If you're considering breast reduction...
Women with very large, pendulous breasts may experience a variety of medical
problems caused by the excessive weight-from back and neck pain and skin
irritation to skeletal deformities and breathing problems. Bra straps may
leave indentations in their shoulders. And unusually large breasts can make
a woman — or a teenage girl — feel extremely self-conscious.
Breast reduction, technically known as reduction mammaplasty, is designed
for such women. The procedure removes fat, glandular tissue, and skin from
the breasts, making them smaller, lighter, and firmer. It can also reduce
the size of the areola, the darker skin surrounding the nipple. The goal
is to give the woman smaller, better-shaped breasts in proportion with the
rest of her body.
If you're considering breast reduction, this will give you a basic
understanding of the procedure- when it can help, how it's performed, and
what results you can expect. It can't answer all of your questions, since
a lot depends on your individual circumstances. Please be sure to ask your
doctor if there is anything about the procedure you don't understand.
The best candidates for breast reduction
Breast reduction is usually performed for physical relief rather than simply
cosmetic improvement. Most women who have the surgery are troubled by very
large, sagging breasts that restrict their activities and cause them physical
In most cases, breast reduction isn't performed until a woman's breasts
are fully developed; however, it can be done earlier if large breasts are
causing serious physical discomfort. The best candidates are those who are
mature enough to fully understand the procedure and have realistic expectations
about the results. Breast reduction is not recommended for women who intend
All surgery carries some uncertainty and risk
Breast reduction is not a simple operation, but it's normally safe when
performed by a qualified plastic surgeon. Nevertheless, as with any surgery,
there is always a possibility of complications, including bleeding, infection,
or reaction to the anesthesia. Some patients develop small sores around
their nipples after surgery; these can be treated with antibiotic creams.
You can reduce your risks by closely following your physician's advice both
before and after surgery.
The procedure does leave noticeable, permanent scars, although they'll be
covered by your bra or bathing suit. (Poor healing and wider scars are more
common in smokers.) The procedure can also leave you with slightly mismatched
breasts or unevenly positioned nipples. Future breast-feeding may not be
possible, since the surgery removes many of the milk ducts leading to the
Some patients may experience a permanent loss of feeling in their nipples
or breasts. Rarely, the nipple and areola may lose their blood supply and
the tissue will die. (The nipple and areola can usually be rebuilt, however,
using skin grafts from elsewhere on the body.)
Planning your surgery
In your initial consultation, it's important to discuss your expectations
frankly with your surgeon, and to listen to his or her opinion. Every patient-and
every physician, as well-has a different view of
what is a desirable size and shape for breasts.
Heavy breasts can lead to physical
discomfort, a variety of medical
problems, shoulder indentations due
to tight bra straps, and extreme
The surgeon will examine and measure your breasts, and will probably photograph
them for reference during surgery and afterwards. (The photographs may also
be used in the processing of your insurance coverage.) He or she will discuss
the variables that may affect the procedure-such as your age, the size and
shape of your breasts, and the condition of your skin. You should also discuss
where the nipple and areola will be positioned; they'll be moved higher
during the procedure, and should be approximately even with the crease beneath
Your surgeon should describe the procedure in detail, explaining its risks
and limitations and making sure you understand the scarring that will result.
The surgeon should also explain the anesthesia he or she will use, the facility
where the surgery will be performed, and the costs. (Some insurance companies
will pay for breast reduction if it's medically necessary; however, they
may require that a certain amount of breast tissue be removed. Check your
policy, and have your surgeon write a "predetermination letter"
Preparing for your surgery
Your surgeon may require you to have a mammogram (breast x-ray) before surgery.
You'll also get specific instructions on how to prepare for surgery, including
guidelines on eating and drinking, smoking, and taking or avoiding certain
vitamins and medications. Some surgeons suggest that their patients diet
before the operation.
Breast reduction doesn't usually require a blood transfusion. However, if
a large amount of breast tissue will be removed, your physician may advise
you to have a unit of blood drawn ahead of time. That way, if a transfusion
should be needed, your own blood can be used.
While you're making preparations, be sure to arrange for someone to drive
you home after your surgery and to help you out for a few days if needed.
Where your surgery will be performed
Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. If you are admitted to the hospital, your stay will be a short one.
The surgery itself usually takes two to four hours, but may take longer
in some cases.
Type of anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll
be asleep through the entire operation.
Techniques for breast reduction vary, but the most common procedure involves
an anchor-shaped incision that circles the areola, extends downward, and
follows the natural curve of the crease beneath the breast. The surgeon
removes excess glandular tissue, fat, and skin, and moves the nipple and
areola into their new position. He or she then brings the skin from both
sides of the breast down and around the areola, shaping the new contour
of the breast. Liposuction may be used to remove excess fat from the armpit
Incisions outline the area of skin,
breast tissue, and fat to be removed
and the new position for the nipple.
In most cases, the nipples remain attached to their blood vessels and nerves.
However, if the breasts are very large or pendulous, the nipples and areolas
may have to be completely removed and grafted into a higher position. (This
will result in a loss of sensation in the nipple and areolar tissue.)
Skin formerly located above the nipple
is brought down and together to reshape
the breast. Sutures close the incisions,
giving the breast it's new contour.
Stitches are usually located around the areola, in a vertical line extending
downward, and along the lower crease of the breast. In some cases, techniques
can be used that eliminate the vertical part of the scar. And occasionally,
when only fat needs to be removed, liposuction alone can be used to reduce
breast size, leaving minimal scars.
Scars around the areola, below it, and
in the crease under the breast are
permanent, but ban be easily concealed
After your surgery
After surgery, you'll be wrapped in an elastic bandage or a surgical bra
over gauze dressings. A small tube may be placed in each breast to drain
off blood and fluids for the first day or two.
You may feel some pain for the first couple of days-especially when you
move around or cough-and some discomfort for a week or more. Your surgeon
will prescribe medication to lessen the pain.
The bandages will be removed a day or two after surgery, though you'll continue
wearing the surgical bra around the clock for several weeks, until the swelling
and bruising subside. Your stitches will be removed in one to three weeks.
If your breast skin is very dry following surgery, you can apply a moisturizer
several times a day, but be sure to keep the suture area dry.
Your first menstruation following surgery may cause your breasts to swell
and hurt. You may also experience random, shooting pains for a few months.
You can expect some loss of feeling in your nipples and breast skin, caused
by the swelling after surgery. This usually fades over the next six weeks
or so. In some patients, however, it may last a year or more, and occasionally
it may be permanent.
Getting back to normal
Although you may be up and about in a day or two, your breasts may still
ache occasionally for a couple of weeks. You should avoid lifting or pushing
anything heavy for three or four weeks.
Your surgeon will give you detailed instructions for resuming your normal
activities. Most women can return to work (if it's not too strenuous) and
social activities in about two weeks. But you'll have much less stamina
for several weeks, and should limit your exercises to stretching, bending,
and swimming until your energy level returns. You'll also need a good athletic
bra for support.
You may be instructed to avoid sex for a week or more, since sexual arousal
can cause your incisions to swell, and to avoid anything but gentle contact
with your breasts for about six weeks.
A small amount of fluid draining from your surgical wound, or some crusting,
is normal. If you have any unusual symptoms, such as bleeding or severe
pain, don't hesitate to call your doctor.
Your new look
Although much of the swelling and bruising will disappear in the first few
weeks, it may be six months to a year before your breasts settle into their
new shape. Even then, their shape may fluctuate in response to your hormonal
shifts, weight changes, and pregnancy.
Your surgeon will make every effort to make your scars as inconspicuous
as possible. Still, it's important to remember that breast reduction scars
are extensive and permanent. They often remain lumpy and red for months,
then gradually become less obvious, sometimes eventually fading to thin
white lines. Fortunately, the scars can usually be placed so that you can
wear even low-cut tops.
Of all plastic surgery procedures, breast reduction results in the quickest
body-image changes. You'll be rid of the physical discomfort of large breasts,
your body will look better proportioned, and clothes will fit you better.
However, as much as you may have desired these changes, you'll need time
to adjust to your new image-as will your family and friends. Be patient
with yourself, and with them. Keep in mind why you had this surgery, and
chances are that, like most women, you'll be pleased with the results.
With smaller, better proportioned
breasts, you'll feel more comfortable
and your clothes will fit better.