Breast Reduction


Sarah Lewis, PharmD

What is a breast reduction?

A breast reduction is the surgical reshaping of the breast to make it smaller. Breast reduction, also called reduction mammoplasty, involves removing excess fat, glandular tissue, and skin to reduce breast size. Some people seek breast reduction for cosmetic or aesthetic reasons. Your doctor may also recommend it if large breasts are causing discomfort, back problems, or other health problems.

Breast reduction surgery is a common but major surgery with significant risks and potential complications. You may have less invasive treatment. Consider getting a second opinion about all your choices before having breast reduction surgery.

Types of breast reduction surgery

The types of breast reduction procedures include:

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  • Free nipple graft (FNG) involves removing your nipple and grafting it in a new location on your breast. Your surgeon removes breast tissue while your nipple is off, and then grafts your nipple back into place.

  • Liposuction involves injection and suction of fatty tissue and usually leaves little or no scarring.

  • Pedicle method involves making a circular incision around your areola (the dark area that surrounds your nipple) to remove breast tissue.

  • Anchor incision is an extension of the pedicle method with an incision that runs vertically down from the areola to the bottom of your breast and into a semi-circle around the bottom of your breast. This makes an anchor-like incision.

  • LeJour incision is an extension of the pedicle method with an incision that runs vertically down from the areola to the bottom of your breast and stops at your chest wall.

  • Stevens laser bra uses a laser and the extra skin that would normally be discarded to create a permanent internal support structure for your breasts.

Other procedures that may be performed 

Your surgeon may perform other procedures in addition to breast reduction surgery. The most common combination is a breast reduction with a breast lift (mastopexy). A breast lift is a procedure to boost sagging or loose breasts.

Why is a breast reduction performed?

Your doctor may recommend breast reduction surgery if you want smaller breasts for cosmetic reasons. Your doctor may also recommend it if large breasts are causing discomfort or medical problems.

Not everyone is a good candidate for breast reduction surgery. A good surgical candidate is physically healthy, does not smoke, has fully developed breasts, and has realistic expectations of improvement, not perfection. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on breast reduction surgery.  

Your doctor may recommend breast reduction surgery if you are a good surgical candidate and:

  • One breast varies in size or shape from the other one.

  • One or both breasts did not develop normally.

  • You are self-conscious about your breasts or feel that your breasts are too large or are disproportionate to your body size.

  • Your breasts interfere with your ability to participate in sports or other physical activities.

  • Your breasts cause sleep difficulties.

  • You have poor posture or numbness and tingling in your arms due to the weight of your breasts.

  • You have headaches or back, neck or shoulder pain due to weight of your breasts.

  • You have permanent grooves in your shoulders from your bra strap holding the weight of your breasts.

  • You have skin irritation, rashes, sores, or infections under the crease of your breast.

  • Your breasts have stretched skin, stretched areolas, or nipples that hang below your breast crease.

  • You are a male with gynecomastia (breast enlargement in males).

Who performs a breast reduction?

A plastic surgeon or a cosmetic surgeon performs breast reduction. A plastic surgeon is a specialist in aesthetic and reconstructive surgery. A cosmetic surgeon focuses on aesthetic surgery—most procedures are elective and not medical necessary. A cosmetic surgeon performs some of the same surgeries as a plastic surgeon, including breast augmentation, but the surgeons’ education and training are different.

How is a breast reduction performed?

Your breast reduction will be performed in a hospital or outpatient surgery setting. Your surgeon will use one of the following approaches:

  • Minimally invasive surgery involves inserting special instruments and an endoscope through small incisions in your underarm or around the base of your breasts. An endoscope is a thin, lighted instrument with a small camera. The camera sends pictures of the inside of your body to a video screen viewed by your surgeon while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision(s) instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

  • Open surgery involves making a large incision around your areola and under your breast. Open surgery incision allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your surgeon will advise you on which type of surgery is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different breast reduction procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used

Your surgeon will perform breast reduction surgery using either general anesthesia or regional anesthesia, depending on the specific procedure.

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your breast reduction

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the surgeon, anesthesiologist, or nurse anesthetist about your medical history and the type of anesthesia you will have.

  • A surgical team member will start an IV.

  • The surgeon, anesthesiologist, or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a breast reduction?  

As with all surgeries, a breast reduction involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery 

The general risks of surgery include: 

Potential complications of a breast reduction

Complications of a breast reduction include:

  • Change in color of nipples and areola, which may be permanent

  • Change or loss of nipple and areola sensation, which may be permanent

  • Differences in breast sizes

  • Difficulty with breastfeeding or inability to breast feed

  • Large scars that may remain