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Breast Reduction (Mammaplasty)

Women with large breasts may experience a variety of medical problems caused by the excessive weight—from back and neck pain to skeletal deformities. Breast reduction, or reduction mammaplasty, is usually performed for physical relief rather than cosmetic improvement.

Who’s a Candidate?

The best candidates for breast reduction are women who are troubled by large, sagging breasts that restrict their activities and cause them physical comfort. This surgery is not performed until a woman’s breasts are fully developed.  Women who select this procedure during the years of childbearing age may not be able to breast-feed following surgery.

What Are the Risks?

As with any surgery, there is always a possibility of complications, including bleeding, infection or reaction to anesthesia. Some patients develop small sores around their nipples following surgery that can be treated with antibiotic cream.

The procedure will leave noticeable, permanent scars, which can be covered by a bra or bathing suit. (Poor healing and wider scars are more common in smokers.) It can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible since surgery removes many of the milk ducts leading to the nipples. Some patients also experience a permanent loss of feeling in their nipples or breasts.

Preparing for Surgery

The surgeon will examine and measure your breasts. 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 may also be required to have a mammogram (breast X-ray) prior to surgery.

Breast reduction doesn’t usually require a blood transfusion; however, if a large amount of breast tissue will be removed, your doctor may advise you to have a unit of blood drawn ahead of time.

The Surgery

Breast reduction is usually done as an inpatient or outpatient procedure. The surgery usually takes two to four hours.

Performed under general anesthesia, the most common procedure involves an anchor-shaped incision that circles the areola (the dark skin surrounding the nipple), 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 to their new position.

The skin is then brought 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.  A vertical incision and approach is a variation and the most common procedure we perform.

In most cases, the nipples remain attached to their blood vessels and nerves. If the breasts are very large, however, the nipples and areolas may have to be completely removed and grafted into a higher position, resulting in a loss of sensation in the nipple and areolar tissue.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. Occasionally, when only fat needs to be removed, liposuction alone can reduce breast size, leaving minimal scars.

After the Surgery

Following surgery, you will 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 couple of days. You may feel some pain for first few days, especially when you cough or move around. Your surgeon will prescribe pain medication. The bandages will be removed a day or two after surgery, although you’ll continue to wear the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches if not absorbable will be removed in one to three weeks.

Your breasts may still ache occasionally for a couple of weeks. Avoid lifting or pushing heavy objects for the first month. Most women can return to work (if it’s not too strenuous) and social activities in about two weeks.