Breast Reduction 101


The symptoms associated with breast hypertrophy (large breasts) affect a fair number of women in the United States.  This condition can be associated with a number of debilitating symptoms such as neck and back pain, shoulder grooves from bra straps, headaches, rashes (intertrigo), upper extremity numbness, difficulty with exercise, and psychological issues.   Breast reduction surgery involves the removal of excess skin and breast tissue in these patients with excessively large breasts.  The procedure is considered reconstructive in nature for the majority of patients in that the purpose of the surgery is treat the symptoms by dramatically decreasing the size of the breasts.  The American Society of Plastic Surgeons (ASPS) estimate that roughly 62,000 breast reduction procedures were performed in the United States in 2013 for reconstructive reasons.   Another 41,000 procedures were performed for cosmetic reasons.

Breast reduction surgery is done under general anesthesia usually on an outpatient basis.   The surgery typically takes three to four hours to perform.   The type and length of incisions will vary depending on how large the breasts are prior to surgery.  Most commonly, patients will end up with a scar around the areola (darker, pigmented skin) and a vertical extension down to the fold under the breast.  This is commonly known as a “vertical breast reduction” technique.  With this procedure the scar is sometimes said to look like a “lollipop.”  Although incisions are made around the nipple and areola, the nipple and areola are usually not removed and are left in connection with the blood supply, sensory nerves, and milk ducts.

Another commonly used approach is the Wise pattern technique.   This technique uses vertical and horizontal incisions and is also referred to as an “upside down T” or “anchor” pattern.  Only on extremely rare occasions are the nipples removed and replaced as free nipple grafts.  The incisions are typically closed with dissolving staples and sutures, and covered with clear dressings.  Most patients will have plastic drains in place for a couple of days to prevent fluid collections.

Patients typically require pain medicine for the first five to seven days after surgery.   Patients are permitted to drive once they are no longer on narcotic pain medications.  Most patients return to work within one week after undergoing their surgery.  Typically patients are allowed to begin easing back into their normal activities by 2-3 weeks.   The majority of the bruising and swelling resolves by 4-6 weeks, and patients typically state they are feeling back to normal by 6-8 weeks.   A sports bra is worn for the first 4 to 8 weeks following surgery.   Scars can be red and easy to see during the first few months after surgery.   Most patients will notice a dramatic improvement in the appearance of their scars after six to 12 months.  It usually takes a minimum of one year to be completely healed from surgery.

The risks of breast reduction surgery include the following:  infection, bleeding/hematoma, unsightly scars, loss of nipple sensation, asymmetry, delayed wound healing, seroma, persistent back/neck/shoulder pain, fat necrosis, and patient dissatisfaction with size.

Most patients are thrilled with the results and notice a dramatic decrease in symptoms within the first few weeks following surgery.
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Yuba City Plastic Surgeon