Breast reduction surgery, also known as reduction mammaplasty, is a procedure used to remove excess fat, tissue and skin from the breasts. If you have large breasts, you might choose to have breast reduction surgery to ease discomfort or to achieve a breast size proportionate to your body.

Breast reduction surgery might also help improve your self-image and self-confidence and your ability to participate in physical activities.

If you're considering breast reduction surgery, consult a board-certified plastic surgeon. It's important to understand what breast reduction surgery entails — including possible risks and complications — as well as set realistic expectations.

Breast reduction surgery is meant for women who have large breasts and want to resolve issues such as:

  • Chronic back, neck and shoulder pain
  • Chronic rash or skin irritation under the breasts
  • Deep grooves in the shoulders from bra strap pressure
  • Restricted activity
  • Poor self-image related to large breasts
  • Difficulty fitting into bras and clothing
  • Difficulty sleeping

You can have breast reduction surgery at any age — even as a teenager in some cases. However, it's usually best to wait until your breasts are fully developed.

If you haven't started a family or your family isn't yet complete, you might postpone breast reduction surgery until pregnancy isn't an issue. Changes to breast tissue during pregnancy could affect your surgical results.

Also, breast-feeding might be challenging after breast reduction surgery — although some research suggests that breast-feeding difficulty after breast reduction surgery is related to a lack of support or coaching rather than the surgery itself.

Breast reduction surgery has the same risks as any other type of major surgery — bleeding, infection and an adverse reaction to the anesthesia. Other possible risks include:

  • Scarring
  • Loss of sensation in the nipples and skin surrounding the nipples (areolae)
  • Difficulty or inability to breast-feed
  • Differences in the size, shape and symmetry (asymmetry) of the surgically altered left and right breasts, which might lead to further surgery to improve appearance

The risk of poor wound healing seems to increase with the amount of breast tissue removed. However, it isn't clear that women with a higher body mass index are at greater risk of complications from breast reduction surgery.

Your plastic surgeon will likely:

  • Evaluate your medical history and overall health
  • Discuss your expectations for breast size and appearance after the surgery
  • Provide a detailed description of the procedure and its risks and benefits, including likely scarring and possible loss of sensation
  • Examine and measure your breasts
  • Take photographs of your breasts for your medical record
  • Explain the type of anesthesia used during surgery

Before breast reduction surgery, you might also be asked to:

  • Complete various lab tests
  • Get a baseline mammogram
  • Stop smoking for a certain period of time before and after surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements to control bleeding during surgery

Ask your surgeon whether you'll be able to go home the day of the surgery or whether you'll need to spend a night in the hospital. In either case, arrange for someone to drive you home after surgery.

Breast reduction surgery is usually done under general anesthesia, either in a hospital or outpatient surgical facility.

During the procedure

The specific technique used to reduce the size of your breasts may vary. Generally, the surgeon makes an incision around the areola and down the breast. Excess breast tissue, fat and skin are then removed to reduce the size of each breast.

In most cases, the nipple and areola remain attached to the breast. If your breasts are very large and droopy, however, your nipple and areola might need to be removed and then reattached at a higher position on your breast as a skin graft.

After the procedure

Your breasts will be covered with a gauze dressing or bandages. A tube might be placed under each arm to drain any excess blood or fluid. Your surgeon will likely prescribe medication for pain as well as antibiotics to decrease your risk of infection.

For the first days or week, your breasts will probably feel tender and sensitive. They might also be swollen and bruised. Your surgeon might recommend an elastic compression bra initially to protect the breasts.

You'll need to limit physical activity for two to four weeks while the breasts heal. Your surgeon also may recommend avoiding underwire bras for a month after surgery.

Scarring usually fades over time. You will need a follow-up visit with your surgeon to remove stitches and check your recovery.

Successful breast reduction surgery can relieve pain in your upper back, neck and shoulders. It might also increase your ability to participate in physical activities and promote a more positive self-image.

Although you'll see results immediately, remember that it can take months for the swelling to completely go down and the surgical scars to fade. The final result is generally permanent — although breast shape and size can change due to factors such as aging and weight gain or loss.

Sep. 10, 2014