Would I benefit from a reduction + lift or just a lift? (photo)

Question

I’m 21 years old, 5’5, 68kgs with a bra size of 30J. Today I had a consultation with a surgeon that told me I don’t need a breast reduction, just a breast lift because in her opinion my breasts are entirely made up of lose skin. I’ve been experiencing severe back pain and am very surprised she didn’t think my breasts were large. They feel like they weigh a lot.

Christine Fisher, MD, FACS · Answer

Hi Exciting!  How exciting that you are taking this step to feel better.  A breast reduction can be life changing.  Most women with heavy breasts experience symptoms such as yours with back and neck pain, grooves in their shoulders from bra straps and rashes underneath their breasts.  Ultimately they are your breasts and if you feel like they are too heavy, then I encourage you to seek out a reduction as well as the lift.  A mastopexy (lift) only will raise the position of the breast and nipple on your chest wall, but will not change the heaviness of them.  I also recommend the use of an absorbable mesh to create an internal support to help maintain your results over time.  I highly encourage you to seek out a board-certified plastic surgeon specializing in surgery of the breast and body to hear your concerns and come up with a plan to reach your goals.  Best of luck!

Emre Guvercin, MD, FEBOPRAS · Answer

I understand why you’re confused &mdash; but based on what you’ve shared, a lift alone is very unlikely to solve your problem.Key point firstIf you are a 30J and have severe back pain, your breasts are not just loose skin.They may look soft or deflated, but they still carry significant weight.- Skin does not cause back pain. Weight does.Why a lift alone is usually the wrong solution hereA breast lift:Repositions skin and nippleDoes NOT remove weightDoes NOT reliably improve back or shoulder painIn fact, a lift alone can sometimes make symptoms worse, because:The same heavy tissue is simply moved higherThe load on your back and shoulders remains unchangedSo if your breasts “feel heavy” &mdash; that sensation is real and mechanical.What your size actually meansA 30J on a 5’5” frame is a very large volume-to-body ratio, even if the tissue is soft.Many patients with:Soft breastsPost-weight change breasts“Loose” appearing tissue&hellip;still require substantial tissue removal to feel relief.Soft ≠ light.What would actually benefit youYou are a very strong candidate for a Push-Up Breast Reduction + Lift, not a lift alone.Why Push-Up Reduction is ideal in your caseA Push-Up Breast Reduction:Removes excess breast weight (the source of pain)Repositions remaining tissue upward and inwardPreserves breast shape and projectionPrevents a flat or boxy resultGives real relief for:Back painShoulder strainPosture issuesThis is especially important in young patients, where we want:Long-term comfortStable shapeMinimal need for future surgeryIs your surgeon “wrong”?Not necessarily &mdash; but this reflects a difference in philosophy.Some surgeons:Focus on appearance aloneUnderestimate symptoms in young patientsAvoid reduction if breasts look softA surgeon experienced in functional breast reduction looks at:SymptomsWeightFrame proportionBiomechanics &mdash; not just how the breast looks at restYour symptoms matter more than how the tissue feels.What size would typically bring reliefMost patients like you feel dramatic improvement when reduced to:C–D range (sometimes full D depending on frame)You do not need to be “tiny” &mdash; you need to be lighter and supported.
I would strongly recommend getting a second opinion, ideally with a surgeon who regularly performs breast reductions for symptom relief, not just cosmetic lifts. Your body is telling you something &mdash; and it deserves to be taken seriously.

James N. Romanelli, MD, FACS · Answer

Dear Exciting652298

Thank you for your question.  Certainly, from you photo, it looks like you will benefit from a breast lift, and very likely from a breast reduction as well.

Breast size is a choice.  Patients often ask me what size will look best on them.  I like proportion, but proportion is a range of sizes, not exactly one size.

Breast reduction can reduce back pain, and it is also important to note that back pain can have many causes.

Consider a second consultation with another board certified plastic surgeon.  You deserve to have the breast size you desire.

Best of luck
Dr. Romanelli

Caner Kacmaz, MD · Answer

From your picture , I can easily see that you definitely need breast reduction surgery. This surgery also includes an uplift. Breast reduction surgery provides significant benefits for improving physical health as it addresses the chronic back and neck pain experienced by women with larger breasts and discomfort caused by shoulder grooves from bra straps as well.

Stanley Okoro, MD · Answer

Hello! Great question. From the photo you uploaded, it appears you would benefit from both a reduction and a lift. Since you are having back pain especially, removing some of the tissue would be beneficial for not only aesthetic purposes, but functionality. Good luck!

Oliver Chang, MD · Answer

Based off your limited photo (would ideally like to see more angles of your breast and without a physical exam) - if the breasts are heavy to you, then ideally a lift with reduction should take place. The planning of your surgery is important for you and the surgeon to discuss what the limitations are for wanting to decrease in a medium versus significant size reduction (the more you take, the possibility of more issues with healing, nerves etc). And if you remove a lot, it still doesn't guarantee that the 'back pain' you experience will be treated completely or any at all (so also be ready to have this happen). So this is a must have talk with your surgeon and even if you are a lot of skin - there is still breast tissue under and being that you are young, reductions will likely enlarge some or a lot again - secondary to pregnancy, weight gain or just re-growth over time (so be ready for that as well). Try to seek a second opinion if you are not completely in agreement with your first surgeon to see if there's a consensus and then decide.

Ajaya Kashyap, MD · Answer

Thank you for your query. It is difficult to say based on this single picture, but if you are indeed a size j cup, a breast reduction would certainly be worth considering. I would recommend finding another experienced board certified plastic surgeon who can examine you and help you with all your concerns. All the best!

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Hi, thanks for your question which is one that is often considered in clinic. A question that I often ask patients is whether they are happy with their breast volume in a bra? If the answer is yes, then a mastopexy (breast uplift) is likely to achieve the desired outcome - a change in shape but not volume. If you are getting symptoms from heavy breasts (back / neck ache, bra strap indentation, infections / inflammation in the lower fold of your breast) and would like a reduction in volume as well as an uplift, then a breast reduction is likely to be the choice for you as this will improve both shape and symptoms. Your surgeon should be able to tailor their recommendations based on your desired outcome. Make sure you consult with a surgeon who is a specialist in aesthetic breast surgery and is appropriately qualified to provide an expert opinion.

Wayne I. Yamahata, MD · Answer

A breast reduction and a breast lift are very similar procedures. Both procedures will lift the breast. The breast reduction will also reduce the breast volume. As you are currently wearing a J cup bra, I personally would favor some degree of reduction. Keeping your current size may lead to future problems. The heavy weight will accelerate the recurrence of sagging. The weight will also place you at risk of developing chronic pain in your back, neck, and shoulder areas.

Krishna Vyas, MD, PhD, MHS · Answer

Symptomatic macromastia refers to a condition where a person has excessively large breasts (macromastia) that cause physical symptoms or discomfort. The term "symptomatic" means that the condition leads to issues such as chronic back, neck, or shoulder pain, poor posture, skin irritation, or rashes under the breasts, and difficulty with physical activities or finding properly fitting clothing. These symptoms can significantly affect daily life and may interfere with a person's ability to perform everyday tasks comfortably.

A breast reduction involves the removal of excess breast tissue and skin to reduce the size of the breasts. A breast lift (mastopexy) focuses on raising and reshaping the breasts without reducing their size.

Based on your description, a breast reduction may help to address both issues by reducing the size of your breasts and give you a lifted appearance. On the other hand, if your primary concern is the sagging and you don't mind keeping the volume of your breasts, a lift alone could improve the appearance without altering the size.

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

Would I benefit from a reduction + lift or just a lift? (photo)

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