circumstances, advise you to donate your own blood in preparation for surgery.
Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time. Permanent loss of sensation in the nipples or breasts may occur rarely. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts. You can help to lessen certain risks by following the advice and instructions of your surgeon, both before and after surgery.
How will I look and feel initially?
The day after surgery, you will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts.
Any surgical drains will be removed a day or two after surgery, at which time your dressings may also be changed or removed. You will be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminishes. Generally, stitches will be removed two to three weeks unless dissolving stitches are used.
You may notice that you feel less sensation in the nipple and areola areas. This usually is temporary. It may, however, take weeks, months or even more than a year before sensation returns to normal. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery.
When can I resume my normal activities?
After breast reduction surgery, it is often possible to return to work within just a couple of weeks, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor.
There are risks and complications with this procedure.
They include but are not limited to the following.
- Infection can occur, requiring antibiotics and further treatment.
- Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood-thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
- Small areas of the lung can collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
- Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
- Heart attack or stroke could occur due to the strain on the heart.
- Blood clot in the leg (DVT) causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs.
- Death as a result of this procedure is possible.