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    Breast reduction

    Reduction mammoplasty

    Breast reduction is surgery to reduce the size of the breasts.

    Description

    Breast reduction surgery is usually done under general anesthesia(asleep and pain-free).

    For a breast reduction, the surgeon removes some of the breast tissue and skin. Your nipples may be moved higher to reposition them for cosmetic reasons.

    In the most common procedure:

    • The surgeon makes three surgical cuts: around the areola (the dark area around your nipples), from the areola down to the crease under your breast, and across the lower crease of your breast.
    • Extra fat, skin, and breast tissue are removed. The nipple and areola are moved to a higher position. Often the areola is made smaller.
    • The surgeon closes the cuts with stitches to reshape the breast.
    • Sometimes liposuction is combined with breast reduction to improve the shape of the breast and armpit areas.

    The procedure can last 2to 5 hours.

    Why the Procedure Is Performed

    Breast reduction may be recommended if you have very large breasts (macromastia) and:

    • Chronic pain that affects your quality of life. You may be having headaches, neck pain, and shoulder pain.
    • Chronic nerve problems caused by poor posture, which result in numbness or tingling in your arms or hands.
    • Cosmetic problems, such as persistent bra-strap groove, scar-like lines in the skin (striae), difficulty finding clothes that fit, and low self-confidence.
    • Chronic rashes under your breasts
    • Unwelcome attention that is making you feel awkward
    • Inability to participate in sports

    Some women may benefit from non-surgical treatments, such as:

    • Exercising to strengthen their back and shoulder muscles
    • Losing excess weight
    • Wearing supportive bras

    Risks

    Breast reduction surgeryis generally safe. Ask your doctor about these complications.

    Risks of any surgery are:

    • Bleeding
    • Infection

    Risksof any anesthesia are:

    • Breathing problems, such as pneumonia
    • Heart problems
    • Reactions to medicines

    Risksof this procedure are:

    • Difficulty breastfeeding, or being unable to breastfeed
    • Large scars that take a long time to heal
    • Loss of feeling in the nipple area
    • Uneven position of the nipples or differences in the size of the breasts

    Before the Procedure

    If you smoke, you must stop. Women who smoke after breast surgery have a higher risk of poor healing, infection, and scarring. Youshould even avoid breathing in secondhand smoke.

    Tell your surgeon:

    • If you are or could be pregnant
    • What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

    Before surgery:

    • You may need a mammogrambefore the surgery. Your plastic surgeon will do a routine breast exam.
    • Several days before surgery, you may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
    • Ask yoursurgeon which drugs you should still take on the day of the surgery.
    • You may need to fill prescriptions for pain medicine before surgery.
    • Arrange for someone to drive you home after surgery and help you around your house for several days.

    On the day of surgery:

    • Follow the surgeon's instructions about not eating or drinking anything before the surgery.
    • Take the drugs yoursurgeon told you to take with a small sip of water.
    • Wear or bring loose clothing that buttons or zips in front.
    • Arrive at the hospital on time.

    After the Procedure

    You may have to stay overnight in the hospital.

    After surgery, a gauze dressing (bandage) will be wrapped around your breasts and chest. Or you will wear a surgical bra. Wear the surgical bra or a soft supportive bra for as long as your surgeon tells you to. This will likely be for several weeks.

    Drainage tubes may be attached to your breasts. These tubes will be removed withina fewdays.

    Your pain should decrease in a few weeks. Take pain medicine to control it. Be sure to take the medicine with food and plenty of water. Do not apply ice or heat to your breasts unless your doctor has told you that is okay.

    Within a few weeks, the swelling and bruising around your incisions should disappear. You may have a temporary loss of sensation in your breast skin and nipples after surgery. Sensationmay return over time. Your stitches, if any,will be removed within 2 weeks after surgery.

    Outlook (Prognosis)

    You are likely to have a very good outcome from breast reduction surgery. You may feel better about your appearance and be more comfortable with various activities.

    Pain or skin symptoms, such as striation,may disappear. You may need to wear a special supportive bra for a few months to reshape your breasts.

    Scars are permanent. They will be more visible for the first year, but will then fade. Thesurgeon will make every effort to place the cuts so that scars are hidden. Cuts are usually made on the underside of the breast. Most of the time, the scars should not be noticeable, even in low-cut clothing.

    References

    McGrath MH, Pomerantz J. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.

    Roehl KR, Wilhelmi BJ, Phillips LG. Breast reconstruction. In: Townsend CM, Beauchamp RD,Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 37.

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                Review Date: 1/24/2013

                Reviewed By: Debra G. Wechter, MD, FACS, General Surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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