Introduction: What is Breast Reduction?
Breast reduction, also referred to as reduction mammoplasty, is a surgical procedure in which excess fat, breast tissue, and skin are removed from the breasts. The surgery is usually sought by women who wish to accomplish an aesthetically pleasing breast contour and size proportionate to their body, and to mitigate the discomfort associated with unusually large breasts (macromastia). Men with gynecomastia (enlarged male breast tissue) may also receive breast reduction surgery to flatten and enhance the chest contour.
Who is an Ideal Candidate for a Breast Reduction?
Breast reduction surgery is indicated for women with abnormally large breasts and the issues related to it, such as the following:
- Persistent neck, shoulder, and back pain requiring medication
- Persistent rash or skin irritation below the breasts
- Activity restrictions
- Nerve pain
- Trouble fitting into clothing, swimsuits, and bras
- Poor self-esteem due to large breasts
Men can be candidates for breast reduction surgery for gynecomastia
- Condition not corrected by alternative medical treatments
- Stabilized breast development
- Men bothered by feeling that their breasts are too large
For breast reduction in both men and women patients should be:
- Healthy individuals without significant medical comorbidities
- Non-smokers
- Realistic about expectations of surgical outcomes
- At their goal weight and stable at this weight for some time
Preoperative Assessment
Before your procedure, a detailed medical history is obtained, and a thorough physical examination is performed. During your consultation, your doctor will advise you to stop smoking, if you smoke, to avoid post-surgical complications and delayed healing. You should eat a healthy diet and avoid any restrictive dieting during this time. You should inform your doctor of all medications that you are taking and about significant medical conditions, allergies and previous surgeries if any.
Depending on your age, exam, family history and breast health history you may require breast imaging prior to your procedure.
Photographs will also be taken during pre-operative consultation to submit for insurance, to be used in surgical planning and for before and after comparison. Your goals will be discussed, and realistic expectations will be set. After discussing surgical options, we will make an individualized surgical plan together that best suits your goals.
This is the best time to ask all your questions so that you can feel comfortable and confident going into surgery.
Procedure: Breast Reduction
Breast reduction for a woman is performed under general anesthesia either in an outpatient or hospital setting. Based on the size and composition of the breasts, your surgeon may employ various techniques to carry out the procedure: liposuction, vertical or "lollipop", or inverted-T ("Anchor") breast reduction. In general, your surgeon will take the following steps:
- In the pre-operative area a surgical marker will be used to draw guidelines on the breasts to carry out the incisions
- Surgical incisions will be made based on your breast anatomy to achieve the best new breast contour
- Remove extra fat, breast tissue, and skin to decrease the size of each breast
- Reposition the areola and nipple and reshape the breast
- Breast reduction in males is performed under general anesthesia either in an outpatient or hospital setting. Based on the size and composition of the excess tissue on the chest wall, different technique may be used to carry out the procedure including: liposuction alone, excision of breast tissue, a combination of excision and liposuction or excision of excess tissue with free nipple graft.
- In the pre-operative area a surgical maker will be used to draw guidelines on the chest to help carry out incisions or to mark areas that require liposuction.
- Liposuction can be done through small incisions
- Incisions for excision of excess breast tissue will vary in size based on how much tissue needs to be removed and if skin needs to also be removed to obtain improved chest contour. Incisions may be peri-areolar, at the nipple line or along the inframammary fold.
- Remove extra fat, breast tissue and possibly skin to decrease the size of each breast
- Potential need to reposition the nipple areola complex
- Chest binder to be placed postoperatively.
For both male and female breast reductions
- In each of these procedures your incisions will be closed with dissolvable sutures that will be under the skin and you will have either surgical glue or surgical tape over your incisions which take about 1-2 weeks to fall off.
- You will potentially have drains in place after surgery based on the amount of tissue that needs to be removed that will be removed in 1-2 weeks.
Risks and Complications of a Breast Reduction
Breast reduction is a relatively safe procedure; however, as with any surgery, the following risks and complications are possible:
- Anesthetic risks
- Blood clots in the lungs or legs, cardiac and pulmonary complications
- Breast scarring
- Pain in the breasts
- Changes in sensation in the breasts or nipples
- Infection
- Bleeding under the skin (hematoma)
- Fat necrosis
- Asymmetric appearance of nipples or breasts or suboptimal aesthetic results
- Incomplete healing in the nipple area
- Delayed healing
- Accumulation of fluids in breast tissue (seroma)
- Possibility of revision surgery
Recovery after Breast Reduction Procedure
Most people can go home the same day of surgery if no complications are noted. In general, postoperative care instructions and recovery involve the following:
After breast reduction surgery there will be some temporary pain, discomfort, bruising and swelling. Medications will be prescribed to relieve pain. You will wear a contoured elastic garment for extra support around the chest/breasts. Most patients go home the same day of surgery if no complications are noted. Upon discharge, patients will be instructed about proper wound care and how to manage their drains at home if they have them. For women having breast reduction, you should avoid underwire bras for at least 6 weeks while healing. Stitches are usually dissolvable and internal. Specific post-operative care regimen to minimize scarring will be discussed with each patient. Strenuous physical activity and heavy lifting over five pounds is discouraged for six weeks post-operatively – details of this limitation will be discussed with you specific to the surgery that you will be having. You will likely be able to resume work in 1 to 2 weeks depending on what kind of job you have and how you are feeling. Full recovery may take up to one year and you need to have follow-up appointments to ensure a positive surgical outcome.
Summary
Breast reduction surgery for both men and women can help to improve self-image and confidence. For women, you will likely gain relief of symptoms caused by your large, heavy breasts and have breasts that are more well-proportioned to your body in a more youthful, lifted position.
