A breast reduction (reduction mammaplasty) is an elective procedure to reshape and reduce the size of the breasts. Results of breast reduction surgery are aimed at relieving health symptoms, improving self-image, and giving the woman a breast size and shape in proportion with the rest of her body.
Breast reduction may also be performed after reconstructive surgery following surgical treatment of breast cancer
, in order to make the breasts more symmetrical.
Anatomy of the breast
Breast tissue is made up of a mixture of fatty tissue and glandular tissue. Breasts also contain fibrous tissue, milk ducts, nerves, blood vessels and lymphatic vessels. The lymphatic vessels drain into lymph nodes situated under the arms and breastbone. These act as filters to help the body fight infection and are part of the body's lymphatic system.
Breasts sit on a large muscle called the pectoralis major. The ribs lie beneath this muscle and at the bottom of each breast is a ridge of tissue called the inframammary ridge. The nipple is surrounded by a darkened area called the areola. Both the nipple and the areola contain muscle fibres.
No two breasts are the same and will vary in size and shape. They are sensitive to hormonal changes and respond to these fluctuations as happen in puberty, menstruation, pregnancy, menopause and when taking hormone replacement therapy or oral contraceptives. Breasts will also change in size with weight gain or loss.
Breast reduction can be performed at any age but plastic surgeons usually recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of the breasts.
Impacts of excessively large breasts
Having excessively large breasts can have a number of physical, psychological, social and practical impacts.
Physical symptoms experienced can include:
- Neck, back and shoulder pain
- A dragging discomfort across the front of the breast
- Strap mark indentations on the shoulders
- Irritation and/or infection of the skin under the breasts
- Shortness of breath
- Poor posture
Psychological impacts can include:
- Feeling self-conscious or embarrassed
- A negative body image
- Restricted social interaction
- Sexual embarrassment
Socially and practically, having large breasts may make it difficult for women to participate in sporting and recreational activities, and there may be difficulty in finding correctly fitting bras, clothing and swimwear.
Before the procedure
While deciding whether to proceed with breast reduction surgery a woman will have a consultation with the surgeon to discuss her motivations for breast reduction surgery and her expectations of the surgery's outcomes. This will include agreeing on the desired size and shape of the breasts. It is important to agree on a realistic outcome where the breast size is in proportion with the rest of the body.
Prior to surgery a breast examination will be required and the breasts will be measured and possibly photographed. This is to have a reference available during and after surgery. In some cases a mammogram will be recommended before surgery.
Just prior to the surgery the surgeon will mark on the breasts where the incisions are to be made. The incisions are made where the eventual scarring will be inconspicuous and hidden beneath the bra line.
As with any surgery there are associated risks. These should be discussed with the surgeon prior to surgery and include:
Risks that are a part of all operations
- Anaesthetic risks.
- Bleeding, infection, swelling, and bruising
Risks specific to this operation
- A possible risk of breastfeeding difficulty in the future
- Asymmetry of the nipples and breasts.
- Noticeable scarring.
- Loss of sensation in the nipples or breasts.
- Lack of blood supply to the areola and nipples causing the tissue to die
Usually, a plastic surgeon or specialist breast surgeon performs breast reduction surgery. It is performed under a general anaesthetic and usually takes between two and four hours to complete. A one to two day stay in hospital after the surgery is expected.
Diagram courtesy of FDA
There are a number of different breast reduction surgery techniques. Most commonly, incisions are made on the underside of the breasts and excess fat, skin and glandular tissue are removed until the desired breast size and shape is achieved. In some cases, liposuction may be used during the surgery to remove excess fat.
The areola may be reduced in size and, along with the nipple, is moved to a higher position and re-attached. This is commonly achieved by leaving the nipple and areola attached to a pedicle of tissue. This has the advantage of maintaining blood supply and sensation to the nipple. However in cases where the breasts are particularly large, the areola and nipple may need to be removed completely and grafted to a new position on the breast.
At the conclusion of the operation, small drainage tubes may be positioned in each breast. These reduce swelling and bruising by draining off excess fluid and are removed before discharge home.
The remaining incisions are then stitched (sutured) together using small dissolvable stitches. Small paper tapes (steristrips) may be placed along the suture lines for extra support. Dressings are applied and the breasts are wrapped in elastic bandages or a surgical bra is fitted.
During the recovery period immediately following surgery fluids may be given through a drip into the arm or back of the hand (intravenously). The drip is removed when the patient is drinking well.
Bruising and swelling after breast reduction surgery is expected and this can initially cause pain and discomfort after the surgery - particularly when moving. Any pain or discomfort experienced can be relieved by medication given into the drip while in hospital, or by giving pain relieving tablets such as paracetamol or voltaren.
Other medications that may be given include anti-nausea medications and antibiotic medications to prevent infection.
The bandages are usually removed after one or two days, although it will be necessary for the surgical bra to be worn day and night for up to two weeks following surgery. After this, a supportive sports bra is usually recommended. It is generally recommended that underwire bras be avoided for four to six weeks after the surgery.
During the initial recovery period it is important to notify the doctor if:
- There is any increase in swelling, bruising or discomfort.
- There are any signs of infection eg: redness, discharge or an elevated temperature
Follow-up appointments with the surgeon will be made to check healing and to assess the cosmetic result of the operation.
Activity guidelines will be given prior to discharge home. It is usually advised that heavy lifting, pushing and strenuous exercise are avoided for at least three to four weeks after surgery.
Overall rates of recovery vary between individuals and the decision as to when to return to work and other activities will vary from person to person. This will need to be discussed with the surgeon.
It may take six to 12 months for the breast shape to settle. During this time the scarring will reduce to become fine white lines.
Note, Southern Cross health insurance plans offer some benefit cover for breast reduction surgery that is medically indicated. For further information please consult your policy documents or contact our Prior Approval department on 0800 800 181.
Clinical Reference Systems (2006) Breast Reduction (Reduction Mammoplasty). McKesson Health Solutions LLC. Health and Wellness Resource Center. Farmington Hills MI.
MayoClinic.com (2011) Breast reduction surgery. Mayo Foundation for Medical Education and Research. All Rights Reserved.
Last reviewed May 2013