Regarding Breast Reduction Mammoplasty: Is It Possible to Reduce the Breast Size from 36D to 34AA?

My figure would best be described as slender and a little on the shorter side. 36D has begun causing extreme back problems in posture and poise, even up to inflammation and eczema underneath my bust (due to the skin-on-skin friction and increased sweat), as well as on my shoulders from the bra straps. I want to reduce my breast size to the smallest size possible. Is that a realistic goal? If it wouldn't work, what would be the smallest possible size I'd be able to achieve, and why?

Doctor Answers 7

Breast reduction

First, a breast reduction reduces mainly cup size and not the band width (36 to 34). Second, your breast size and bra size may be quite different as I find many large breast women wearing the wrong bra size. Lastly, it is important to maintain good proportions and keep enough tissue behind to allow the nipple complex to survive. You would need to see a surgeon to determine the amount of reduction that is advisable. I would think an AA would be a bit small.

Nashville Plastic Surgeon
4.9 out of 5 stars 63 reviews

Breast Size after Breast Reduction?

Thank you for the question.
Unfortunately, no plastic surgeon is able to predict exactly what cup size you will be after breast reduction surgery. As you know, cup sizes vary depending on who makes the bra; this makes discussing cup size an inaccurate way of communicating your goals.  
Also, every patient's chest width varies;  if the patient has a wide chest wall it may not be possible to achieve a smaller width  or cup size.
In my practice I use goal pictures to communicate with patients.  With this technique patients are able to demonstrate what they are trying to achieve and what type of looks they do not like as well.   The patient's goal pictures are hanging on the wall, and allow for direct comparison.
 I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 

It is possible to reduce the breasts size very significantly.   Sometimes  when patients want "the smallest size possible”  the reduction should be done in 2 stages.  The concern with the amount of tissue removed is related to blood flow to the remaining tissue;  if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola)  may be compromised.   Part of the tissue that is left in place is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible)  then patient will likely have problems with tissue survival.  Doing the procedure in more than one stage allows the tissues to  acclimate to the surgically decreased blood flow before  further tissue removal (and potentially further decreased blood flow)  occurs ( with the 2nd stage operation).
The other concern with overly aggressive breast reduction surgery is patient dissatisfaction  afterwards.  It is not unusual for patients who have lived with very large breasts to want to have as much as possible removed. Care must be taken to be judicious in this removal to avoid an outcome where the breasts  are too small in relation (proportionately) to the patient's other body parts.  Again, it is not uncommon, for patients'  breasts to become smaller ( after the breast reduction procedure) with time and/or weight loss-  breast augmentation may become necessary to achieve the patient size goals.
It will behoove you to seek consultation in person with a well experienced board-certified plastic surgeon.
I  hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 reviews

Breast Reduction Affects Only Cup Size Not Chest Size

A breast reduction surgery only affects your cup size, so it will not change your 36" chest wall.  It is not realistic to wear a 34AA bra post-op (which by the way is the same cup size as a 36A);this would not leave sufficient tissue to nourish you nipple or the skin flaps.  A B cup should be achievable and should result in the correction of your physical complaints.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast Reduction - Is Going From a D to an AA Too Much of a Reduction?

Hi Siraya,

What's possible is not always advisable.

First of all, there is, in general, a limit as to how much tissue can reasonably be removed during a breast reduction.  As you go for the smaller sizes, you risk impairing the blood supply to the nipple and areola (you have to leave enough tissue to "protect" the nipple/areola) and, furthermore, you risk compromising the shape of the breast.  It may then wind up too small for your chest, too wide, etc.  So I would generally suggest that the smaller you go (ie, the greater the change from your pre to your post-operative size) the greater the risk that the change will be unaesthetic.  There's a generally acceptable range of reduction, but if you go TOO small the risk of these problems goes up.

Of course, exactly what constitutes too small is subject to individual interpretation from different surgeons and patients but my guess is that going from a D to an AA would be too much of a change.  I'd probably recommend a small C or a large B as about the smallest you should go, although it is very difficult to make that assessment without being able to examine you in person.

And that's what you should do:  see a few plastic surgeons near you to get their advice, and then make a decision based on that.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

How small can I be after breast reduction

The number in your bra size is how big around your chest wall is and this is not affected by breast reduction. The breast size determines the cup size and, as you have probably noticed, varies considerably among bra manufacturers. There is a certain amount of tissue that must be left in order for the skin and nipple area to survive and for the breast to be a reasonable and pleasing shape. Therefore it is impossible to tell what size you will be after surgery. Your surgeon has some choice in how much tissue can be removed safely and can probably give you a guess as to what approximate size you might be but be wary of anyone who guarantees a size. You should discuss your goals with your surgeon and be comfortable with the answers he or she gives you. In general, a AA is probably not realistic for anyone after a breast reduction.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon
3.6 out of 5 stars 13 reviews

Breast reduction and final bra size.

Breast reductions rely on a pedicle of tissue to keep blood flow going to the nipple areola complex.  This pedicle needs to be a certain size.  One also must have enough thickness to insure blood flow to the flaps of breast tissue remaining.  The other tissue can be taken out.  As one can see, there must be some bulk remaining for the construct to survive.  This will be your final size.  Going from DD to AA is usually not in the range of possible.  To add to the variables there is not really standardization of bra sizes anymore either.  Best to speak with your board certified plastic surgeon and see what is appropriate for you.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Bra size after Breast Reduction

It is generally not possible to predict an exact bra size after breast reduction.  The goal in this procedure is to remove as much breast tissue as possible safely to help reduce the symptoms of neck pain, back pain, rashes , etc.. A minimum amount of tissue must be preserved, however, to preserve nerve and blood supply to the nipple/areola complex.  This volume of tissue(different in every patient) will dictate what size results postop. 

In general, most patients will go down a bra size or 2 and it seems unlikely to go from a D cup to an AA cup in most cases.  Your best bet would be to consult a board-certified plastic surgeon in your area.  

Stephen Delia, MD
Boston Plastic Surgeon
5.0 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.