A breast reduction, or reduction mammoplasty, is a surgery that removes the excessive fat, glandular tissue, and skin in the breast. Through this plastic surgery the breast can be reshaped, and the size of the nipple-areola complex can be reduced to improve the proportions of the patient's body. In some cases this surgery has medical implications, for example; when the breasts are so big that they cause discomfort in the back. A breast reduction removes the extra weight and can fix those back issues.
Breast size is mainly determined by hormones, weight and genes. Breasts are very sensitive to hormones, and they usually grow and change their shape during adolescence, after menopause, or due to the use of hormone replacement therapies. If a woman gains weight or becomes pregnant, the breasts’ shape and size may change, even after the surgery.
Overly large breasts can cause health and emotional problems; self-image issues, back pain or discomfort, and the weight of excess breast tissue can impair her ability to carry out an active lifestyle. Men can also undergo this surgery to treat a medical condition known as, gynecomastia, caused by an imbalance of estrogen and testosterone.
It is important that the patient understand that breast reduction surgery is a highly individualized procedure. The patient should do it for themselves, not for someone else’s desires or to try to fit any sort of ideal image.
Who are ideal patients for breast reduction surgery?
A person who desires to undergo this procedure should be physically healthy, who are unhappy with the shape, weight or drop of their breasts, whose breasts limit their physical activity, or the patient experiencing back, neck or shoulder pain caused by the weight of their breasts. Additional situations, such as, the patient having regular indentations from bra straps, and skin irritation in the breast crease area. It is important for anyone undergoing this procedure to have realistic expectations.
The patient will need to have a consultation with a breast or plastic surgeon, and in some cases they should consult a psychiatrist or psychologist before the surgery. If they consider the patient will gain enough social, psychological or physical benefits, the patient can undergo surgery.
Are there non-surgical alternatives?
The breasts can become large because of fatty deposits within them, both in women and men. This means that the patient may be able to reduce the size of their breasts by losing weight. Nevertheless, medical conditions like breast hypertrophy (macromastia, less than 500grs overweight) and gigantomastia (less than 1000grs overweight) does not respond to exercise or medical therapy, they can only relieve some symptoms of the excessive size.
The physical therapy provides some relief for those patients who suffer from neck, back or shoulder pain. Skincare can help prevent breast crease inflammation and other symptoms due to moisture, including irritation and infection.
How is breast reduction surgery performed?
This procedure is usually bilateral, being performed unilaterally only when the patient has an important asymmetry between the breasts. This surgery commonly takes between 2 and 4 hours to complete and is done under general anesthesia. The patient will usually need to stay in the hospital for one or two nights after the surgery.
There are several techniques that the surgeon could use, and they will select the most appropriate method for each patient depending on; the size of the breasts, breast composition, the degree of breast ptosis present, and the amount of reduction that the patient desires.
This plastic surgery basically consists of; removing the excessive fat, glandular tissue and skin from the patient's breast through incisions. Liposuction can sometimes be used along with the surgery. In other cases, using the liposuction technique alone, the extra fatty tissue can be removed, especially when the patient has no excess of skin.
Breast reduction surgery is performed in two steps. First, the skin incision, and the second, when the plastic surgeon makes the excision including all the mammary parenchyma (fat, glands, etc.). The skin incisions include:
- Periareolar technique: A circular pattern is made around the areola. The incision lines that remain are visible and scars are permanent, although they are usually in areas where they can be easily concealed beneath a swimsuit or the bra.
- Vertical scar technique (lollipop, keyhole or racquet incision): The incision is made around the areola; after that, the plastic surgeon makes another incision that goes vertically down to the breast crease. It usually has, as a result, a best-projected breast, small incision scars, and a functional nipple-areola complex. This technique is recommended to eliminate small amounts of excess skin, and less amount of parenchyma from different parts of the breast.
- Inferior pedicle technique (Anchor pattern, inverted-T incision, or wise pattern): Is an incision around the nipple-areola complex, which then extends downwards, following the natural curve of the breast hemisphere. The inferior pedicle (central) features a blood vessel supply and innervation for the nipple-areola complex, which produces a reduced and sensitive breast, with full lactational capability and function. This technique effectively reduces conditions like macromastia and gigantomastia.
- Horizontal scar technique: In this technique, the plastic surgeon makes an incision horizontally in the inframammary curve, maintaining pedicle with the nipple-areola complex. This technique is used as an alternative to the vertical incision technique because the vertical incision can’t be used in too large breasts. This technique does not leave scars like the vertical incision and promotes cicatrization of the new nipple-areola complex.
- Free nipple graft technique: This method consists of the nipple-areola complex as graft, the plastic surgeon doesn't conserve a pedicle. An important advantage of this technique is the big volume of parenchyma that the plastic surgeon can remove in one procedure. However, the disadvantage is that the patient obtains a non-sensitive nipple-areola complex, and the breast loses the capability to breastfeed. There are few medical conditions where this technique is suggested: patients with high probability of ischemia and necrosis, with diabetes or a tobacco smoker, and patients with macromastia (these patients requires the resection of a lot of breast tissues).
Using any of the incisions listed above, the plastic surgeon can reshape and resize the areola, by cutting out the excessive skin at the perimeter of the nipple.
- Liposuction-only technique (lipectomy): This style of breast reduction is commonly used in those patients that desire to remove a medium amount of tissue, and who have health problems that prevent them being under extended anesthesia.
The ideal candidates for this technique are patients with breast tissue mainly composed of fat, skin in relatively good condition and a mild degree of droopage. The advantages of this method are little incisions that the plastic surgeon requires to eliminate the parenchyma of the breast; however, the disadvantage is the limited amount of breast-reduction volume.
Once any of those incisions have been made, their borders should be brought together to reshape the now smaller breast; the sutures, skin adhesives and/or surgical tape are are placed by layers within the breast tissue to provide more support to the new breasts. Incision lines are permanent, but in most cases will fade and significantly improve over time. The results of your breast reduction surgery are immediately visible.
When is breast reduction suggested?
A breast reduction is a procedure that should be avoided if; the woman is currently breastfeeding or has breastfed recently, if her breasts have any masses or microcalcifications that have not been studied, if the woman has systemic disorders, or if she does not understand the limitations, potential complications and risks of the surgery.
When the plastic surgeon and the patient have decided to perform a breast reduction only through liposuction, the patient should undergo a mammogram first. This is to determine if the enlarged breast is mainly composed of mammary tissue; likewise, it is suggested in cases where there is a great degree of breast ptosis, and an inelastic skin envelope.
How much does a breast reduction cost?
The average price for breast reduction surgery is $6,150, however, costs can vary widely based on factors such as surgeon experience level, the technique used, and breast size.
Breast reduction surgery is generally considered a reconstructive procedure, so it may be covered by some health insurances, especially when the patient presents medical symptoms due to this condition.
How is the preoperative preparation for breast reduction done?
In the first consultations with the plastic surgeon the patient should discuss: why they want the surgery, their expectations and desired outcome, their medical record including any medical conditions, allergies, current treatments, tobacco and drugs, previous surgeries (and if they had any complications). For this kind of plastic surgery, it is very important for the plastic surgeon to know the patient's history of breast cancer (including family history). If the patient has previous results of mammograms and biopsies, she should hand them into the surgeon.
The plastic surgeon will evaluate the patient's general health condition and risk factors, will examine their breasts to determine the size and shape, study the skin quality, and the complex nipple-areola position on the patient's breasts. After that, the surgeon can take photographs for the patient's medical record. This is the moment to discuss the different options for the procedure, desired outcomes of the breast reduction, and the type of anesthesia that will be used during the surgery.
The patient also needs to get some lab testing, take certain medications or adjust their current medications to avoid bleeding. Before and after breast surgeries it is recommended they undergo a mammogram to help detect any change of the tissue. The patient should also stop smoking at least two weeks before surgery.
What are the postoperative cares of a breast reduction?
Immediately after surgery, gauze is placed over the incisions, and the breasts are wrapped in an elastic bandage. In other cases, the patient can only use a special post-operative bra to minimize swelling and to bring support to the breasts as they heal (it should be used 24 hours a day). Sometimes, the plastic surgeon leaves a small tube in each breast, this helps to eliminate the remaining blood and fluids during the first days after surgery. The stitches should be removed between 1 and 2 weeks.
The first days after the surgery, most women have breast pain. This pain progressively becomes a mild discomfort, and it may last between 1 and 2 weeks. The doctor can prescribe some medication to help relieve the pain, and antibiotics to reduce the risk of infection. Other symptoms, such as swelling and bruising, can remain for several weeks.
The patient will likely resume their normal work and social activities within a couple of weeks, but activities that involve heavy lifting or other strenuous exercises should be avoided longer. Recovery time depends on patient's age and general fitness. It's important to wear a bra that supports the breasts well during strenuous activities after the surgeon approves doing them.
The patient must wait for several weeks, or between 6 months to a year, to observe the final results of the surgery. Women who have undergone a breast reduction surgery get the desired outcome and feel satisfaction, because with this surgery the woman can possess smaller, firmer, lighter, and more evenly proportioned breasts, as well as eliminating the discomfort caused by enlarged breasts.
The results of breast reduction surgery are permanent. However, the breast may change again by conditions like pregnancy, weight gain, or weight loss, hormonal factors and gravity.
The patient will have visible scars on their breasts after the procedure, but they are placed in areas where they can be easily covered when the patient is using bras or swimsuits. The scars usually lighten over time, but they will not disappear completely. The patient will feel that they have a better-proportioned figure, will likely enhance their self-image and boost their self-confidence.
What are the most common risks of breast augmentation?
All surgeries carry out risks; the most common complications, specific to breast surgery, include: visible scarring, unevenly shaped breasts or nipples, wound healing problems, loss of breast or nipple sensation (this is often temporary, however, it may become permanent), or permanent inability to breastfeed (depending what type of reduction was done).
Other, less common, complications, include damage to the blood vessels of the breast, which can delay the healing process, and loss of part or all of the nipple-areola complex.
During surgery, medical complications can occur, such as: excessive bleeding, infection, reaction to the anesthesia and pulmonary embolism. These risks can be serious or even life-threatening, but they rarely occur.
Dr. Amjadi MD, DDS, FACS
Certified by the American Board of Plastic Surgeons
915 Gessner Rd #870
Houston, TX 77024