Breast reduction

Definition

Breast reduction is surgery to reduce the size of the breasts.

Alternative Names

Reduction mammoplasty

Description

Breast reduction surgery is usually done under general anesthesia. You will be asleep and pain-free. Or, you may have local anesthesia. You will be awake and will receive medicine to numb your breast area to block pain. If you have local anesthesia, you will also receive medicine to relax you.

For a breast reduction, the surgeon removes some of the breast tissue and skin. Your nipples may be moved higher to center them, for cosmetic reasons.

In the most common procedure,

• The surgeon makes three incisions (cuts): around the areola (the dark area around your nipples), from the areola down to the crease under your breast, and across the lower crease of your breast.
• Extra fat, skin, and breast tissue are removed. The nipple and areola are moved to a higher position. Often the areola is made smaller.
• The surgeon closes the incisions with stitches to reshape the breast.
• Sometimes liposuction is combined with breast reduction to improve the shape of the breast and armpit areas.

The operation can last 2 - 5 hours.

Why the Procedure Is Performed

Breast reduction may be recommended for you if you have very large breasts (macromastia) and:

• Chronic pain that affects your quality of life. You may be having headaches, neck pain, and shoulder pain.
• Chronic nerve problems caused by poor posture, which result in numbness or tingling in your arms or hands.
• Cosmetic problems, such as persistent bra-strap groove, scar-like lines in the skin (striae), difficulty finding clothes that fit, and low of self-confidence.
• Chronic rashes under your breasts

Some women may benefit from non-surgical treatments, such as losing excess weight, exercising to strengthen their back and shoulder muscles, and supportive bras.

Risks

Breast reduction is generally safe. Ask your doctor about these complications.

Risks for any surgery are:

• Bleeding
• Infection

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems, such as pneumonia
• Heart problems

Risks for this procedure are:

• Difficulty breastfeeding
• Loss of feeling in the nipple area
• Large scars that take a long time to heal
• Uneven position of the nipples or differences in the size of the breasts

Before the Procedure

If you smoke, you must stop. Women who smoke after breast surgery have a greater chance of slow wound (incision) healing, infection, and scarring. You must even avoid breathing in secondhand smoke.

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

During the days before surgery:

• You may need mammograms or breast x-rays before the surgery. Your plastic surgeon will do a routine breast exam.
• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.
• You may need to fill prescriptions for pain medicine before surgery.
• Arrange for someone to drive you home after surgery and help you around your house for 1 or 2 days.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Wear or bring loose clothing that buttons or zips in front.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You may have to stay overnight in the hospital.

After surgery, a bulky gauze dressing (bandage) will be wrapped around your breasts and chest, and drainage tubes may be attached to your breasts. These tubes will be removed within 3 to 5 days. You will remove the ace wrap, bra, or dressings after surgery, as your doctor has told you.

Within the first week, you will replace your dressing with a soft bra. You must wear this bra for several weeks.

Your pain should decrease in a few days. Take pain medicine to control it. Be sure to take the medicine with food and plenty of water. Do not apply ice or heat to your breasts unless your doctor has told you that is okay.

Within a few days, the swelling and bruising around your incisions should disappear. You may have a temporary loss of sensation in your breast skin and nipples after surgery. Sensation will return over time. Your stitches will be removed within 2 weeks after surgery.

Outlook (Prognosis)

You are likely to have a very good outcome from breast reduction surgery. You may feel better about your appearance and be more comfortable with various activities. Pain or skin symptoms, such as striation, will disappear. You may need to wear a special supporting bra for a few months to reshape your breasts.

Scars are permanent. While they will be more visible for the first year they will then fade. The doctor will make every effort to place the incisions so that scars are hidden. Most of the time, the scars should not be noticeable, even in low-cut clothing (incisions are usually made on the underside of the breast).

References

Burns JL, Blackwell SJ. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 73.

Brown JR, Holton LH 3rd, Chung TL, Slezak S. Breast-feeding, self-exam, and exercise practices before and after reduction mammoplasty. Ann Plast Surg. 2008 Oct;61(4):375-9.

Handschin AE, Bietry D, Hüsler R, Banic A, Constantinescu M. Surgical management of gynecomastia--a 10-year analysis. World J Surg. 2008 Jan;32(1):38-44.