Breast reduction

Definition

Breast reduction is a surgical procedure performed to decrease the size of the breasts.

Purpose

Women with very large breasts (macromastia, or mammary hyperplasia) seek breast reduction for relief of back, shoulder, and neck pain. They may also feel uncomfortable about their breast size and have difficulty finding clothing that will fit properly. Additionally, breast reduction may be needed after reconstructive surgery following the surgical removal of cancerous breast tissue (mastectomy), to make the breasts more symmetric.

Men who have enlarged breasts (gynecomastia) may also be candidates for breast reduction surgery. However, excessive alcohol intake, marijuana use, or using anabolic steroids may cause gynecomastia. Surgery is not recommended for men who continue to use these products.

Demographics

According to the American Society of Plastic Surgeons, more than 70,000 women underwent breast reduction surgery in 1999, while fewer than 40,000 women had the procedure performed in 1992. Breast reduction

In a breast reduction surgery, the breast tissue is cut along predetermined lines and (A) excess tissue is removed (B). The nipple is placed higher on the breast (C), and the two sides of the incision are brought together (D), removing any excess skin (E). (

Illustration by GGS Inc.

)

Description

Breast reduction is also called reduction mammoplasty. It is most often performed in a hospital, under general anesthetic. However, studies have suggested that an outpatient procedure, using local anesthetic and mild sedation, may be appropriate for some persons. The operation requires approximately two to four hours. The most commonly made incision encircles the areola (darkened area around the nipple) and extends downward and around the underside of the breast. This produces the least conspicuous scar. Excess tissue, fat, and skin are removed, and the nipple and areola are repositioned. In certain cases, liposuction (fat suctioning) is used to remove extra fat from the armpit area. A hospital stay of up to three days may be needed for recovery.

Breast reduction surgery for males with gynecomastia is similar to that described for females.

If deemed medically necessary, breast reduction is covered by some insurance plans. However, a specified amount of breast tissue may need to be removed in order to qualify for coverage. Surgeon's fees range from $5,000 to $6,500, or more.

Diagnosis/Preparation

Consultation between surgeon and patient is important to ensure that there is understanding and agreement with the expected final results of the procedure. Measurements and photographs may be taken. Many doctors also recommend a mammogram before the operation to ensure that there is no cancer.

Aftercare

After the surgery, an elastic bandage or special supportive bra is placed over gauze bandages and drainage tubes. The bandages and tubes are removed in a day or two. The bra is worn around the clock for several weeks. Stitches are removed one to three weeks after the operation. Normal activities, including sexual relations, may be restricted for several weeks. Scars will typically remain red and perhaps raised for up to several months, but will gradually fade and become less noticeable. It may take up to a year before the breasts achieve their final position and size.

Risks

Breast reduction surgery is not recommended for women whose breasts are not fully developed or who plan to breastfeed.

Risks common to any operation include bleeding, infection, anesthesia reactions, or unexpected scarring. Breast reduction may result in decreased feeling in the breasts or nipples and/or impaired ability to breastfeed. When healing is complete, the breasts may be slightly uneven, or the nipples may be asymmetric. However, this is consistent with normal breast tissue.

Normal results

Smaller breast size should be achieved and, with that, the accompanying pain and discomfort should be alleviated. Self-esteem should be improved for both females and males having breast reduction surgery.

Morbidity and mortality rates

Deaths associated with breast reduction surgery are extremely rare. Most post-surgical mortality has been attributed to anesthesia errors, overdoses of pain medications, or postoperative infections.

In very rare cases, the skin of the breast or nipple does not heal properly and additional surgery is necessary to graft skin. Approximately 10% of women experience some loss of sensation in their nipples.

Permanent scars are left after breast reduction surgery. At first, the scars usually appear red and raised but will become less obvious over time. Women who smoke often experience more prominent scars. This is because smoking interferes with the healing process.

Alternatives

There are no alternatives to surgery as a way to reduce breast tissue, although significant weight loss can decrease the size of the breast.

Resources

books

Ball, Adrian S., and Peter M. Arnstein. Handbook of Breast Surgery. London: Edward Arnold, 1999.

Berger, Karen J., and John Bostwick. A Woman's Decision: Breast Care, Treatment & Reconstruction, 3rd edition. St. Louis: Quality Medical Publshers, 1998.

Bostwick, John. Plastic and Reconstructive Breast Surgery, 2nd edition. St. Louis: Quality Medical Publishers, 1999.

Engler, Alan M. BodySculpture: Plastic Surgery of the Body for Men and Women, 2nd edition. London: Hudson Pub., 2000.

periodicals

Chao, J. D., H. C. Memmel, J. F. Redding, L. Egan, L. C. Odom, and L. A. Casas. "Reduction Mammaplasty Is a Functional Operation, Improving Quality of Life in Symptomatic Women: A Prospective, Single-center Breast Reduction Outcome Study." Plastic and Reconstructive Surgery 110, no. 7 (2002): 1644–1654.

Jejurikar, S. S., J. M. Rovak, W. M. Kuzon Jr, K. C. Chung, S. V. Kotsis, and P. S. Cederna. "Evaluation of Plastic Surgery Information on the Internet." Annals of Plastic Surgery 49, no. 5 (2002): 460–465.

Johansson, A. S., H. Wennborg, L. Blomqvist, D. Isacson, and E. Kylberg. "Breastfeeding after Reduction Mammoplasty and Augmentation Mammoplasty." Epidemiology 14, no. 1 (2003): 127–129.

Qiao, Q., J. Sun, C. Liu, Z. Liu, and R. Zhao. "Reduction Mammaplasty and Correction of Ptosis: Dermal Bra Technique." Plastic and Reconstructive Surgery 111, no. 3 (2003): 1122–1130.

Smith, M., and K. Kent. "Breast Concerns and Lifestyles of Women." Clinics in Obstetrics and Gynecology 45, no. 4 (2002): 1129–1139.

Spear, S. L., C. V. Pelletiere, A. J. Wolfe, T. N. Tsangaris, and M. F. Pennanen. "Experience with Reduction Mammaplasty Combined with Breast Conservation Therapy in the Treatment of Breast Cancer." Plastic and Reconstructive Surgery 111, no. 3 (2003): 1102–1109.

organizations

American Board of Plastic Surgery. Seven Penn Center, Suite 400, 1635 Market Street, Philadelphia, PA 19103-2204. (215) 587-9322. http://www.abplsurg.org/ .

American College of Plastic and Reconstructive Surgery. http://www.breast-implant.org .

American College of Surgeons. 633 North Saint Claire Street, Chicago, IL 60611. (312) 202-5000. http://www.facs.org/ .

American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. http://www.surgery.org/ .

American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (888) 475-2784. http://www.plasticsurgery.org/ .

other

"Breast Implants." U.S. Food and Drug Administration. [cited February 24, 2003] <http://www.fda.gov/cdrh/breast implants/labeling/mentor_patient_labeling_5900.htm> .

"Breast Implants and Breast Reconstruction." National Library of Medicine. [cited March 20, 2003]. http://www.nlm.nih.gov/medlineplus/breastimplantsbreastreconstruction.htm .

"Implants on Trial." Public Broadcasting Systems. [cited March 20, 2003] http://www.pbs.org/wgbh/pages/frontline/implants/cron.html .

"Information about Breast Surgery." American Society of Cosmetic Breast Surgery. [cited March 20, 2003] http://www.breast-implant.org .

L. Fleming Fallon, Jr., MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Breast reduction surgery is normally performed by a surgeon with advanced training in plastic and reconstructive procedures. It is commonly, but not exclusively, performed as an inpatient procedure in a hospital.

QUESTIONS TO ASK THE DOCTOR

• What will be the resulting appearance?
• Is the surgeon board certified in plastic and reconstructive surgery?
• How many breast reduction procedures has the surgeon performed?
• What is the surgeon's complication rate?