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Women with large, heavy breasts may experience several health concerns related to their breasts: back pain, neck pain, chronic headaches, shoulder indentations, breathing problems, skin irritation and a variety of other medical problems. Some women have trouble finding clothes that fit and feel physically uncomfortable with the size of their breast. Breast reduction can minimize or eliminate these problems. Breast reduction surgery, technically called mammaplasty, involves removal of excess breast tissue to reshape and lift the breasts. The results are smaller, lighter and better-shaped breasts.

The Surgery

Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. Breast reduction is nearly always performed under general anesthesia. The surgery generally takes about one to three hours per breast, depending on the techniques being used. The procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Excess glandular tissue, fat, and skin are removed, and the nipple and areola are moved into their new position. The surgeon 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 area.

The Recovery

Your breasts will be wrapped with gauze bandage, plus a tighter bandage for protection and support. You may feel some pain and discomfort for a week or more, especially if you’re moving around. Bandages will be removed after a day or two, and you will continue wearing a surgical bra for several weeks, until the swelling and bruising subside. Sutures are removed within the first two weeks following surgery. Within two weeks, mild exercise and non-strenuous work may be resumed. After a few months your breasts will settle into a more natural shape. As with all cosmetic procedures, the final result will be noticeable in about one year.

The Best Candidates for Breast Reduction

In most cases, breast reduction isn't performed until a woman's breasts are fully developed. The best candidates for breast reduction are those 18 years of age or older who are experiencing physical discomfort or self-consciousness due to large breasts. It’s important you’re not currently pregnant or breast-feeding and don’t intend on breast-feeding in the future.

The Risks

Potential complications of breast reduction include, small areas of infection or delayed healing in the incision. Some women develop small sores around their nipples, which can be treated. Others report loss of sensation in their nipple or hypersensitivity. Although every attempt is made to obtain symmetry and a natural shape, there may be some irregularities in the final size and shape of the breasts or in the positioning of the areola and nipple. The procedure does leave noticeable, permanent scars. Future breast-feeding may not be possible.

Background

Breast reduction, also called reduction mammaplasty, is designed to relieve the physical discomfort often associated with very large breasts and to enhance the overall appearance of the breasts. The procedure removes excess breast tissue and skin, making breasts smaller and firmer. The areola (the pigmented skin surrounding the nipple) may be reduced and repositioned. Breast reduction can be performed at any age, but plastic surgeons usually recommend waiting until breast development has stopped.

Technique

Individual factors and personal preferences will determine the specific technique selected to reduce the size of the patient’s breasts. The most common method of reducing the breasts involves three incisions: One is made around the areola; another runs vertically from the bottom edge of the areola to the crease underneath the breast; the third incision is horizontal beneath the breast and 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. Lipoplasty 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. 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.

Benefits

• Breasts will be more proportional to rest of the patient’s body, and clothes will fit better. Breast reduction often makes a dramatic change in appearance as well as physical comfort. The level of patient satisfaction from breast reduction is among the highest of any plastic surgery procedure.
• Significant complications from breast reduction are infrequent.
• It is often possible to return to work within one or two weeks, depending on your job. Resumption of most normal activities, including some form of mild exercise, is often possible after several weeks.

Other Considerations

• Every surgery carries some risk. Potential complications include reaction to anesthesia, bleeding, infection and poor healing.
• Patient may be instructed to wear a support bra for a few weeks, until swelling and discoloration of breasts diminishes.
• Diminished sensation in the nipple and areola areas usually is temporary. However, it may take weeks, months or even more than a year before sensation returns to normal. Permanent loss of sensation in the nipples or breasts may occur rarely.
• Incisions will initially be red or pink in color, and will remain that way for a number of months following surgery.
• Incision lines will be permanently visible, more so in certain individuals than others. The incisions for breast reduction are in locations easily concealed by clothing.
• 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, but patients should remember that natural breasts usually show some variation.
• Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly.