What are small breast reduction options?

Question

Hi, I am a large B/small C cup and cosmetically I would like to be reduced to an A cup. **Aside from my personal reasons for wanting it done**, I'd just like to know what's really possible. I'm aware of the likelihood of sensation loss and inability to breastfeed. 1. Would a "keyhole" incision & scar be necessary, even to remove such a small amount of fat/tissue? 2. Assuming a consultation goes well, would a good surgeon still be reluctant to perform this for medical reasons?

Eric Pugash, MD · Answer

I will assume that you are shown in the left-hand photo.

	You would benefit from a vertical breast reduction which will leave you with a 'lollipop'-style scar on each breast. This procedure would leave you with reasonably-shaped, smaller breasts. As you have noted, loss of sensation is a risk of the surgery. In practice I have not found that patients are much concerned by this after surgery. You may also be unable to breastfeed after reduction. If this is potentially important to you, then you should delay having surgery until you have had your children.

	Your breasts are somewhat 'bottomed-out' and I do not think you would be happy with their appearance after liposuction alone.

	I recommend you see an experienced cosmetic breast surgeon. He or she will discuss your wishes with you, explain the procedure in depth, and help you decide whether it's right for you.

	Good luck!

George Marosan, MD · Answer

Thank you for the photo (I asssume the one on the left is you). A small breast reduction can be done via a short vertical scar technique. If you are concerned about scarring and or breast feeding, you might consider liposuction breast reduction only. There's a good chance that this will not raise your nipple areolar complexes to the desired level. In the US, insurance does not cover this procedure since there's a weight requirement. In your case that would be a mastectomy. Loss of sensation is rare and the ability to breast feed is unpredictable with this surgery.

Tom J. Pousti, MD · Answer

Thank you for the question.

	It is possible to reduce the breasts size very significantly.   Sometimes  when patients want &ldquo;almost nothing left&rdquo;  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 &ldquo;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.
	 
	 
	I  hope this helps.

David L. Abramson, MD · Answer

When you reducte the size of the breast the skin envelope will frequently need to be reduced as well. Examination of the fat content of your breasts and the quality of the skin will help determine the options available to you.

Malik Kutty, MD · Answer

You should not have trouble finding a surgeon who can help you. You don't look like you would need a "keyhole" incision since the photo does not show skin excess. Liposuction for reduction is generally reasonable, but if you're young you probably have mostly glandular tissue (as opposed to fat) which might make it tougher to remove volume that way.

Peter E. Johnson, MD · Answer

The vertical reduction technique works very well in a small breast to made smaller, often combined with liposuction to thin and tailor the breast tissue. There is no reason for a surgeon to be reluctant, and reduction of a smaller breast is a very common procedure to improve breast symmetry after reconstruction. You can almost imagine breast reduction progressing to breast lift as a continuum which can be adapted to any need. Be certain your surgeon is well experienced and understands your goals.
	Best of luck,
	peterejohnsonmd

Robin T.W. Yuan, MD · Answer

Depending on the fat vs. gland content of your breasts, you might consider a liposuction only technique to reduce the breast size. If your skin is young and elastic and the breast is fairly taut, the reduction in weight might be enough to procude the small lift you might find acceptable without the scars of a lift.

	Robin T.W. Yuan, M.D.

Jack Peterson, MD · Answer

You could do a Le Jour reduction, which would eliminate the inframammary crease incision. Any plastic surgeon experienced in breast reduction surgery could perform this as a cosmetic procedure.

	In the US, you most likely would not be able to have this surgery performed for medical reasons because insurance has very specific requirements with how much breast tissue needs to be removed. They would also require documentation that you are having medical problems due to large breast size.

Carlin Vickery, MD (retired) · Answer

Patients vary widely in what they call a B or C cup. As a practice, I look at the relationship between the size of a patient's breast, her skeletal frame (large, medium, fine) and her average weight. It is critical to keep a balance between the upper and lower part of a woman's body. If a surgeon over reduces a patient's breasts , then it is likely that the patient will forever look wide in the hips or have her abdomen as her leading projection --- not a pretty look! If a patient has a fine frame, and a low body mass and is requesting to be an A size, then the surgeon needs to be sure the patient understands the look and size of an "A" cup. I find it is important to have patients bring in sample pictures of their ideal breasts as it insures we are speaking the same language.

Alan M. Engler, MD, FACS (retired) · Answer

Hi vxc61,

	It's not at all unreasonable to consider a small breast reduction (essentially a breast lift, since the amount of tissue you'd need removed may not qualify to be termed a "reduction").

	As always, you'll need to know whatever is good and bad about the procedure, including risks and scarring.  Assuming that your photo is the one on the left I would think that you can get a nice result with a vertical pattern alone.  If, however, you have excess or particularly lax (loose) skin, you may benefit from a small horizontal incision in the crease to achieve the best result possible.  Though many people specifically so not want that scar, that's often the least visible of the scars that make up the keyhole shape.

	I would advise you to have a few consultations with plastic surgeons to see exactly what they'd recommend.  As long as you understand what are termed the "risks, benefits and alternatives," you would be that much more likely to be happy with the results of this procedure.

	As a last thought, I would advise not going too small, as it would be a dramatic change and, as you go too small, you risk affecting both the final shape (may be too flat) and the blood supply to the nipple and areola, which increases the risk of certain wound healing problems.

	That being said, it's more than reasonable to explore.

	I hope that this helps, and good luck,

	Dr. E

What are small breast reduction options?

Answers (12)

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