Breast Reduction

Breast reduction surgery (reduction mammoplasty) removes some of the tissue and skin from the breasts to reshape and reduce the size of the breasts. It can also make the area of dark skin surrounding the nipple (areola) smaller.

To remove tissue and skin from the breast, the surgeon first makes one or more cuts in the breast. After the excess tissue and skin have been removed, the skin is closed with stitches. Sometimes the nipple and areola have to be removed and stitched to a new spot. This can cause a loss of feeling in the nipple, since it has to be cut off from the nerves supplying it.

Breast reduction surgery is done in a hospital or surgical center using general anesthesia. The surgery usually takes 2 to 4 hours. An overnight stay is not usually required.

Breast lift (mastopexy) is similar to a breast reduction, except that in most cases only skin is removed for a breast lift. A breast lift can raise sagging or drooping breasts, which is a common problem with large, heavy breasts, and can elevate the nipple and areola. To lift the breasts, excess skin from the bottom of the breast and the area around the areola is removed. The remaining skin is then brought together, which tightens and raises the breast.

What To Expect After Surgery

Immediately after surgery, gauze is placed over the incisions, and the breasts are wrapped in an elastic bandage or supported with a special surgical bra. In some cases, there may be a small tube in each breast to help drain blood and fluid for the first couple of days. Stitches may be removed in 1 to 2 weeks.

Most women have some breast pain for the first few days after surgery and then milder discomfort for a week or longer. Medicine can help relieve the pain. Swelling and bruising may last for several weeks. Wearing a surgical bra 24 hours a day can help reduce swelling and support the breasts while they heal.

You will likely resume your normal work and social activities within a couple of weeks, unless those activities involve heavy lifting or strenuous exercise. You may need to avoid more vigorous exercise and activities for 3 to 4 weeks or more. It’s important to wear a bra that supports the breasts well, such as a sports or athletic bra.

You will have visible scars on your breasts after breast reduction surgery. These are almost always in areas that can be covered by a bra or swimsuit. Scars may fade over time, but they will not disappear.

Why It Is Done

Breast reduction surgery is done to change the size, weight, firmness, and shape of the breasts. You may decide to have breast reduction surgery to:

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1. Feel more comfortable. Large, heavy breasts can cause back and neck pain, skin irritation, and posture problems. The constant pull of heavy breasts may make bra straps leave painful indentations in a woman’s shoulders. Breast reduction surgery can eliminate these problems in most cases.

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1. Reduce the limitations that large, heavy breasts place on participation in sports or other activities. Some physical activities may be painful or awkward for women with large breasts.

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Alter your appearance. Large breasts, especially when they are out of proportion to your height and weight, can be embarrassing. Teenagers and young women with large breasts may especially feel self-conscious wearing swimsuits and other types of clothing due to unwelcome attention to large breasts. It also may be difficult to find clothes that fit well.

How Well It Works

Women who have breast reduction surgery are often extremely satisfied. It can make the breasts smaller, firmer, lighter, and more evenly proportioned. It usually relieves the physical discomfort and pain caused by large breasts.

The results of breast reduction surgery are considered permanent. However, the breasts may become larger or their shape may change as a result of pregnancy, weight gain, or weight loss.

Risks

The most common risks of breast reduction surgery include:

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1. Scars. Breast reduction surgery always leaves visible scars on the breasts, but how bad the scars are varies from person to person and by the type of incision. Although red and swollen at first, scars typically fade over time. However, scars may remain very noticeable in some women long after surgery. Fortunately, the incisions usually can be limited to areas of the breast that can be covered by a bra.

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1. Unevenly positioned nipples, or breasts that are not the same size or shape.

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1. Loss of feeling in the nipples or breasts. This is often temporary, lasting a few months, but in some women it lasts much longer or becomes permanent. However, because many women with large breasts do not have a lot of feeling in their breasts before surgery, this may not be a concern.

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Inability to breast-feed after surgery. Some women may still be able to breast-feed, depending on what type of reduction was done, but in some cases the milk ducts under the nipple may be permanently damaged.

Less commonly, damage to the breast’s blood supply may occur during surgery. This may delay the skin’s healing process. Loss of part or all of the nipple and areola can also occur, but this is not common.
Other risks of surgery include:

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1. Excessive bleeding during surgery.

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1. Infection.

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1. Reaction to the anesthesia.

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Blood clots in large veins traveling up to the heart and lungs (pulmonary embolism). This is not common.

These risks can be serious or even life-threatening, but they rarely occur.

What To Think About

If you are thinking about having a breast reduction, contact your insurance company. Some insurance companies cover some or all of the costs of breast reduction surgery if surgery is being done to relieve back pain, skin problems, or other medical problems caused by large or heavy breasts. They generally will not cover breast reduction surgery being done solely to change the appearance of the breasts, because it is not considered a medically necessary procedure when done for this reason.

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