Key facts about breast reduction
- Breast reduction surgery is usually performed for relief of pain or discomfort. It can be performed on females of any age but is most advisable that breasts are fully developed.
- Pregnancy, or significant weight loss or gain after breast reduction surgery can alter the outcomes of the surgery.
Breast reduction surgery has a very high level of patient satisfaction, with most patients being extremely positive about their improved quality of life and comfort. - After a breast reduction, your breasts should be smaller and have a better shape.
- The surgery results in permanent scars, which usually follow the natural curved line under the breast with a vertical scar to the nipple and another around the areola. Either a lollipop pattern or an anchor pattern is used, depending upon the individual breast size and shape being reduced.
- Loss of some or all nipple sensation is common, and the bigger the volume of reduction, the more likely it is to lose nipple sensation.
- Most women who have a successful breast reduction are able to wear more revealing clothing, have less back and neck pain, are more comfortable with their appearance, and find that their personal and sexual relationships improve.
- Possible risks and complications of breast reduction surgery include bleeding, infection, bleeding, asymmetry, wound breakdown, poor scars, nipple irregularities, loss of nipple sensation, and fat necrosis resulting in hard lumps in the breast.
- Major complications of breast reduction are uncommon, but minor wound healing delays are seen from time to time. While this can be frustrating and slow down the healing process, the final result will not be compromised.
What is a breast reduction?
Breast reduction surgery, also known as reduction mammoplasty, removes excess breast fat, glandular tissue and skin to relieve the physical discomfort associated with overly large breasts. A breast reduction will make your breasts smaller, more streamlined and with an improved shape.
Who is breast reduction for?
Breast reduction surgery is suitable for women with naturally large breasts who experience a variety of problems from the weight and size of their breasts, such as back, neck, and shoulder pain, and skin irritation. Having excess breast tissue can limit a woman's ability to lead healthy and active life.
The best candidates for breast reduction surgery are women who have realistic expectations about the results and are mature enough to understand the surgical procedure.
You may be a good candidate for breast reduction surgery if:
- You’re self-conscious about the size of your breasts.
- Your breasts are overly large in proportion to your body frame
- You find it hard to sit up and stand with good posture
- You experience back, neck, shoulder, or head pain caused by the weight of your breasts.
- You have pendulous, heavy breasts with downward-pointing areolas and nipples.
- One breast is a lot larger than the other breast.
- Your bra straps create grooves in your shoulders.
- You experience skin irritation or rashes under your breasts.
- Your physical activity is restricted because of your breasts’ size and weight.
Before deciding if breast reduction surgery is suitable for you, the Breast Surgeon will carry out a detailed assessment. They will examine your breasts, ask you questions about your medical history and may take photos for your medical records.
If you’re planning to lose a lot of weight, it may be better to lose the weight first before having surgery. It’s also important to let your Breast Surgeon know if you are pregnant or planning to become pregnant in the future. Pregnancy can change the size and shape of your breasts and may affect the long-term results of surgery.
How is breast reduction surgery performed?
Breast reduction surgery methods include pedicle procedures, nipple graft procedures, liposuction procedures and combinations. The most common surgical technique to reduce breast volume requires three incisions. One around the areola (a periareolar incision), another incision that runs vertically from the bottom of the areola to the crease underneath your breast, and a third incision following the natural line of your breast crease.
Your Breast Surgeon will remove the excess fat and tissue through these incisions before lifting the nipple and areola to a higher position. The size of your areola may be reduced, with liposuction sometimes being used to adjust the contour. The surgeon then places stitches deep inside your breast tissue to add support before the skin incisions are closed.
If your breasts are large, your surgeon may also need to make an incision on the crease under your breast (inframammary fold). This incision will leave an anchor-shaped scar. If your breasts are droopy or large, your surgeon may need to completely detach your nipple and areola before replacing them at a higher position. To help your wounds heal, you may have drains inserted in the incisions. These are usually closed with dissolvable stitches.
Breast reduction surgery is performed under a general anaesthetic and usually takes about 90 minutes. You may get injections of local anaesthetic to help with the pain after your operation. To reduce the risk of infection, you may be given antibiotics during the breast reduction operation. After surgery, your breasts may be wrapped in bandages for support.
Are there risks or complications with breast reduction surgery?
It’s important to note that any surgical operation brings complications of anaesthesia. Your anaesthetist will outline the possible complications of having an anaesthetic.
General complications of every surgery include:
- Pain. Your healthcare team will give you medication to control the pain. To reduce discomfort and prevent headaches, it’s important that you take the medication.
- Blood clot in your leg (deep-vein thrombosis – DVT). This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. Your healthcare team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medication, or special stockings to wear. Let the healthcare team know straightaway if you think you might have a DVT.
- Blood clot in your lung (pulmonary embolus). If a blood clot moves through your bloodstream to your lungs. If you become short of breath, feel pain in your chest or upper back, or if you cough up blood, let the healthcare team know straightaway. If you are at home, call an ambulance or go immediately to your nearest Emergency department.
What are the specific risks and complications of breast reduction surgery?
- Asymmetry: Most women’s breasts are not identical, with size and shape differences. Equally so, asymmetries may also occur after surgery including breast size, shape, and nipple position, and the shape and sizes of the nipples themselves. Following the initial breast reduction procedure, additional surgery may be necessary to revise residual asymmetry. This is usually minor if needed.
- Bleeding: Bleeding can occur in the first 24 hours after a breast reduction. This is not life threatening and usually self-limiting. It is very rare to require a blood transfusion. A collection of blood under the skin is called a haematoma. If the haematoma is large and puts pressure on the skin it could affect wound healing, so further minor surgery may be required to remove the haematoma.
- Breast disease: It is recommended that all women perform regular self-examination of their breasts and have breast screening including mammograms or ultrasounds. This will depend upon your age, risk profile and need. Your Breast Surgeon may request you have a pre-operative mammogram prior to proceeding with your surgery. If you’re over 40, or under 40 but with a family history of breast cancer a mammogram before surgery is recommended. Breast tissue removed during a reduction procedure is routinely sent for examination and you will be notified of in the event of suspicious tissue being detected for further follow up.
- Breastfeeding: Breast reduction surgery is likely to reduce your ability to breastfeed. This is not universal and is unpredictable. It’s important to note that up to 20% of women are unable to breast feed even without having breast reduction surgery.
- Breast growth: Your breasts may still increase in size even after having had a breast reduction surgery. This can be associated with weight gain or the onset of menopause. If your breast growth increase is significant, you may need another breast reduction surgery.
- Breast shape and size changes: Following breast reduction surgery, your breasts will still be affected by gravity and ageing, as well as weight gain or loss, pregnancy and menopause. The shape of your breasts will usually change to a degree over time.
- Fat necrosis: In some breast reduction patients (especially those that undergo large reductions) breast lumps and/or areas of breast firmness may be noticed for months after surgery. This occurs where small areas of the fat tissue within the breast lose its blood supply and dies. Your body will eventually absorb these areas, and it should not affect the final result or the volume of your breast. Additional surgery is sometimes required to remove areas of fat necrosis. Contour irregularities in the breast skin are possible due to fat necrosis.
- Loss of nipple and areola tissue: In very rare cases the nipple and areola can lose its blood supply and die. In these rare cases, reconstruction will be required to “build” a new nipple and the areola area at a later stage.
- Loss of sensation in the nipple and areola: Following breast reduction surgery you may experience a diminished or lack of sensation of the nipples and skin of your breasts. This is usually temporary, but sensation may take several months to return to normal or near normal. In some cases, the loss of sensation may be permanent. Occasionally you may experience hypersensitivity, or increased sensitivity of the nipple. This usually settles down within a few weeks after surgery. It’s important to note that these changes in sensation may affect your sexual response or the ability to breastfeed a baby.
- Mammograms: Breast reduction surgery will cause internal scarring which may make it difficult to interpret mammograms for up to 2 years.
Mastitis and infection: Infection after breast reduction surgery occurs but is very uncommon. Occasionally, because breast tissue is removed and breast ducts have to then heal, temporary mastitis can occur. This is very uncommon, - Scars: After breast reduction surgery, you will have scars on your breast. Your surgeon will demonstrate the approximate position of these to you during the consultation. Normally, a breast reduction scar pattern is either a vertical (lollipop) pattern, or an inverted T (anchor) pattern. The decision depends upon which will result in the best postop shape, and will best meet your goals of surgery. Scars generally fade over time but will not disappear. It is normal for scars to take up to 2 years to fully mature.
- Size: While your Breast Surgeon can reduce your breasts to approximately the agreed desired size, it’s important to note it’s difficult to predict your future exact cup size after a reduction procedure. Your Breast Surgeon will discuss with you the cup size you would prefer.
- Skin contour irregularities: After breast reduction surgery, visible wrinkling and depressions in your skin may occur. Contour and shape irregularities may also occur. Residual skin irregularities at ends of the incisions known as “dog ears” are not uncommon as is skin pleating. These usually improve over time, or can be surgically corrected at a later stage, if needed, usually through a small office procedure under local anaesthetic only.
Stiff shoulders: Your healthcare team will give you exercises and it is important that you do them to keep your shoulder moving. Take painkillers as you are told if you need to relieve the pain. - Wound healing: Minor wound healing delays are not uncommon with Breast Reduction surgery. Generally dressings are sufficient to assist with this healing, and the final result is not usually affected. Women that have particularly large breast reductions may sometimes experience wound separation after surgery. Should this occur, additional treatment including further surgery may be required.
What results can you expect after breast reduction surgery?
After breast reduction surgery, it takes around four months for your breasts to adjust to their new form. It can take a year or more for the scars to fade. Women who genetically take a long time to heal can have readily visible scars for life.
While most women only have one breast reduction in their life, if your body shape changes a lot or you have pregnancies, there can be a need for further surgery. This breast surgery may be a breast lift, a further breast reduction or if there has been major weight loss, breast augmentation.
If you become pregnant after having a breast reduction and want to breast feed, it may be possible. Many women who have had breast reduction still produce some breast milk after pregnancy.
Breast reduction surgery is effective at reducing a large breast to less than a C cup. Most women who need a breast reduction are used to a large bust size and look more natural with at least a C cup. It is very important to discuss this carefully with your Breast Surgeon. If you want a smaller breast reduction, you may end up with badly shaped breasts that have noticeable differences between them.
Post surgery breast reduction care
After your breast reduction surgery, you’ll be given medication to limit any pain and nausea. You will also have an intravenous drip in place. Most breast reduction surgery does not require drainage tubes.
While breast reduction patients report that it is not very painful, recovery and pain varies from patient to patient. You will feel sore and bruised, but this type of pain responds well to oral painkillers. Most patients stay overnight in hospital, but a day stay is possible. Some patients find that having family or friends care for them on the day of the surgery and a few days later is helpful.
Once you’re at home you should rest and take the medication for pain as directed. Daily walking is encouraged but it’s recommended that you avoid heavy lifting and strenuous exercise for up to six weeks. Wearing a light pressure bra or sports bra will give you support in the first few weeks after breast reduction surgery. For at least six weeks following the breast reduction procedure, it’s important to handle your breasts gently.
After your surgery, you may be advised to sleep on your back. This will help you avoid putting pressure on your breasts. Some patients report having reduced sensation in the areolas and nipples. While this is usually temporary, it’s important to note that sensation may not fully return for weeks, months, or even years.
Following breast reduction surgery, most women take one to two weeks off work. Driving can be resumed once you are comfortable, can react quickly if necessary, and are not taking strong painkillers. This is normally within five to seven days.
Alternatives to breast reduction surgery
If you choose not to have breast reduction surgery and are overweight, you may be able to reduce your breast size by losing weight. Some women report that losing weight reduces their breast by as much as 1cup size.
Women who have large breasts and don’t choose to have breast reduction surgery find that wearing a custom made bra is useful.
To find out if breast reduction surgery is appropriate for you to consult a Breast Surgeon.
Breast reduction surgery to make your breasts smaller is only suitable for certain women. It’s important to consider the options carefully and have realistic expectations about the breast reduction results. While breast reduction surgery is usually effective and safe, complications can occur. Knowing about the risks and complications of the surgery is vital.
We suggest you make a shortlist and consult with a few Breast Reduction Surgeons. You can find the best Australian Breast Reduction Surgeons here.
Important to know
So you can make an informed decision, your elected surgeon will discuss the possible risks associated with a breast reduction. Although the majority of patients do not experience these complications, it's important to understand how they can be managed in the event that they occur.
