Breast Reduction

Women with large, pendulous breast may experience a variety of problems caused by the pull of the excess weight. Neck and back pain, breathing difficulty, bra strap indentation, and skin rashes may occur, as well as the psychological results of being self-conscious from having unusually large breasts. Physical activity is often limited by these symptoms.

Breast reduction, or reduction mammaplasty, can be used to remove excess fat, glandular tissue, and skin, making the breasts smaller, lighter, and firmer. The operation is performed for physical relief rather than for cosmetic purposes, and produces smaller breasts that are in proportion to the rest of the body. In most cases, breast reduction is not performed until the breasts are fully developed, but in some cases of extreme breast size and discomfort the procedure is done at an earlier age.

Some insurance companies will pay for breast reduction if it is medically necessary, but may require that a certain weight of tissue be removed. A “predetermination letter” is usually required, and photographs are usually taken and sent in with the letter.

Patients will often be asked to have a mammogram prior to surgery. Weight loss may also be recommended preoperatively in order to reduce the medical risks of the surgery, and to help maximize the chance of having a good breast contour following surgery. Larger amounts of breast tissue removal may require a blood transfusion. For this reason, the surgeon will sometimes recommend that patients donate a unit of their own blood in advance, so that the patient’s own blood can be given back to them if necessary.

The surgery is usually done in a hospital under general anesthesia. The operation time varies, but generally takes from 2 to 6 hours. The most common type of surgery involves an anchor-shaped incision that circles the areola, extends down the center, and then follows the natural curve of the crease beneath the breast near the crease. Excess fat, glandular tissue, and skin is removed, and the nipple and areola are moved into a new higher position. Absorbable sutures or those requiring removal may be used, and a temporary drainage tube is sometimes placed.In some cases the horizontal portion of the incision can be eliminated. Occasionally liposuction can be used alone in cases in which only fat needs to be removed.

Patients are usually asked to wear a surgical bra for a few weeks postoperatively. The majority of the pain usually occurs during the first few days, but the breasts may ache for a few weeks. Heavy lifting or pushing should be avoided for a few weeks.

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