This article has been medically reviewed for accuracy by Bloomfield Hills, MI plastic surgeon Dr. Ellen Janetzke on August 13, 2020.
As the eighth most popular cosmetic operation across the globe in 2018, breast reduction surgery, also known as reduction mammoplasty, can be truly life-changing for the patients who undergo it. Whether it’s chronic neck or back pain, restricted movement, trouble finding clothing that fits, general discomfort, or insecurity that leads women to want to downsize, breast reduction is often the perfect solution. The procedure, in which breast tissue and fat are removed using either a lollipop technique (around the areola and straight down) or an anchor technique (adding a horizontal extension), is relatively simple and typically takes about three to four hours.
Breast reduction has one of the highest patient-satisfaction rates in all of plastic surgery, and studies show that it can significantly boost self-esteem and improve quality of life for decades to come. “It’s one of those operations that so many people think about for a long time before they come in, and they really, really want it,” says Dr. Melissa Doft, a board-certified plastic surgeon in New York City. “They know how uncomfortable they are, and most patients feel better immediately after.” But, as is the case with most surgeries, breast reduction can have some unexpected impacts on day-to-day life, both during a patient’s recovery and even years after the procedure.
Post-surgery pain and swelling
“When somebody wakes up from their operation, they’ll be in a surgical bra, their pain will be controlled, and they’ll have some gauze or padding inside the bra, for additional support,” explains Dr. Lara Devgan, a board-certified plastic surgeon in New York City. Patients are sent home the same day with pain medicine, usually Norco or something similar, and in a compression bra that resembles a sports bra but has a zipper or velcro closure in front. Some doctors will use a long-acting numbing agent, like Exparel, during the procedure so that it will continue to dissolve and release for the following three days, which tend to be the most painful. “Overall though, breast reduction is surprisingly comfortable because it’s a surgery of the soft tissue, not the deep tissue,” Dr. Devgan adds.
There will be swelling for the first few days, and often, patients will lose sensation around the nipple as a result, but as the swelling goes down, the sensation will usually return. “Sometimes it can take up to two years for the nerves to grow back, if they’re cut,” says Dr. Doft. “Some people will also get these little shooting pains in the months after surgery as the nerve is recuperating, but for most, sensation comes back as the swelling goes away.” By about six weeks post-op, the swelling should be 50% gone, she notes, and by six months, you’ll probably reach your final size.
Some surgeons will use drains on their breast reduction patients to lessen immediate swelling, but Dr. Doft isn’t a fan. “I actually think being slightly more swollen afterward can be a good thing, because you’re going from so big to much smaller, so making that transition a little slower can be helpful.” She does, however, recommend taking arnica or bromelain after the procedure, as both can help reduce swelling. “You can find bromelain naturally, in pineapples, so a lot of people will just eat pineapple or have a pineapple smoothie, but there are also formulas containing bromelain, arnica, and vitamin C that we can send to patients,” she says.
When it comes to scarring, the road to recovery is a bit longer. “It takes a full calendar year for the body to replace immature collagen with mature collagen. It’s almost like replacing a brick wall one brick at a time,” says Dr. Devgan, but she assures that scarring will continue to improve “in terms of the color, texture, and overall look.” In the weeks immediately following surgery, a regimen of silicone gel during the day and silicone tape at night can help flatten scars, take the redness down, and make scars less itchy. There are also a number of in-office options that can address scarring, if patients are unwilling to wait for their bodies to heal on their own. Although some doctors offer laser treatments after the six-week mark, Dr. Devgan suggests waiting a few months before trying any lasers or microneedling but notes that both can significantly improve scars earlier on.
For any itchiness experienced around the breasts during the first few weeks, Dr. Doft recommends using a moisturizer that contains oatmeal. “It’s very soothing and can be applied directly to the area.”
Post-surgery clothing and activity
Breast reduction patients typically take the first week off from work and will need to take it easy during that time, but Dr. Doft says it’s important to get up and walk around the house a few times a day, to help prevent blood clots. “We also really encourage people to take deep breaths, to prevent pneumonia and deep-vein thrombosis,” she says. Additionally, it’s wise to sleep elevated on your back immediately following the procedure in order to avoid crushing the surgical wounds.
When healing from a breast reduction, physical activity needs to remain limited. “The average patient will take four to six weeks off [from] strenuous exercise, including swimming, yoga, biking, running, and weightlifting,” Dr. Devgan explains, but full activity is okay after that. “You’re pretty tired the first couple of weeks anyway, so most people don’t really have the energy for serious exercise,” adds Dr. Doft.
In the days immediately after surgery, patients can either continue to wear a surgical bra day and night for four to six weeks post-op or switch to a sports bra. Underwire bras are not to be worn during that time, and most women don’t even return to underwire for several months, since the surgery usually includes an incision underneath the breast and the wire pushing against it can be very uncomfortable. Different surgeons have different recommendations. “I tell my patients to buy something that’s not so expensive at first but at six months, go and treat yourself,” Dr. Doft says. “Go to a lingerie or specialty shop and get measured by somebody who does this all the time, because you’re going to be a totally different size and you’ll want to wear different brands than you used to. It’s like getting a bra for the first time.”
Related: The Best Bras to Wear After Your Breast Augmentation, According to RealSelf Members
Long-term impacts
Although the biggest changes arise within the first year of breast reduction surgery, it does have some effects that continue well into the future. “Generally speaking, with modern breast reduction techniques, patients go back to their full range of activities, including things like pregnancy, sports, intimacy, arousal, and life,” Dr. Devgan explains. “And the most common response long-term is ‘I wish I had done this sooner.’” Even so, it’s important to note both the limitations of the surgery and how breasts can change down the line.
“A lot of breast reduction patients are in their 20s, so they ask what future pregnancy could mean for them, and the truth is we don’t 100% know,” says Dr. Doft. “Some people find that their breasts really grow during pregnancy, and others don’t, but their breasts are never going to grow to that same size they were before surgery.” During pregnancy and, sometimes, menopause, breasts can go up a cup size, so women who’ve had a breast reduction once before want slightly more taken out when this happens. “You can’t take out quite as much tissue, and you have to be a little bit clever about it, but most surgeons who do this operation should easily be able to do a second,” Dr. Doft notes.
The question of breastfeeding after breast reduction remains somewhat unanswered. “I usually say it’s about a 50/50 chance. You decrease your chance a bit with breast reduction surgery, but it’s hard to know how well somebody could breastfeed even without the procedure,” says Dr. Doft. “Most of the patients who are having breast reductions haven’t had children yet or [have] had their children and are all done, so it’s just not a big enough group to have a great idea.”
Most breast reduction patients think the benefits of the procedure significantly outweigh the risks and drawbacks. “It’s such a nice transformation, and you can actually see this newfound comfort and confidence in patients when they come in for their post-op visits in the days, weeks, and months after surgery,” Dr. Doft says. “I think a lot of that satisfaction just comes from feeling free of this burden that weighed them down, both physically and emotionally, their entire lives.”
