Breast Reduction (Reduction mammaplasty)
The goal of breast reduction surgery is to reduce the size of your breasts and reshape them so that they are proportionate to the rest of your body and are no longer a source of physical discomfort.
This commonly requested, predictable procedure has the dual benefits of improving your appearance while relieving the physical and emotional burden of overly large breasts.
When to Consider Breast Reduction
- If your breasts are too large for your body frame and create neck, back, or shoulder pain
- If you have heavy breasts with nipples and areolas (pigmented skin surrounding the nipples) that point downward
- If one breast is much larger than the other
- If you are unhappy and self-conscious about the large appearance of your breasts
- Your breasts will be in better proportion with your body and will feel firmer.
- Surgery will alleviate neck, back, and shoulder pain and make it easier to breathe and exercise.
- Your clothes will fit better and you will feel more confident about your appearance.
- You may have decreased sensation in some areas, including the nipples and areolas.
- Some women complain that their breasts and nipples look slightly uneven.
- Breast-feeding may be a problem.
Am I a good candidate for a breast reduction?
- You have backaches, neck aches, or skin irritation under your breasts.
- You have difficulty breathing and notice grooves in your shoulders from your bra straps.
- You have poor posture or numbness in parts of your breasts and upper chest from excessive breast weight.
- You find it nearly impossible to buy dresses and blouses and difficult to find tops that fit.
- You are very unhappy with your appearance because of your breast size.
- You are in good health with no active diseases or pre-existing medical conditions.
- You have realistic expectations of the outcome of your surgery. You must be able to discuss what you want with your plastic surgeon so that you can reach an understanding of what can realistically be achieved.
- Your skin has adequate elasticity, so it can resume its former tightness following surgery.
- You are mentally and emotionally stable. Breast reduction requires patience and stability to deal with the healing period.
- You are old enough so that your breast development has stopped.
- You have finished having children and breast-feeding, because this can have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this with your plastic surgeon
About your Procedure
How is a breast reduction procedure performed?
Breast reduction surgery, which usually takes from three to five hours, is performed in a hospital or surgical center. The surgery commonly involves three incisions. After the surgeon removes excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areolas may be reduced in size. Skin that was located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.
- Your surgeon will use a surgical marker on your skin to indicate where the incisions will be. These markings are especially important, because your breasts change shape once you are lying on your back on the operating table.
- Most surgeons prefer general anesthesia for this procedure. A few may perform breast reduction with intravenous sedation, also known as twilight sedation.
- Your incision pattern will depend on the size of your breasts, how much your breasts sag and where your nipple-areola complex is positioned. With each technique the areolas can be made smaller if they are too large. An areolatome, more commonly known as a “cookie cutter,” is used as a circular template to make the new areola size. The cookie cutter diameter ranges from thirty-eight to forty-five millimeters.
- Your surgeon will remove excess breast skin and fat with a scalpel and/or cautery instrument based on the size breast you desire. If your breasts are asymmetrical (or uneven), the surgeon may remove more tissue from one breast than the other. He or she will then reshape the remaining skin and fat to create a more youthful breast shape and move the nipple-areola complex to a higher position.
- In most cases, drains will be placed in the breasts to collect excess fluid.
- Breast incisions are then closed with sutures that go from the deep tissue layers to the more superficial layers (the skin).
The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.
Preparing for Your Procedure
You may be asked to have a mammogram (if youre over forty years of age), electrocardiogram (ECG) or chest x-ray. If your surgeon recommends weight benchmarks or lifestyle changes, do your best to achieve them to ensure the best results and minimize the chance of complications.
In advance of your procedure, your surgeon will ask you to:
- Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
- Stop smoking at least six weeks before undergoing surgery to promote better healing.
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and critical outcomes.
- Keep alcohol consumption at less than two to three drinks per week.
Aftercare and Recovery
Immediately after your breast reduction surgery
- If youve had general anesthesia, you might wake up feeling disoriented.
- You will have a surgical dressing over your upper chest and will probably have drains coming from each breast.
- You may have compression sleeves on your legs to help with circulation
- You will feel discomfort, but your medication will keep you from feeling pain.
- After the hospital staff observes you for a few hours it is likely that you will be allowed to go home,where you will need someone to care for you for the next few days.
- Before the hospital or surgical center releases you, they will show you how to care for your incisions, instructing you on how frequently to change the bandages and how to empty your drainage tubes.
- When the anesthesia wears off, you may have some pain. Any discomfort can be controlled with pain medication. If the pain is extreme or lasts long, contact your physician.
- You might notice a change in breast size, but at this point you will have significant swelling. In most cases, this swelling will remain for weeks or even months.
Recovery time frame after breast reduction
Here is a general idea of what you can anticipate:
- Drains. Your drains will more than likely be removed at your first follow-up appointment, which is usually within the first week after surgery.
- Incision care. Keep your incisions/suture line dry. Your surgeon may have placed Steri-Strips on top of your incision line and sutures, or you may have sutures internally and tissue glue externally to bind your incision edges
- Suture removal. Your incision sites will be checked and your stitches removed in approximately ten days.
How Long Will the Results Last?
Unless you gain or lose a significant amount of weight or become pregnant, your breasts will remain a consistent size. However, gravity and the effects of aging will eventually cause your breasts to loosen and sag over time.
Limitations and Risks
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in skin sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
- Blood clots in the legs or lungs