Breast reduction surgery (or reduction mammoplasty) is a procedure to reduce the size of the breasts. The surgery is usually performed on women with overly large breasts who suffer from back or neck pain, shoulder grooving from bra straps, infections or rashes under the breasts, or even a feeling of numbness in their fingers due to the weight of the breasts. Overly large breasts can also interfere with sports and exercise. Breast reduction surgery alleviates these and other problems by removing portions of the breast skin, glands, and fat. Multiple scars will remain after the procedure. Though the results of breast reduction surgery are partially cosmetic, the procedure can help women pursue many activities they were previously unable to perform. Of all types of plastic surgery, women who have breast reduction are usually the most satisfied with the outcome.
According to the American Society of Plastic Surgeons, over 106,000 women undergo breast reduction surgery each year. Breast reduction surgery is one of the fastest growing areas of breast reconstruction; less than 40,000 women had the procedure done in 1992. Women most likely to undergo breast reduction range from age 19 to age 50. Though the procedure is usually performed on women whose breasts have fully developed, occasionally teenage girls undergo breast reduction surgery if their breasts are causing severe physical discomfort. Many women prefer to wait to have breast reduction surgery until after they have had children since the breasts tend to shrink after pregnancy and nursing. Breast reduction surgery may also interfere with a woman’s ability to breast-feed.
Of all types of plastic surgery, women who have breast reduction are usually the most satisfied with the outcome.
In most cases, women who are considering breast reduction surgery will set up an initial consultation with a plastic surgeon. All plastic surgeons should be certified by the American Society of Plastic Surgeons (ASPS). The surgeon will review the breast concerns, including any history of previous breast surgeries such as lumpectomy (removal of a breast lump). He or she will also make measurements to determine the amount of breast tissue to remove to make the breasts more proportionate with the rest of the body. Many women who have overly large breasts want to have as much breast tissue removed as possible, but surgeons prefer not to over-remove tissue and will usually suggest a moderate removal.
Issues discussed in the initial consultation may include:
- Preparing for surgery
- Cost of surgery (many insurance providers will cover the cost of breast reduction surgery because they do not consider the procedure to be cosmetic. However, women will usually have to send pictures of their breasts and recommendations from the plastic surgeon to obtain authorization. Some insurance companies require a certain amount of breast tissue be removed).
- Type of facility where the operation will be performed
- Type of anesthesia
- The operation itself
- Recovery
- Possible side effects and complications
As with any surgery, women considering breast reduction should tell their plastic surgeons about any medications, vitamins, or other drugs they may be taking. The plastic surgeon must be certain that no medical problems exist that may interfere with the surgery. Typically, a baseline mammogram is taken before the operation. Breast reduction surgery does not usually interfere significantly with mammography after the surgery (it typically does not obscure large abnormalities).
Breast reduction surgery is usually performed under general anesthesia in an inpatient or outpatient clinical setting. Many women spend one to three nights in the hospital after surgery, although some may be driven home a few hours after the procedure if no complications occur.
Before the procedure, the surgeon may mark incision lines on the breast while the patient is sitting up to ensure that the breasts are proportioned correctly. During the surgery, the plastic surgeon will make incisions around the areola (the dark pigmented area around the nipple), down the mid-line of breast and in the fold beneath the breast. In small reductions, incisions may not be necessary in the fold beneath the breast. All incisions will leave scars once healed.
There are two main types of breast reduction surgeries. In the first procedure, the surgeon removes excess breast tissue and skin but preserves the tissue where the nipple and areola are attached. This technique helps maintain optimal blood circulation to the nipple and areola and may allow women to breast-feed after surgery (although some milk ducts are removed with this technique). In the second technique, the breast ducts and nerves are cut and the nipple and areola are completely removed while the tissue is removed, and they are grafted to a higher position. Women will usually not be able to breast-feed if a free-nipple technique is performed. Small drainage tubes are also placed in the breast or under the arm to help remove blood or other fluids which may accumulate during the healing process. The tubes are usually removed within a few days after surgery, depending on the amount and rate of fluid drainage. Incisions will be closed with stitches, and gauze bandages may be placed over the breasts to facilitate healing. Breast reduction surgery usually takes approximately three hours but may take longer if a large amount of breast tissue is removed.
Most women will experience fatigue and breast pain for a few days after breast reduction surgery. Heavy lifting, pushing, or pulling should be avoided for four to six weeks after surgery; these activities may delay wound healing and cause more prominent scars. Moderate breast pain and sores around the nipple are usually controlled by prescription antibiotics, though some women experience random shooting pains in their breasts for the first several months after surgery. Drainage tubes and stitches will be removed within a few days after surgery (unless the surgeons uses dissolvable stitches). Severe complications are not common after breast reduction, but as with any surgical procedure, some women may experience problems.
Side effects of breast reduction surgery may include:
- Bleeding or infection
- Delay in healing
- Abnormal scarring
In rare cases, the breast or nipple skin does not heal properly and an additional surgery to graft the skin is necessary. Approximately 10% of women experience some loss of sensation in the nipple. The first menstrual cycle after surgery may cause the breasts to swell and become temporarily painful. As the breasts heal, swelling will subside and the breasts will become smaller. The breasts will also descend slightly as gravity acts on the new breast envelope. Most patients are pleased with this effect since it makes the breasts look more natural.
Breast reduction surgery leaves permanent scars. The scars will usually appear red and lumpy at first but will become less obvious over time. Women who smoke often have wider scars, since smoking interferes with the healing process. Women should continue to perform breast self-examinations each month and have annual mammograms if they are 40 years of age or older or at high risk of breast cancer, as determined by a physician.
Breast-feeding is possible in some cases after breast reduction surgery if the nipple and areola (dark pigmented area around the nipple) remain intact during surgery. Research has also shown that the less breast tissue removed, the higher the chances women may establish lactation. Many women who have had breast reduction surgery are not able to produce enough milk for their children. If the woman is able to produce some milk, she may use a nurse supplementer if she wishes to breast-feed. A nurse supplementer is a device worn around the neck like a necklace. It consists of a container that holds the supplemental milk, and thin tubes that may be taped to the woman’s breasts. When the woman breast-feeds, the baby will receive the small amount of milk that the woman is able to produce along with the milk from the nurse supplementer. Many women feel that this helps them establish a bond with their children as they would if they breast-fed.
- The American Society of Plastic Surgeons (ASPS) provides information on breast reduction surgery at http://www.plasticsurgery.org/
Updated: July 28, 2008
