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:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
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 visible
Loss of nipples and areola
Uneven position of nipples or contour of your breasts
Reducing your risk of complications
You can reduce the risk of some complications by following the treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy. It is also important to tell your doctor if you plan on becoming pregnant, breastfeeding, or losing weight in the future.
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
Wearing a post-surgical support bra as directed by your healthcare provider
How do I prepare for my breast reduction?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for breast reduction surgery by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a breast exam, mammograms, chest X-rays, blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions your appointments. Questions can include:
Am I a good candidate for breast reduction surgery? Are there any other options for me?
Which type of breast reduction surgery procedure will I need?
What results can I expect?
What options do I have if I am not satisfied with the results?
What other breast-related or revision surgery should I expect to have over my lifetime?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
How do I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my breast reduction?
Knowing what to expect can help make your road to recovery after breast reduction surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have tubes attached to your breasts to drain fluids. Your surgeon will usually remove them within three days. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may go home on the same day if you are recovering well. In other cases, a hospital stay of one day is required.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. You may need to wear a surgical support bra for several weeks after your surgery. Full recovery takes a couple of weeks to a month.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after breast reduction surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, palpitations, or uneven heart beats
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. You should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication
Sudden change in shape or firmness of your breast or breasts
Unexpected drainage, pus, redness or swelling of your incision
How might abreast reduction affect my everyday life?
Breast reduction surgery can have dramatic effects on your physical well-being if the weight of your breasts caused problems or interfered with your life. You should have less pain, improved sleep, and better comfort when participating in physical activities.
Breast reduction surgery may also improve your satisfaction with your appearance and boost your self-confidence. Surgeons caution that it is important to be realistic about how much breast reduction may improve your self-image.
Be aware of what cosmetic breast reduction surgery can and cannot do for your overall appearance. Time, gravity, weight changes, and aging will eventually affect the size and shape of your breasts.
It is also important to tell all your healthcare providers about your breast reduction surgery. The type of procedure you had can affect future breast surgeries or revisions. Breast reduction can also complicate breastfeeding.
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- Breast Reduction. The American society for Aesthetic Plastic Surgery. http://www.surgery.org/consumers/procedures/breast/breast-reduction
- Breast Reduction. American Society of Plastic Surgeons. http://www.plasticsurgery.org/reconstructive-procedures/breast-reduction.html
- Breast Reduction for Men. American Society of Plastic Surgeons. http://www.plasticsurgery.org/cosmetic-procedures/breast-reduction-for-men.html
- Pile, JC.Evaluating postoperative fever: A focused approach.Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
Surgery vs. Plastic Surgery. American Board of Cosmetic Surgery. http://www.americanboardcosmeticsurgery.org/patient-resources/cosmetic-surgery-vs-plastic-surgery/