Breast Reduction

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What is Breast Reduction?

One of the most common procedures among patients who have symptomatic issues is breast reduction. Patients usually want this procedure not because they want to reduce the size for appearance, but because of a lot of symptomatic problems like neck pain, upper back pain, and shoulder pain. Some patients have had large breasts their whole life, and their shoulders are rotated forward and hunched over. Those are all common symptoms for patients with heavy breasts. The range of patients for breast reduction varies. There are some with large breasts and others just a little bit heavy, giving not severe symptoms but nagging, constant annoying symptoms.

The goal of breast reduction surgery is to improve the symptoms. Usually, that goal is achieved, reducing the size, trying to make things better, and at the same time give a lift and make the breasts look aesthetically appealing. After all, it is plastic surgery, so appearance is important, but the main goal of this procedure is to make the patient feel better. The procedure works very well. Patients usually get a very nice benefit concerning their symptoms. Rarely, a patient does not feel better after a breast reduction.

Is this procedure right for me?

The best candidates for the procedure are patients who have had large breasts and can tell that it is the breasts that are causing those problems. Most of the time, the surgeon can tell ahead of time that patients will be improved with breast reduction surgery. Occasionally, there are patients for whom it is not completely clear. In that case, the consultation can delineate whether the procedure is a good idea or not.

How is the procedure done?

For the procedure itself, there are a couple of different ways to do it. There is what is called a wise pattern or inverted T breast reduction. It is an incision around the areola down to the fold from the areola and an incision underneath the breast. The reason we make those incisions is that with breast reduction, in addition to the breast tissue being too big, the skin has been stretched out by large breasts. So, in addition to taking out the breast tissue, you also want to remove a lot of the breast skin. It is very similar to what is done for a breast lift. So, it is common to incorporate a breast lift technique into the procedure so that the breast is also lifted and gets a nice rejuvenated appearance. That is some bonus to the reduction. In certain patients who have less extra skin or who have less of a breast to reduce, there are other ways to do it. Another way is a vertical breast reduction, which is incisions around the areola and downward. Some people call it the lollipop incision. It depends on the degree of breast tissue that needs to be taken out and the degree of excess skin. That is something that the surgeon assesses in the consultation with the patient. As always, all these plans have to be individualized because people do have a lot of differences.

Very often, as part of the individualization, patients who need a breast reduction have a pretty asymmetric type of breasts. One side is significantly bigger than the other, or one nipple may be considerably lower than the other. Then, of course, the goal of surgery is to make this closer as much as possible.

How much does the surgery last, and how is the recovery process?

The surgery itself, depending on the technique, usually lasts about three hours or so. It’s done under general anesthesia, the patient’s asleep the whole time, and it’s more comfortable for them. Again quite straightforward with the procedure where the goal is to reduce the skin and excess breast tissue. After the procedure, patients usually put in some sterile dressings and a special surgical bra that the surgeon puts on at the time of surgery. Some patients leave that on until the first post-operative visit. Then the surgeon takes off the dressings, double-check for signs of infection, and things like that. Occasionally in some patients, the surgeon drains where the patient has some tubes that go into the tissue to remove any excess fluid that remains. Patients can expect bruising and swelling. A lot of it to goes away in the first two weeks or so so, but expect the majority of swelling to go away by six weeks. The breast will continue to remodel and get better in terms of shape in six weeks to six months to a year. By that time, a lot of scars have faded as well. The scars, as always, peak in terms of darkness in about four to six weeks after surgery. Afterward, it will start this slow lightening process that goes on for the first 12 months. Breast reduction works very well for patients. Remember, the goal is a symptomatic improvement, usually, in back pain, neck pain, my patients are delighted with the result.