Breast reduction is a surgical procedure performed to decrease the size of the breasts.
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.
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
surgery is becoming more common each year. Women most likely to undergo breast reduction range in age from 19 to 50.
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.
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.
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.
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.
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.
There are no alternatives to surgery as a way to reduce breast tissue, although significant weight loss can decrease the size of the breast.
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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?