Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia).
Disproportionately large breasts can cause both physical and emotional distress for patients. Patients with macromastia may experience physical discomfort resulting from the weight of their breasts. The resulting pain can make it challenging for some patients to perform common physical activities. Along with the physical ailments of macromastia, some patients may suffer from emotional distress or more significant mental health problems as a result of their large breasts.
Although breast reduction is often performed to address medical issues, patients who do not have the symptoms of macromastia but are unhappy with the size of their breasts can still pursue breast reduction as an aesthetic procedure. Patients choosing to undergo breast reduction surgery for cosmetic reasons may cite any number of factors, including social stigmas and wardrobe concerns.
You may be a candidate for breast reduction surgery if:
Breast reduction surgery is meant for women who have large breasts and want to resolve issues such as:
Breast reduction surgery generally isn't recommended if you: Smoke, Have certain conditions such as diabetes or heart problems, Are very obese, or Want to avoid scars on your breasts
You can have breast reduction surgery at any age — sometimes even as a teenager. But if your breasts aren't yet fully developed, you might need a second surgery later in life.
You might postpone breast reduction surgery if you have certain future plans, such as:
Childbirth. If you haven't started a family or your family isn't yet complete, you might wait until pregnancy isn't an issue. Breast-feeding might be challenging after breast reduction surgery — although certain surgical techniques can help preserve your ability to breast-feed.
Weight loss. If you are interested in losing weight by changing your diet and starting an exercise program, you might wait to decide if reduction mammoplasty is for you. Losing weight can often result in changes to your breast size.
Ability to participate in sports and other activities. Many times, excessively large breasts get in the way of movement and discourage people who have them from participating in activities. They can also cause repetitive stress injuries (known as “jogger’s breast”) during exercises that require repetitive motion. Ultimately, this could become a bigger health problem if those with excessively large breasts decide to refrain from exercise in general to avoid injury and embarrassment. But after your recovery from breast reduction, you’ll find it much easier to dive into these types of activities with a new sense of balance and mobility.
Easier shopping and better deals. Not surprisingly, those with excessively large breasts tend to have problems finding clothes that fit them properly. Clothes either fit the chest region or the rest of the body, but not both. Even when things do fit, odd sizes usually mean limited availability and lack of good deals. With breast reduction, comes a more streamlined physique that will likely better fit off the rack garments. For these individuals, that means more clothing options, more freedom to dress how they want to, and more savings because they can fit into a larger variety of clothes.
Reduced stretch marks and better look as you age. No one likes to think about stretch marks, but due to the inevitabilities of gravity, they’re a fact of life. The heavier and more out-of-proportion a particular part of the body is, the higher the likelihood stretch marks will appear in that region. A breast reduction procedure not only improves comfort and posture but also helps to avoid stretching and stretch marks over time, allowing your breasts and the areas around them to age better. While this may not be something you’re thinking about now, it is something to consider for later on in life.
Alleviate Back Pain. The weight of by heavy breasts often results in strain and discomfort in your back, neck, and shoulders. By reducing your breast size, you can alleviate that tension, and reduce or eliminate the pain.
A Well-Proportioned Body. Some women seek a breast reduction because their larger breasts are disproportionate to their body frame. By reducing the size, they have a well-balanced figure with breasts that are more shapely and perkier.
Better Clothing Fit. Finding clothes that fit correctly can be a hassle. When you have to buy clothes that are too large for your frame just so you can fasten in the front without pulling or gapping, it can be frustrating. With breasts that are well proportioned for your body, you'll be able to fit into clothing better and alleviate some of the stress of shopping and deciding what to wear in the morning. You can also get relief from your bra straps digging into your shoulders, which can cause marks or even scarring in extreme cases.
More Enjoyable Exercising. A breast reduction may also improve your exercise experience! If breast, shoulder, or back discomfort is a part of your workouts or keeps from the gym altogether, going smaller could mean a more enjoyable workout.
Improved Hygiene. The lower breast and breast fold can be more susceptible to intertriginous rashes. A breast reduction can mean relief from, and prevention of, these rashes. If you have symptoms of intertriginous dermatitis, you should talk to your doctor about treatment right away.
Quick Recovery Time. Breast reduction surgery is safe and has a quick recovery time. There is little pain associated with this procedure, and post-op discomfort usually lasts only a day or so. Breast reduction patients can resume normal activities relatively soon.
Breast Lipolift is a breast lifting technique that uses liposuction to precisely reshape, lift, and reduce the breast. Breast LipoLift was developed when a young woman with connective tissues disorder called Ehlers-Danlos wanted to lift and improve the asymmetry and look of her breasts.. Ehlers-Danlos syndrome is generally characterized by hyper-mobile joints and skin that stretch further than normal, and tissue that is more fragile than the average person due to the fault production of collagen. People with Ehlers-Danlos can have Plastic Surgery, but they are at higher risk for complications. During the procedure removal of tissue is done from one side to correct the size asymmetry, which was accurately measures, Vectra 3D imaging system. Post operative healing is faster and painless.
Diet- The breasts are mostly made up of adipose tissue, or fat. Losing body fat can reduce a person's breast size. People can lose body fat by using up more calories than they eat, and by eating a healthful diet. A low-calorie, highly nutritious diet can indirectly help to shrink breast tissue. Focus on eating nutrient-dense foods that are low in calories. Fruits, vegetables, fatty fish, such as salmon, and lean meats, such as grilled chicken, can help a person feel full while still supporting healthy weight loss.
Exercise- exercise can help a person lose body fat, which might also help reduce breast size over time. Many people mistakenly believe that targeted exercises can burn fat in a specific area. While push-ups and other chest exercises will tone the arm and chest muscles, they will not directly remove fat from the breasts themselves. The key is to burn fat throughout the body. Cardiovascular exercises that increase a person's heart rate are highly effective at burning fat. Depending on health and fitness factors, people can try running, swimming, or taking brisk walks.
Reduce estrogen- Estrogen plays a key role in the development of breast tissue. So countering excess estrogen could reduce breast size, especially in people with hormonal imbalances. Hormonal contraceptives contain estrogen and progesterone and can make a person's breasts grow bigger. The effect usually goes away again once the person stops taking the medication. Some research suggests that a person can reduce their body estrogen levels through dietary changes. For instance, animal studies suggest that flaxseed supplements may help regulate estrogen levels by reducing estrogen expression in the ovaries. Flaxseed may also protect the heart, reduce the risk of cancer, and prevent inflammation. There is, however, little evidence about natural remedies to reduce estrogen in the body. People may wish to talk to their doctor about estrogen-lowering medication.
Binding- Binding involves wrapping material tightly around the breasts to flatten them. It will not shrink breast tissue or prevent the breasts from growing, but binding can help the breasts look smaller and may make a person feel more comfortable. Talk to a doctor about the safest way to use a binder.
Change bra- A bra cannot permanently change breast size, but minimizer bras can create the illusion of smaller breasts. These bras change the breast shape to make the breasts look flatter and higher on the chest. Some minimizer bras also offer more supportive straps, which may reduce back and neck pain.
Reducing breast size after pregnancy- A person's breasts tend to grow during pregnancy and remain large while they are breastfeeding. The increase in size is especially noticeable in the first few weeks after giving birth, as breast milk supply is still regulating itself. Along with milk production and hormonal effects, people also put on body fat during pregnancy, some of which gets deposited in the breast tissue. Many people find that their breasts slowly shrink as they lose pregnancy weight, and others find that their breasts remain slightly larger after having a baby. People can try the above methods to reduce breast size during pregnancy and breastfeeding. Talk to a doctor about any concerns that arise.
Anesthesia is an essential part of any surgical procedure and must be performed safely. General anesthesia is the deepest form of anesthesia. You are asleep, feel no pain, and will not remember the procedure. This form of anesthesia is usually not required for breast reduction unless the patient specifically requests general anesthesia.
Intravenous sedation, called twilight sleep, is a combination of local anesthetic administered at the surgical site and intravenous sedation administered by the anesthesiologist. You breathe for yourself, but you are in a deep sleep throughout the procedure. You should feel no pain, and you will not remember the procedure.
An intermediate form of anesthesia, the laryngeal mask airway (LMA), is a relatively new technique. This technique is similar to twilight sleep in that you are breathing on your own, but the method of sedation differs. With an LMA, you actually breathe anesthetic gases administered by the anesthesiologist, rather than receive intravenous sedation via your intravenous line. These anesthetic gases cause you to sleep during the procedure. At the completion of the procedure, the gases are turned off and you wake up from your sleep. You will feel no pain, and you will not remember the procedure.
After breast reduction surgery, you should expect to feel tired and to have breast pain. This is normal. Your surgeon will give you an oral painkiller to ease you through the first few days after surgery. You should also avoid heavy lifting.
Recovery. It can take two to six weeks to fully recover from breast reduction surgery. You may need to take a week or two off work and shouldn't drive for at least a week. The final appearance of your breasts may not be obvious for several weeks or months after the operation.
The final appearance of your breasts may not be obvious for several weeks or months after the operation.
Some surgeons recommend wearing a sports bra 24 hours a day for up to three months after breast surgery. The length of time you need to keep the dressings on depends on how quickly your wounds healed. Stitches are removed after a week or two, unless they are dissolvable.
You should avoid stretching, strenuous exercise and heavy lifting for up to six weeks after the operation. You can drive again when it's no longer painful to wear a seatbelt, which may be several weeks.
Most patients feel ready to drive and return to a desk job within 1 week, after they are no longer taking prescription pain medication. Your cosmetic surgeon will likely have you wait a minimum of 3 to 4 weeks before resuming exercise other than walking; this helps to ensure your incisions heal properly.
In either case, you will get general anesthesia, which means you will be put to "sleep" during the procedure. Breast reduction surgery will take about two to five hours, sometimes longer. Your surgeon will make a cut around your nipple then downward on the breast in the form of a keyhole.
Step 1: Anesthesia- Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2: The incision- Incisions include: A circular pattern around the areola. The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra. A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease
Step 3: Removing tissue and repositioning- After the incision is made, the nipple is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary. Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast. The nipple is NOT removed.
Step 4: Closing the incisions- The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.
Diverse methods of skin incision and excision existed in the early reports of breast reduction. Some of them were improvised during the surgery; others were planned based on empiric knowledge, and a few followed complicated geometric calculations.
In 1956, Robert Wise published on his experience with a refined pattern that he had previously designed in the form of a key-hole. The Wise pattern has been the workhorse for skin incision for breast reduction for several decades. It leaves an anchor-shaped scar in a periareolar circle, a vertical scar in the midline of the inferior mammary hemisphere, and a curvilinear scar along the inframammary fold that follows the curved shape of the inferior pole of the breast.
In 1972, Paul McKissock modified Wise's technique by increasing the length of the vertical limbs of the design to try to compensate for the flat lower pole that was being achieved. [It is now recognized that McKissock’s technique tends to result in the opposite effect, which is a bottoming-out and is not very well tolerated by patients and surgeons.
To date, the Wise pattern remains the most common method of skin excision performed in the United States, although current trends show surgeons favoring other methods that have been designed with the purposes of shortening and hiding the scar. In South America and Europe, such methods have been very well developed over the years and represent the most common method of skin incision for breast reduction. Among these shorter-scars techniques, the mosque dome pattern of skin incision has gained greatest acceptance. It eliminates the lower curvilinear scar seen with the use of the Wise pattern, leaving only a periareolar scar and a vertical scar along the midline of the lower hemisphere of the breast. For this reason, the technique has been called vertical scar, and breast reductions using this pattern of skin incision are denominated vertical reduction mammaplasties.
The vertical scar incision pattern was originally designed by Claude Lassus in 1964 and reported in 1970, with the particularity that the inferior portion of the vertical scar ended up extending below the inframammary fold. Lassus corrected this by adding a small horizontal scar along the inframammary fold. Later on, he realized that the small horizontal scar ended up migrating up toward the lower hemisphere of the breast. He subsequently redefined his pattern of skin excision until achieving one that left only a vertical scar above the inframammary fold. This is the skin incision that is used in the technique described by Lejour.
The advantages of this pattern of skin incision are that it leaves no scar along the inframammary fold and it reduces the risk of skin edge necrosis at the inferior aspect of the closure, where tension is greatest and skin flap vascular inflow occurs over the longest distance from its source. (Skin edge necrosis was a particular risk at the junction of the inverted T incision of the Wise pattern technique).
With regard to the pattern of glandular resection, the different techniques used in breast reduction are identified by the segment of the breast that is left unresected, which becomes the structure and support of the new breast. This "pedicle" also contains the vascular supply that will nourish the breast mound, including the nipple-areola complex. Various techniques include superior, superomedial, medial, inferior, lateral and central pedicles. Bipedicle techniques, which include either superior and inferior or lateral and medial aspects of the breast, are also used.
The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.
Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
Possible breast reduction surgery risks include:
You should know that:
Other possible risks include:
Scars are a normal side effect of breast reduction surgery. These scars will fade over time but will never completely disappear. Scars can be made worse if you lift heavy objects too soon after surgery. In rare cases, some people have certain complications, such as inadequate healing of the nipple area that may require skin grafting.
Take Time Off — and REST! As you’re scheduling your surgery, keep in mind that you'll need to take time off from work or school for at least two weeks. After the surgery, you will be experiencing swelling and bloating, as well as some itching around the stitches and incision areas.
Your breasts will be wrapped up in gauze and dressings, and you may be wearing a special surgical bra over the garments. You'll be drowsy and will feel a lot of discomfort and pain in your movements within the first 48 hours so you'll need to have someone around to help you out with your daily activities.
After the first several days, you might start feeling stronger and you'll want to get back to your productive ways. This could make you feel guilty about taking time off. It’s crucial that you put your health first and keep resting for at least two weeks following surgery. If you have an office job, returning to work after two weeks is fine, but you have to keep all physical activity to a minimum. Taking short walks is recommended, but any sort of exercise, such as fast-paced movement or lifting, is strictly off limits.
You should also avoid bending over or lifting your arms up. You can put a dangerous strain on your incisions and can severely damage your wounds if you move too much during the day or try lifting beyond the doctor's recommendations — even lifting bags of groceries can be harmful to your recovery.
Sleep in an Elevated Position- During the post-op period, you'll need to sleep exclusively on your back as any pressure applied to your breasts from rolling over can cause complications and damage to your wounds. This is why supporting yourself with pillows is recommended. You should sleep in an elevated position with additional pillows under your feet as support for your lower back for at least the first week. The elevated position helps to reduce swelling. Using pillows as support for your arms and shoulders will prevent you from rolling around too.
Watch Your Nutrition- Obvious or not, it’s very important that you eat well and stay hydrated. You'll be sleeping most of the time and will possibly experience bloating, pain and nausea; all of which will very likely cause you to lose your appetite. Your body needs energy in order to heal, and you have to make sure you stay healthy. Try to eat three meals a day, even if they are in smaller portions than you’re normally used to.
You'll most likely be on pain-killers so make sure you stay well-fed as the drugs will make you feel ill if you take them on an empty stomach. You have to force yourself to drink a lot of fluids, not only to avoid dehydration, but also because the water you drink will help your body flush out the anesthesia and toxins from your body.
Pain medication can also leave you feeling constipated, and water helps food digestion and encourages bowel movements. While juice cannot hurt you, you should drink plenty of water instead. Alcohol is off limits!
Stop Smoking- Smoking is a definite no-no too! Even before you undergo the procedure, you'll be asked to quit smoking for up to a month before your surgery. It’s very important to avoid smoking during the recovery period as well. Smoking one or two cigarettes per day is only recommended for heavy smokers to reduce the stress of going "cold turkey”, but it’s very important to remain disciplined until you are fully healed.
Smoking narrows the blood vessels and decreases the amount of hemoglobin to the wound, which can significantly affect the healing process, and prevent your wounds from closing properly.
Avoid Baths and Running Water- While your wounds are fresh and you still have your stitches in, you'll be advised to avoid showering. You should take this recommendation seriously. You can wash yourself with wet towels or with water from the sink, but putting your incisions in contact with flowing water will seriously affect the healing process and cause unnecessary complications. After you're allowed to shower again, you should use a hand-held shower head which will allow you to control the water flow and the direction in which it’s going.
Avoid direct contact with the wounds and make sure the water flow is low. Soaking in a bathtub should be avoided for at least a month after the surgery.
Refrain from Sexual Activity- If you’re “in the mood” during the first week of recovery, sex is, unfortunately, off-limits. The first month after the procedure, sexual intercourse is generally not recommended. Sex counts as a strenuous physical activity, one that causes too much movement and pressure on the breasts. Plus, sexual arousal can also cause inflammation of the incisions.
Take Care of Your Scars- Scarring is inevitable. To make matters worse, no one can really tell you how your scars will turn out. This depends solely on your skin type and how you've healed in the past. One thing that everyone has in common is the fact that scars look the scariest the first six months after the surgery.
The redness will slowly start to fade away and, if you’re lucky, the scars will eventually melt into your skin and be barely visible to an untrained eye. Still, no matter how your skin reacts to scarring, there are certain steps you can take to make sure the healing process is as fast and as pleasant as possible.
First and foremost, you have to be diligent with the ointment treatment. There are many ointments available, and you should consult your doctor about which one is recommended for your skin type and the severity of the scarring.
Secondly, you should avoid exposing the scars to direct sunlight. Direct exposure to the sun discolors the scars, and makes the tissue thicken. This means that sunbathing your scars will make them look more aggressive and visible.
Finally, you shouldn’t strain the incision. Don't raise your hands above your head, lift heavy things, or bend over. Straining the incision will greatly affect the severity of the permanent scarring.
Many patients have questions about recovery from breast reduction surgery. When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.
A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect. You will be given specific instructions for breast reduction recovery that may include:
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
Successful breast reduction surgery can relieve pain in your upper back, neck and shoulders. It might also increase your ability to participate in physical activities and promote a more positive self-image.
Although you'll see results immediately, remember that it can take months for the swelling to completely go down and the surgical scars to fade. The final result is generally permanent — although breast shape and size can change due to factors such as aging and weight
Breast reduction surgery is typically performed as an outpatient procedure using general anesthesia or intravenous sedation with local anesthesia. After making the incisions using one of the techniques described above, your cosmetic surgeon will remove excess breast tissue, fat, and skin, moving the nipple/areola complex to a higher, more forward position on the chest. The remaining breast tissue and skin will be reshaped and closed with dissolvable sutures. The areolas can be reduced to a more proportional size during the procedure as well.
After spending a brief time in supervised recovery, you will be able to go home that same day to continue your recovery. Your chest will be bandaged, and you may be sent home in a surgical bra. You can expect to feel considerable soreness the first couple of days after your procedure, and your cosmetic surgeon will prescribe pain medication to help keep you comfortable during this initial period. Gently placing ice packs on top of the bandages can help alleviate discomfort as well.
The amount of time you need to recover from breast reduction will depend on your natural healing rate as well as the extent of surgery performed. You will be able to get up and walk around the same day of surgery, although you should have a trusted adult with you during the first 24 hours. While you may be permitted to shower a few days after surgery, you will probably need help getting dressed, as you will not have full range of motion in your chest and shoulders at first.
Most patients feel ready to drive and return to a desk job within 1 week, after they are no longer taking prescription pain medication. Your cosmetic surgeon will likely have you wait a minimum of 3 to 4 weeks before resuming exercise other than walking; this helps to ensure your incisions heal properly. It is essential to follow your cosmetic surgeon’s regarding activity after breast reduction.