Large, heavy, pendulous breasts may cause a woman to potentially experience various medical problems related to the excessive weight of the breasts. These problems can include issues with posture, skeletal deformities, back, neck and shoulder pain, skin irritation, bra strap grooving as well as problems with breathing which are often seen with this condition. In addition there are often issues of self consciousness that can accompany excessively large breasts especially in teenage girls.
The breast reduction procedure removes fat, glandular tissue and excessive skin resulting in smaller, lighter, firmer breasts that have a better shape and are in a much better proportion to the rest of the body. The procedure is now often done on an outpatient basis and is immediately rewarding in alleviating symptoms due to macromastia (large breasts).
Procedure Details: Breast Reduction
Procedure: Reduce the size of overly large, pendulous breasts by removing excess skin and tissue and repositioning remaining tissue and nipples.
Length: 3 to 4 hours.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient. Sometimes inpatient.
Side Effects: Temporary Swelling, bruising, edema, transient altered nipple, and numbness. Permanent scars.
Recovery: You may shower the following day and get back to non-strenuous work activity within a week; exercise after 3-5 weeks.
Duration of Results: Variable; gravity, pregnancy, aging, and weight changes may cause eventual sagging, but significantly less than without a breast reduction.
What is breast reduction surgery?
Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue, and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.
Breast reduction candidates
Overly large breasts can cause health and emotional problems. In addition to self image issues, you may also experience physical pain and discomfort.
The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts can be as important an issue as the physical discomfort and pain.
Breast reduction is a good option for you if you:
- Are physically healthy
- Have realistic expectations
- Don’t smoke
- Are bothered by feeling that your breasts are too large
- Have breasts that limit your physical activity
- Experience back, neck, and shoulder pain caused by the weight of your breasts
- Have shoulder indentations from bra straps
- Have skin irritation beneath the breast crease
Breast reduction costs
Your cost will be based on your individual plan and procedure.
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Breast reduction costs may include:
- Anesthesia fees
- Hospital or surgical facility costs
- Medical tests
- Post-surgery garments
- Prescriptions for medication
- Surgeon’s fee
When choosing a board-certified plastic surgeon for breast reduction, remember that the surgeon’s experience and your comfort with him or her are just as important as the final breast reduction costs.
Breast Reduction and Insurance Coverage
Many health insurance plans cover breast reduction surgery. Your plastic surgeon may need to obtain authorization from your insurer for the surgery. This may require a letter and the submission of photographs. Once an authorization is obtained, you will be able to schedule your surgery.
You will be responsible for any co-pays or deductible required by your insurer. If your health plan does not cover breast reduction, you may decide to pay for the surgery yourself.
What you should know before your breast reduction surgery
The success and safety of your breast reduction procedure highly depends on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
Be prepared to discuss:
- Why you want the surgery, your expectations and desired outcome
- Medical conditions, drug allergies and medical treatments
- Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
- Previous surgeries
- Family history of breast cancer and results of any mammograms or previous biopsies
Your surgeon may also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Examine your breasts, and may take detailed measurements of their size and shape, skin quality, placement of your nipples and areolas
- Take photographs for your medical record
- Discuss your options and recommend a course of treatment
- Discuss likely outcomes of your breast reduction procedure and any risks or potential complications
- Discuss the use of anesthesia during your procedure for breast reduction
Breast reduction risks and safety information
The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.
Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
The risks of breast reduction and breast reduction complications include:
- Unfavorable scarring
- Changes in nipple or breast sensation, which may be temporary or permanent
- Anesthesia risks
- Bleeding (hematoma)
- Blood clots
- Poor wound healing
- Breast contour and shape irregularities
- Skin discoloration, permanent pigmentation changes, swelling and bruising
- Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
- Breast asymmetry
- Fluid accumulation
- Excessive firmness of the breast
- Potential inability to breastfeed
- Potential loss of skin/tissue of breast where incisions meet each other
- Potential, partial or total loss of nipple and areola
- Deep vein thrombosis, cardiac and pulmonary complications
- Pain, which may persist
- Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
- Fatty tissue deep in the skin could die (fat necrosis)
- Possibility of revisional surgery
You should know that:
- Breast reduction surgery can interfere with certain diagnostic procedures
- Breast and nipple piercing can cause an infection
- Your ability to breastfeed following reduction mammaplasty may be limited; talk to your doctor if you are planning to nurse a baby
- The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
- Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single breast reduction procedure and another surgery may be necessary.
Where will my surgery be performed?
Breast reduction procedures may be performed in your plastic surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or a hospital. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.
When you go home
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these breast reduction complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself and minimize breast reduction surgery risks.
Preparing for breast reduction surgery
After researching the basics about breast reduction, many patients want to know what to expect before breast reduction surgery.
Prior to surgery, you may be asked to:
- Get lab testing or a medical evaluation
- Take certain medications or adjust your current medications
- Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
- Stop smoking well in advance of breast reduction surgery
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Special instructions you receive will cover:
- What to do on the day of surgery
- Post-operative care and follow-up
Your plastic surgeon will also discuss where your procedure will be performed. Breast reduction surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center, or a hospital.
You’ll need help
If your breast reduction procedure is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery, and to stay with you the following night.
What happens during breast reduction surgery?
Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.
In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.
The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice.
Step 1 – Anesthesia
Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The incision
Incision options include:
- A circular pattern around the areola
The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.
- A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease
- An inverted T or anchor-shaped incision pattern
Step 3 – Removing tissue and repositioning
After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.
Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).
Step 4 – Closing the incisions
The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.
Step 5 – See the results
The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.
Recovery time for breast reduction
Many patients have questions about recovery from breast surgery.
When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.
A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.
You will be given specific instructions for breast reduction recovery that may include: how to care for your breasts following breast reduction surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon. Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery? When will they be removed?
- Are stitches removed? When?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
Breast reduction results
The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction.
Your better proportioned figure will likely enhance your self image and boost your self-confidence.
However, over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.
Breast reduction glossary
- Areola: Pigmented skin surrounding the nipple
- Breast reduction: Also known as reduction mammaplasty, the surgical removal of breast tissue to reduce the size of breasts
- General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness
- Hematoma: Blood pooling beneath the skin
- Intravenous sedation: Sedatives administered by injection into a vein to help you relax
- Liposuction: Also called lipoplasty or suction lipectomy, a procedure that vacuums out fat from beneath the skin’s surface to reduce fullness
- Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain
- Mammogram: An x-ray image of the breast
- MRI (Magnetic Resonance Imaging): A painless test to view tissue, similar to an x-ray
- Reduction mammaplasty: The surgical removal of breast tissue to reduce the size of breasts; also known as breast reduction surgery
- Sutures: Stitches used by surgeons to hold skin and tissue together
Questions to ask your breast reduction surgeon
It is important for you to be an active participant in the process of considering and planning your breast reduction surgery. The following list of questions will help you obtain the information you need during your consultation.
Use these questions as a guide during your consultation:
- Are you certified by the American Board of Plastic Surgery?
- Are you a member of the American Society of Plastic Surgeons?
- Were you trained specifically in the field of plastic surgery?
- How many years of plastic surgery training have you had?
- Where and how will you perform my breast reduction procedure?
- Do you have hospital privileges to perform this procedure? If so, at which hospitals?
- Is the office-based surgical facility accredited by a nationally or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
- Am I a good candidate for breast reduction?
- What will be expected of me to get the best results from breast reduction surgery?
- What surgical technique is recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my breast reduction procedure?
- How are breast reduction complications handled?
- How will breast reduction affect my ability to breastfeed?
- How can I expect my breasts to look over time? After pregnancy? After breastfeeding?
- What are my options if I am dissatisfied with the outcome?
- Do you have breast reduction before-and-after photos I can look at for this procedure? Which results are reasonable for me to expect?
Choose a surgeon you can trust
Breast reduction surgery involves many choices. The first and most important is selecting a member of the American Society of Plastic Surgeons (ASPS) surgeon you can trust.
- ASPS member surgeons meet rigorous standards:
- Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by The Royal College of Physicians and Surgeons of Canada®
- Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
- Pass comprehensive oral and written exams
- Graduate from an accredited medical school
- Complete continuing medical education, including patient safety, each year
- Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities
Do not be confused by other official sounding boards and certifications.
The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name.
By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highlytrained plastic surgeon who is board-certified by the ABPS or The Royal College of Physicians and Surgeons of Canada.
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