Breast reduction 43 years after breast lift - Risk of complications? What can I expect from recovery?

Question

69 y.o. 5'2" 34Hh hoping to reduce to D cup. Had mastopexy years ago, is it called reduction with revision? Likelihood of complications. No hypertension, cardiovascular disease or diabetes. Advice on prep and aftercare. Eczema

Mert Demirel, MD · Answer

Yes, this would usually be considered a breast reduction, and because you had a mastopexy many years ago, it is also a revision breast surgery. The prior lift matters because the surgeon needs to understand the old scar pattern and likely blood supply to the nipple.
At 69, age alone does not prevent surgery. Your lack of hypertension, heart disease, and diabetes is favorable. The bigger questions are overall fitness for anesthesia, smoking/nicotine status, BMI, medications, skin quality, breast measurements, mammogram status, and how much reduction is needed.
Reducing from a 34HH toward a D cup may be reasonable, but exact cup size cannot be guaranteed. The main revision risks include delayed wound healing, nipple/areola blood supply problems, sensation changes, fat necrosis, asymmetry, scarring, infection, and skin breakdown. A prior lift can increase complexity, but a 43-year interval also means the tissues are fully healed and the old scars are mature.
Eczema should be well controlled before surgery, especially near the breasts, folds, or planned incision lines. Active rash, scratching, or skin irritation can increase infection and wound-healing risk, so it is wise to coordinate with a dermatologist before surgery.
Preparation should include updated breast imaging, medical clearance if your surgeon recommends it, good nutrition and protein intake, stopping nicotine completely, reviewing blood-thinning medications/supplements, and optimizing skin health. After surgery, expect several weeks of swelling, bruising, tightness, and limited activity, with most patients returning to light daily activity in 1–2 weeks and avoiding heavy lifting for about 4–6 weeks.
My advice would be to choose a board-certified plastic surgeon experienced in revision breast reduction. Bring any old operative records if available, and ask specifically how they will protect nipple blood supply, what scar pattern they recommend, and what size range is realistic and safe for you.

Kelly Schultz, MD · Answer

Hi! Having had a breast lift in the past does not necessarily prevent you from safely having a breast reduction now. Since your original surgery was many years ago, your breasts have had plenty of time to heal and develop additional blood supply. I would typically refer to this as a secondary breast reduction rather than simply a revision.
There can be a slightly increased risk of complications with a secondary breast reduction, particularly related to the blood supply and sensation of the nipple and areola. If your previous operative report is easily available, it can be helpful to bring it to your consultation so your surgeon knows which technique was originally used. However, if the records are no longer available after many years, that does not necessarily mean you cannot safely have another surgery. There are established techniques for approaching secondary reductions even when the original surgical technique is unknown.
At 69 years old, I would be much more interested in your overall health than your age alone, although it sounds like you don't have any concerning chronic medical conditions! Your surgeon should review your medications and other risk factors and may recommend medical clearance before surgery.
Going from a 34HH to a D cup sounds like a significant reduction, so an in-person examination will be important to determine what size and shape can safely be achieved while preserving healthy breast and nipple tissue. Cup size can never be guaranteed, but your surgeon should be able to give you a good idea of what is realistic for your anatomy.
Before surgery, I recommend being nicotine-free, reviewing all medications and supplements with your surgical team, being up to date on appropriate breast screening, and arranging for some help during the early part of your recovery. After surgery, following your surgeon's instructions regarding your surgical bra, incision care, activity restrictions, and follow-up appointments will be important for a smooth recovery.
Overall, if you are healthy and medically optimized, your previous mastopexy alone should not discourage you from exploring a breast reduction. I would recommend consulting with a board-certified or board-eligible plastic surgeon who is comfortable performing secondary breast surgery.
Wishing you the best of luck!

Gary M. Horndeski, MD · Answer

The fact that you had a previous breast lift done increases the possible complications because of scarring and injury to the blood supply during surgery. However, since it's been 43 years the likelihood has diminished. The technique I recommend is the Bellesoma. This will reduce and reshape your breasts 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 and nipple sensation (in 95%) if not injured during your previous surgery.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

John LoMonaco, MD, FACS · Answer

Your reduction should go well, but certain scar types used in your first surgery might raise the risk of poor healing. Much depends on the type of suregry that was done, and the type your surgeon is planning. Be sure he or she gives you a clear explanation of this question as they may need to modify their technique to ensure the best result.

Camille Cash, MD · Answer

Having a breast reduction years after a lift or even another reduction is not uncommon.  If you are in general good health and otherwise a candidate you should have nice results.  The best place to begin is a consultation with a board certified plastic surgeon near you.  She/He will examine you and review your medical history.  Further lab work, tests or medical clearance will be discussed if needed.  I've included a video on the procedure that I hope you find helpful.

Breast reduction 43 years after breast lift - Risk of complications? What can I expect from recovery?

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