I want a drastic breast reduction; some think it's too extreme. Advice? Experience?

Hi RileyLouise320,
Patients choose to optimize their breast aesthetics for many reasons. Ultimately, what you choose to do with your body is up to you.
Patients with large breasts often have multiple problems, including but not limited to back and neck and shoulder pain, bra strap grooving, trouble finding clothes that fit, and awkwardness in social situations. Breast reduction can be impactful in treating all of these symptoms.
You correctly note that there are limitations to how small the breast can be made, given the breast tissue that needs to be retained in order to keep the nipple alive. For women with substantial ptosis, or descent, of the breast, amputation and Free nipple graft technique and often help the breasts to be as small as possible. As such, and with your goals, your surgeons plan seems reasonable.
Ultimately, I would suggest making an informed decision after an in-depth consideration of your own goals, and with the guidance of your experienced board-certified plastic surgeon.
I hope this helps.
Sincerely,Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

It is possible to dramatically reduce the size of the breasts with a successful outcome, though it is more common for patients to be satisfied with their results when the reduction gives them proportionate results. It is your body and you should make the decision based on your opinion, not on the opinion of others.

The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary Horndeski, M.D.

Hello and thank you for your question.
This is a personal decision. Schedule a reconsult with your surgeon to discuss your options, sizing, and what will work best for your body. Best wishes!

Dear RileyLouise320,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I’ve seen plenty of women pretty upset at their surgeon for making them too small. I don’t blame the one surgeon for refusing to operate.

Yes, I have had a few patients who basically wanted a simple mastectomy and wanted most of their breast tissue removed. Not all were transgender patients either, but all had a variety of reasons, including a higher chance of breast cancer in some. All that I did were very happy and none returned to me for any augmentation. You could consider going down to a small B as well and save the nipples. Ask to look at small B photos and A photos of preop augmentation patients.

If you want to have A cup breasts and your surgeon is confident that he/she can achieve your desired result with a free nipple graft, then go for it! Keep in mind that you will not have nipple sensation after a free nipple graft, but if you are fine with that too, go for it! You mentioned "reverse dysmorphia" so if your family members or you are concerned about body dysmorphic disorder (BDD) you may want to investigate this further by seeing a psychologist or psychiatrist who helps patients with these issues. If this is not a concern for you and you think this is the right decision for you, go for it! Yes, reductions with free nipple grafts look great and are frequently used in women who want a very big reduction.

While I don’t typically perform a very large and drastic reduction for safety reasons, I think it is important to remember that the size of the breast after the operation is dependent on a few factors. Number one, there has to be enough breast tissue remaining to supply blood flow to the nipple and to the skin. This can often make reducing the breast to a drastic level very difficult. Furthermore, in my experience, going too small has led to a postoperative realization that the aesthetics of this breast may not meet the long-term goals. This is always a very difficult scenario. When making such a drastic reduction, you have to consider the very long term ramifications of this. Furthermore, there are several surgeons that would consider this more of a mastectomy and not feel comfortable performing this operation. I think the important thing is that you look at this from a safety standpoint in the viability of the tissue remaining. This should be your greatest concern, and also is a concern of your surgeon. Have a conversation about your goals with a board-certified plastic surgeon. We are happy to help in any way we can.

The decision you are making is for very personal reasons and it sounds as if you have considered this procedure for awhile and thought through it carefully. Be sure that you are comfortable and confident in your surgery and your surgeon. Ask lots of questions and know and make sure you are comfortable with the risks and benefits.