Your Guide to Breast Reduction
Guide content courtesy of the American Society for Aesthetic Plastic Surgery, with additions from the RealSelf editorial team
Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. If decreased breast size results in sagging, a breast lift may also be performed.
Also called Reduction Mammaplasty, this surgery can eliminate back and neck pain caused by large breasts.
You may be a good candidate for breast reduction if you have one or more of the following conditions:
- breasts that are too large in proportion to your body frame
- heavy, pendulous breasts with nipples and areolas that point downward
- one breast is much larger than the other
- back, neck or shoulder pain caused by the weight of your breasts
- skin irritation beneath your breasts
- indentations in your shoulders from tight bra straps
- restriction of physical activity due to the size and weight of your breasts
- dissatisfaction or self-consciousness about the largeness of your breasts
The most common method of reducing the breasts involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision 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. Liposuction 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.
Incision Variations: There are many variations to the design of the incisions for breast reduction. The size and shape of your breasts, as well as the desired amount of reduction, are factors that will help your plastic surgeon determine the best technique for you.
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.
Rarely, if your breasts are extremely large, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In such a case, you will need to have made the decision to sacrifice sensation and the possibility of breast-feeding in order to achieve your desired breast size.
In addition to your surgeon conducting a medical history and physical examination, your doctor consultation is the time to ask questions.
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During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they realistically can be achieved.
Your plastic surgeon will examine your breasts, taking measurements and perhaps photographs for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.
You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. It is important for you to provide complete information.
You should tell your plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss. Your surgeon may recommend that you stabilize your weight before having surgery.
Depending on your age, or if you have a history of breast cancer in your family, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast reduction, you will still be able to perform breast self-examination. Breast reduction surgery will not increase your risk of developing breast cancer.
If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.
Breast reduction surgery may be performed on an inpatient or outpatient basis. If you are to stay in the hospital or surgical facility, it will most likely be for only one night. Whether you are released the day of surgery or the following day, you will need someone to drive you home and to stay with you for the next day or two.
Your breast reduction surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.
Usually, a general anesthetic is administered, so that you will be asleep throughout the procedure.
When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. In many instances, small drain tubes will have been placed in your breasts to help avoid the accumulation of fluids. Gauze dressings will be placed on your breasts and covered with an elastic bandage or surgical bra.
The amount of time it takes to recover from Breast Reduction surgery varies greatly between individuals.
Day after surgery: You will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts.
1 -2 days after surgery: Any surgical drains will be removed a day or two after surgery, at which time your dressings may also be changed or removed. You will be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminishes.
Beyond the first few days: Generally, stitches will be removed in stages over a period of approximately three weeks, beginning about one week after surgery.
You may notice that you feel less sensation in the nipple and areola areas. This usually is temporary. It may, however, take weeks, months or even more than a year before sensation returns to normal. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery.
It is often possible to return to work within just a couple of weeks, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor.
Any sexual activity should be avoided for a minimum of one week, and your plastic surgeon may advise you to wait longer. After that, care must be taken to be extremely gentle with your breasts for at least the next six weeks.
Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" procedure to restore their more youthful contour.
Breast reduction surgery will make your breasts smaller and firmer. Without the excessive weight of large breasts, you may find greater enjoyment in playing sports and engaging in physical activity.
Incisions: The incisions from your breast reduction surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing, even low-cut necklines.
Adjusting to new body image: Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most women, however, eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure.
The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your plastic surgeon, or with a staff member in your surgeon's office.
- Reactions to anesthesia
- Blood accumulation that may need to be drained surgically
- Changes in nipple or breast sensation (usually temporary)
Rarely, a patient may require a blood transfusion during the operation. This usually can be anticipated in advance, and your plastic surgeon may, under certain circumstances, advise you to donate your own blood in preparation for surgery.
Following Breast 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. Permanent loss of sensation in the nipples or breasts may occur rarely. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.
You can help to lessen certain risks by following the advice and instructions of your plastic surgeon, both before and after surgery.
Breast Reduction surgery cost can vary widely as reflected in the Breast Reduction Cost Data posted on RealSelf.com. A surgeon’s cost for Breast Reduction may vary based on his or her experience, the type of procedure used, as well as geographic office location.
- Surgeon’s professional fee
- Facility fee
- Anesthesia fee
- Surgical garments
- Medical tests
- General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- Inframammary incision: Incision made under the breast.
- Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
- Local anesthesia: A drug injected directly to the site of an incision during an
- Periareolar incision: Incision made around the nipple.
- Reduction Mammoplasty: Another term for Breast Reduction surgery.
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