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.)
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.
)


surgery is becoming more common each year. Women most likely to undergo breast reduction range in age from 19 to 50.


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/breastimplantsbreastreconstru tion.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?

User Contributions:

Lynn
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Feb 25, 2006 @ 11:23 pm
In 5 days I am going to have Breast Reduction Surgery. This site has answered many of the questions I planned to ask my doctor about (pre-surgery) which I either neglected or forgot to ask earlier due to being Excited... scared excited.. Scared.

Thank you so much for such an educational site...keep up the great work...very helpful and informative web site. I feel I have a better idea of what is to come with this new knowledge. Thank you
belinda
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Apr 18, 2006 @ 3:15 pm
i want a brest reduction but i am too scared i always think that it coud lead too death i am 16 and i have breast that i think is big i really want it to be normal it hurts me inside to know that i look like this, my question is do you think that it is sensible too under surgery (breast reduction) at the age of 16 and could i die even though it is causing me problems?
aneke
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Jun 30, 2006 @ 5:17 pm
I had a breast reduction done in 3 yrs ago and that was the best decision i could have ever made. There's not too much to be worried about just make sure that you do exactly what your doctor ask. believe me you'll never regret it.
good luck
Karen
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Mar 6, 2008 @ 1:13 pm
I plan to have brest reduction surgery, I am 60 years old and over-weight. When they do the reduction to they automatically do a breast lift with it? I will need that as well....
Brittany Liebhart
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Apr 15, 2008 @ 9:09 am
I really liked your article its very informative, I only had a couple of other questions. I am doing a report for school on breast reduction surgery, and I need to know who all is involved in a breast reduction procedure, like their profession, nurse, plastic surgon, ect. I also need to know if this is all one procedure or if there are steps and other minor porcedures before the actual breast reduction. Lastly I would like to know if you know anything about the new scarfree breast reduction procedure and if you do could you tell me the difference between that procedure and the original procedure. Thankyou for your time and cooperation the earliest you could get me this information would be greatly appreciated.

Sincerly,
Brittany Liebhart
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May 12, 2010 @ 12:00 am
5 days ago, I have breast reduction. My doctor never mentioned to me for drain tubes ( I found in the internet after my surgery) or I need to take care them and I don't see or feel them, is this new type of surgery?
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Jun 25, 2010 @ 10:10 am
Ok so I'm 18 and really want breast reduction but I'm very scared of the surgery however, my breast are unproportional to my body so it's hard for me to find clothes that fit me right and i really don't like looking like this. I also have back pains and I think this would get rid of it. I have a DD cup size..almost a DDD..is that a big enough pain that I should get breast reduction? Also I have a condition where I get raised scares called keloids after surgery like when I had my gall bladder taken out, the scars weren't bad...it just left a bump instead of a line..would breast reduction be a lot worse for me? Also, could someone tell me how bad the pain is if they've had it before so I know what to expect? It would really help.
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Feb 12, 2011 @ 6:18 pm
I had a breast reduction in October of 2009. If you asked me during the recovery period would I have done it again, I would have said "no". It is not a walk in the park by any means. It is a very hard recovery, but very worth it. I would do it again even knowing now how hard it was. I do recommend it! I feel better about myself, my back feels better, I sleep better and everything was worth it!!
Sarah
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Apr 6, 2011 @ 2:14 pm
I had a breast reduction in February 2010. It is the best thing I ever did for my confidence and to relieve the pain. Everybody is different but I found after my operation the pain was bearable just a little sore. I was expecting a lot worse but I resumed the majority of my normal activities within 1-2 weeks (except going to the gym). The first week I was drowsy due to my antibiotics, the second week my glue was flaking off and I found this quite itchy and the third week my stitches were coming out and none of this caused me any pain. If anyone is considering having a reduction I would highly recommend it because of the long term benefits and I am a much happier person and half the size before my operation :)

I hope this helps anyone who reads this.
Marielle
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Jun 11, 2011 @ 8:20 pm
I had breast reduction surgery three days ago and even though recovery has not been "a walk on the park" as explained above, the results are obviously immediate and I don't regret it at all! I am 19 years old, almost 20 and I wanted to to this surgery ever since I was 17, when I was a D cup. As the years went by I grew into a DDD cup, giving me back and neck pains which motivated me to get it even more. The wait was worth the while though, as the condition I have called a Mammary Hypertrophy hit me the most during those 3 years I waited. I am also diabetic but the recovery has been perfectly fine as I do control my sugar levels very well. I understand how it feels like to feel completely uncomfortable and heavy (despite being thin in body-wise) just because of big breasts. I motivate you to get this surgery!! Just make sure you are ready for it because there are some complications to it and the scarring will be permanent. Nevertheless if you follow the doctor's instructions and have patience it will all go well. I'm just 3 days in and yes, despite the pains (which are completely bearable, don't be scared) it's so much worth the while! Seeing my self with significantly smaller breasts make me feel like a new person already, and it will motivate me to exercise even more (as it will be more comfortable to do so) and live an even healthier life. If you have any questions please ask, I was also scared but that quickly goes away as you realize that the pros completely cast a shadow over the cons of this surgery.

I hope this can help.
Kathryn
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Aug 19, 2011 @ 7:19 pm
Im 14 and I want a breast reduction because of many things like I get bullied and I feel really self consious about them and I cant wear the stuff I want without making them look even bigger and it gives me left sholder pain. I have talked to my parents about it and they say they will reseach it and stuff but I think I have made my mind up about it because I have never had surgery before and I was scared but after my reseach (by the way this site really helped) I think I mind ask my parents again about it. So thanks for the information
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Sep 6, 2011 @ 10:10 am
I am 63 yrs old and I am having breast reduction surgery in two weeks. My doctor told me I had to quit smoking at least a month befored my surgery. This has not been easy but I will have been stopped for exactly two weeks before the surgery. I read an article relating to the lenght of time it takes for nicotine to be out of the body and the article reported that within two weeks 90% of the nicotine would be gone and the other 10% would flush out after surgery. Is this enough time even though my surgeon told me a month? I am not second guessing my doctor but I have struggled with the smoking cessation, and want to know if two weeks is long enough.
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Sep 28, 2011 @ 5:17 pm
hi im havin a breast reduction on october 14 2011 and im 15 im nervous but i really need the surgury i wear a 32 h in bras and it kills my back i cnt do proper work outs and i get mad fun of a lot
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Oct 13, 2011 @ 9:21 pm
I had by breast reduction September 21, 2011. I was a 46J. I went to a c cup. It was the best decission I have ever made. I wish I made the decision earlier. My range of motion has come back, my breast in the sink when I brushed my teeth, Gone!! turning over in the bed and having to physically move my breasts gone, backaches gone,my center of gravity was so far off going up and down stairs was awful, I would have to extend my rear to balance my front. My doctor removed 20 lbs of breast tissue. The recovery was painful but not unbearable. After the first week I felt I could take on more of the simple tasks again. After 3 weeks I am ready to go back to work. And wow my Ta Ta's feel so good, and my backache, neck ache and grooves in my shoulder are almost completely gone. If you are on the fence and have a real problem with normal every day tasks, Get it done!!
katherine
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Oct 20, 2011 @ 1:13 pm
when can i get out of bed after surgery
i have to go to school 3 days after mamaplasty is that possible
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Oct 31, 2011 @ 8:08 am
I WOULD LIKE TO FIND OUT HOW MUCH IT COST AND IF IT WOULD BE PAINFUL
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Feb 1, 2013 @ 8:20 pm
I have a complicated situation. I wear binding shirts (that are tank-top like) to hide my breasts (because I want to have no gender specification) on a daily basis. I recently saw a doctor about my back pain and she claims that it is related to the binding shirts I wear, and also suggested I just get a breast reduction. I'm 18 and I'm probably not bigger than a large C cup size. What I want to know is if I can get a breast reduction at my age and at that small of a size.
Kari
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Jun 4, 2013 @ 3:15 pm
I had a breast reduction 2 years ago, at this time I am having stabbing pains in both breasts and one of my nipples is extremely tender. My husband felt a large knot in my left breast, could this be scar tissue? I am extremely worried, I am planning to have a mammogram but they hurt so I am afraid. Can anyone tell me if this is normal?
Innie
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Jul 1, 2013 @ 12:00 am
I'm 16 going to be 17 soon and I have a Consultation for a Breast Reduction at the end of the month. I'm growing out a 40 L I'm really scared though. I got tired of being teased, even adults would stop and make comments which made me feel self-conscious and uncomfortable in public. I think having the breat reduction will help my health and confidence. Does it hurt really bad? Will I have to lay on my back for a while? Thanks
Tbj
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Aug 17, 2013 @ 9:21 pm
Ever since my breast reduction in 1997, I've had a hyper-sensitivity in my right nipple whenever I get cold or my body temperature drops. Once the pain sets in, it does not subside for at least 20 min. My nipple hardens and it feels like someone has a pair of vice grips on my nipple. Initially, the pain stopped me in my tracks and I couldn't concentrate but I'm able to tolerate it better although it's still a nuisance and drives me crazy. I returned back to the surgeon twice, who was clueless to this problem. Please help!
Marilyn
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Aug 22, 2013 @ 3:15 pm
I had a breast reduction December 19, 2012 and now, more than nine months later, have to say that it was one of the best decisions I have ever made. I am 60 years old and had never really considered that option until my 27 y/o daughter had it done months earlier and did so well. I went from DDD status (I always said that I "was born wearing a bra" and they just got bigger and bigger with each pregnancy and nursing over the years) to a more fitting C cup. My back constantly ached and my vertebrae were showing signs of wear and tear from that. I now look younger all over and not so matronly; my back thanks me every day! (The shoulder dents are still there though...) My mammographer commented that in 27 1/2 years, she had never once had a woman say she regretted having this surgery done. Just choose a very experienced and recommended surgeon--this was my surgeon's specialty.

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