Your Health - Breast Reduction

Breast Reduction

(Reduction Mammoplasty)

Definition

Breast reduction is a common surgical procedure. It is done to decrease the size of one or both breasts. While more common in women, this procedure can also be done in men.

Reasons for Procedure

Overly large breasts, resulting in the following symptoms:
- Poor body image
- Back, neck, and shoulder pain
- Posture problems
- Grooving or abrasions from bra straps
- Rash under the lower portion of the breasts
Large breasts—generally acquired naturally or following pregnancy
Breast asymmetry—may be due to previous surgery to one breast (eg mastectomy or lumpectomy)
Large male breasts, known as gynecomastia—can be related to hormonal changes, medicines, or other health conditions

After the surgery, your breasts will be smaller and more symmetrical in appearance. They should reflect the size, shape, and symmetry you desired.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a breast reduction, your doctor will review a list of possible complications, which may include:

Infection
Bleeding and bruising
Possible loss of sensation to the breast, nipple, and/or areola
Possible loss of ability to breast feed
Asymmetry between breasts
Limited arm and/or shoulder movement
Delayed wound healing
Scarring
Fluid or blood-filled cysts may develop in the healing breast tissue
Loss of nipple, areola, skin, or breast tissue due to change in blood supply

Some factors that may increase the risk of complications include:

Obesity
Smoking, alcohol abuse, or drug use
Diabetes
Prior radiation to the breast area
Poor nutrition

What to Expect

Prior to Procedure

You may be asked to look through an album of breast sizes and shapes. This will help the doctor understand the outcome you desire.

Your doctor will likely do the following:

Physical exam, including breast exam
Blood tests
Mammogram
Take "before" pictures

In the days leading up to your procedure:

Arrange for a ride to and from the procedure.
Arrange for help at home after the procedure.
The night before, eat a light meal, and do not eat or drink anything after midnight.
You may be asked to shower before your procedure. You may be given special antibacterial soap to use.

Talk to your doctor about your medicines. You may be asked to stop taking some medicines or herbal supplements up to one week before the procedure, like:

Anti-inflammatory drugs (eg, aspirin)
Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
Gingko biloba or other supplements

Anesthesia

You may be given:

General anesthesia—You will be asleep.
Local anesthesia—The area will be numbed.

Description of the Procedure

The doctor will cut around the nipple and areola. Skin, fat, and breast tissue will be removed in a specific pattern. Depending on how much breast tissue is removed, the doctor may need to reposition the nipple and areola higher up on the remaining breast tissue. Liposuction, a vacuum procedure used to remove excess fat, may also be used. The amount of scarring will depend on the amount that the breast is reduced and the amount of repositioning required of the nipple and areola. The scarring can occur around the areola, around the areola, and down to the breast crease or around the areola, down to the breast crease, and along the breast crease.

Depending on the extent of operating required, the doctor may place a small flexible tube in one or both breasts to drain any fluid build-up during the early phases of healing. These drains may need to stay in place for several days. They can be removed in the doctor's office. You will not need a second surgery to remove them.

The cuts in the breast skin will be closed with tiny stitches.

Breast Reduction Procedure

Immediately After Procedure

You will be tightly bandaged around your chest, or you will have a special surgical bra. These will provide pressure and support.

How Long Will It Take?

2-4 hours

How Much Will It Hurt?

Anesthesia prevents pain during the surgery. You will have tenderness, swelling, and bruising of the breasts for several weeks after surgery. The pain can be controlled with pain medicines.

Average Hospital Stay

The hospital stay may be up to four days. It may be possible to leave the hospital or surgery center on the same day of the procedure. Speak to your doctor to see if this is an option in your case.

Post-procedure Care

Wear a special surgical bra that applies pressure. This will properly shape your breast(s) after the operation.
If drains have been placed in either breast, they will be removed 2-4 days after surgery.
Stitches are usually removed about 7-10 days after surgery.
Absorbable sutures may also be used by your doctor; they do not need to be removed.
Your doctor will probably advise you to avoid heavy lifting, straining, or strenuous exercise for the first week or two after surgery.
Be sure to follow your doctor’s instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site in the operated breasts
Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
Pain that you cannot control with the medicines you have been given
Cough, shortness of breath, or chest pain
Pain or swelling in your calves, legs, or feet
You have concerns about the size and/or shape of your breasts
Fluid or blood collecting in either breast
Any pain or stiffness when moving your arm

In case of an emergency, call 911.

RESOURCES:

American Society for Aesthetic Plastic Surgery
http://surgery.org/

American Society of Plastic Surgeons
http://www.plasticsurgery.org/

CANADIAN RESOURCES:

Canadian Society of Plastic Surgery
http://www.plasticsurgery.ca/

Guide to Breast Augmentation in Canada
http://www.canadaba.ca/

References:

Breast reduction (reduction mammoplasty). Mayo Clinic website. Available at: http://www.mayoclinic.org/cosmetic-surgery/breastreduction.html. Accessed June 10, 2008.

Sabiston DC. Textbook of Surgery. 15th ed. Philadelphia, PA: WB Saunders Co.; 1997.

Sabiston DC. Textbook of Surgery. 17th ed. Philadelphia, PA: WB Saunders Co.; 2003.

Spear SL. Surgery of the breast. Principles and art. 2nd ed. Lippincott Williams and Wilkins 2005.

Last reviewed November 2009 by Mervin Low, MD, PC

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.