Breast Reduction Surgery: Everything You Need to Know

A breast reduction (reduction mammoplasty) is the surgical removal of breast tissue, fat, and skin. It decreases breast size but does not entirely remove them. 

Those assigned female at birth often have this surgery because their large breasts are causing chronic pain or other debilitating symptoms. Some people also have the surgery to increase self-esteem, reduce breast sagging, exercise more comfortably, or fit better in clothing.

While an overall satisfying surgery for most, the acute recovery period can last up to six weeks. It can take up to six months after surgery for the breasts to settle into their final shape, size, and position.

This article reviews breast reduction surgery, various techniques, contraindications and risks, why it’s done, how to prepare, surgical steps, and recovery.

What Is Breast Reduction Surgery?

Breast reduction surgery is an elective procedure almost always performed under general anesthesia, which puts you to sleep.

While not common, the surgery may be performed under local anesthesia with intravenous sedation (your breast area is numbed, and you are put into a light sleep).

During the operation, the surgeon makes two to three breast incisions and removes tissue, fat, and skin. The breast is then reshaped and the nipple/areola is repositioned on the chest.

Even though breast reduction surgery is considered a cosmetic procedure, it's often covered by insurance because of the symptoms and health problems that manifest as a result of having large breasts.

Various Surgical Techniques

Breast reduction techniques vary depending on the amount of tissue that needs to be removed, the position of the nipples, and your and your surgeon's preference.

Two common techniques used to perform a breast reduction surgery include:

• Short scar or lollipop breast reduction: This technique entails making two incisions—one that circles the nipple/areola area and one that extends down vertically from the bottom of the areola to the crease below the breast. This technique is often used for moderately large breasts. Scarring is limited to the area below the nipple.
• Inverted-T or anchor breast reduction: This technique involves three incisions—one around the perimeter of the areola, one vertically down from the areola to the breast crease, and one along the crease below the breast. This technique is used when significant breast reduction is needed. Scarring is present in the area below the nipple and beneath the breast.

Contraindications

Relative contraindications to breast reduction surgery include:

• Severe medical conditions (e.g., heart or lung disease, or uncontrolled diabetes or hypertension)
• Current smoker
• Unrealistic expectations

Potential Risks

Besides the known risks of anesthesia, specific risks associated with a breast reduction surgery include:

• Breast correction problems (e.g., asymmetry, contour or shape problems, extensive firmness)
• Cellulitis
• Breast hematoma
• Breast seroma
• Skin necrosis (tissue death) where skin incisions meet
• Fat necrosis resulting in small, firm lumps beneath the skin
• Partial or total loss of nipple/areola due to impaired blood flow
• Inability to breastfeed
• Sensory changes in the nipple or entire breast (may be temporary or permanent)
• Undesirable scarring or skin discoloration
• Deep vein thrombosis (DVT)

Purpose of Breast Reduction Surgery

Excessively large breasts may cause chronic breast, neck, shoulder, and upper back pain. Skin rashes or infections in the area where your breast meets the skin on your chest can also occur.

In addition, those with very large breasts may find it difficult to find clothes that fit well or may feel embarrassed by persistent deep grooves that bra straps leave on the skin.

If desired, breast reduction surgery can reduce the size and weight of your breasts to treat the above symptoms/issues. It can also be done for aesthetic (appearance) concerns regardless of symptoms. However, insurance may consider it cosmetic and may not cover it if there are no medical issues involved.

With smaller and lighter breasts, you may:

• Alleviate back, neck, and shoulder discomfort
• Notice an improvement in the overall balance between your body and breast size
• Reduce breast sagging
• Fit more comfortably in bras and swimsuits
• Be able to exercise and engage in enjoyable activities that were limited by your breast size
• Improve your self-esteem (if this is an area of concern)

Candidacy

People who are good candidates for breast reduction surgery include those who:

• Have breasts that are fully developed and are a size D or larger
• Are non-smoking and healthy with no significant underlying medical conditions
• Are of a stable, healthy weight (significant weight loss after surgery may affect the results)
• Have realistic expectations (e.g., there will be scarring on the breast and nipple sensation may be affected)
• Are OK with the fact that they may not be able to breastfeed

How to Prepare

If you want to proceed with breast reduction surgery, you will need medical clearance. This involves undergoing a physical exam and presurgical testing, including a complete blood count (CBC), and an electrocardiogram (ECG).

You may also undergo breast cancer screening based on your age and risk factors. For most people age 40 and over, this includes a mammogram.

You can expect a pre-operative appointment with your surgeon a week or so before your scheduled surgery.

At this appointment, you and your surgeon will discuss the planned postoperative cup size. Besides personal preference, this will depend on the surgical technique used and variables like your body shape.

Your surgeon will also take measurements and photographs of your breasts.

Location

Breast reduction surgery is performed in a hospital or surgical center by a plastic surgeon.

What to Wear

Since you will be changing into a hospital gown, wear loose-fitting clothes on the day of your surgery. Do not wear makeup, hairspray, or nail polish. Leave all jewelry at home.

Food and Drink

Do not eat or drink anything, including candy and water, after midnight on the eve of your surgery unless otherwise directed by your healthcare team.

Medications

Around two weeks prior to surgery, you will be advised to stop taking certain medications, like, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), as well as certain vitamins or herbal products (e.g., vitamin E).

What to Bring

On the day of your surgery, be sure to bring:

• Your driver's license and insurance card
• List of your medications
• A shirt to go home in that can be buttoned
• A post-surgical seat belt pillow for the car ride home (talk with your surgeon beforehand to see if this is needed)
• Post-surgical bra (if directed by your healthcare team)

If you are staying overnight in the hospital, remember to pack an overnight bag containing the following:

• Personal items (such as toothbrush and hairbrush)
• Comfort items (such as slippers, earplugs, and a magazine)
• Medical items (such as a CPAP machine if you have sleep apnea)

You will also need to arrange a ride home when you are discharged.

Pre-Op Lifestyle Changes

Your surgeon will ask you to stop smoking and drinking alcohol prior to surgery. Smoking, in particular, increases your risk of complications, like poor wound healing and loss of your nipple/areola.

What to Expect on the Day of Surgery

On the day of your operation, you will arrive at the hospital or surgical center where you will check-in. You may be asked to show your identification and insurance card at this time.

Before the Surgery

After checking in, you will be led into a pre-operative area to change into a hospital gown and grip socks.

A surgical nurse will review your medication list, record your vitals (heart rate, blood pressure, etc.), and place an intravenous (IV) line into a vein in your arm. This IV will be used for administering fluids and medications during and after surgery.

Your surgeon and anesthesiologist will then come to greet you and review the operation with you. You may need to sign a consent form at this time.

Besides citing the medical risks of surgery and anesthesia, the required consent form will review the possibility of unsatisfactory results after surgery (e.g., unanticipated breast shape/size and asymmetry in nipple location).

From there, you will walk on your own into the operating room or be wheeled on a gurney.

During the Surgery

Once you are in the operating room, if you are undergoing general anesthesia, the anesthesiologist will give you inhaled or intravenous medications to put you to sleep. A breathing (endotracheal) tube will be inserted through your mouth into your windpipe (trachea). This tube is connected to a ventilator which helps your lungs breathe during surgery.

Your surgery will take around three to four hours and proceed in this general fashion:

• Incision: Depending on the technique used, the surgeon will use a scalpel to make two to three breast incisions.
• Removal and repositioning: Some breast tissue, skin, and fat will then be removed, and the remaining breast tissue will be reshaped. The nipple and areola—which, in most cases, remain connected to their existing blood and nerve supply—will also be repositioned. Sometimes, the size of the areola is reduced by surgically cutting the skin around its edges.
• Grafting: For those with extremely large breasts, the nipple and areola may need to be removed and grafted into a higher position on the breast (called a free nipple graft).
• Drain placement: In some instances, a drain will be temporarily placed underneath the skin near the incision sites to drain excess blood or fluid.
• Closure: After excess tissue is removed and your breasts are reshaped, the incisions will be closed with stitches, surgical glue, or both. Gauze dressings will then be placed on your breasts and covered with a support bra.
• Pathology review: The removed breast tissue will be sent to a pathology laboratory to examine for pre-cancerous or cancerous cells.
• Prep for recovery: Anesthesia will be stopped, and the breathing tube will be removed (if undergoing general anesthesia). Then, you will be wheeled into a postoperative care unit (PACU).

After the Surgery

After surgery, you will be taken to a recovery area where you will slowly wake up from anesthesia. At this time, you may feel breast pain and nausea. Your nurse will administer medication to ease these symptoms.

If you are being discharged that day, it will likely be a few hours after the procedure. If not, you will be moved to a hospital room for your overnight stay once the staff deems you are ready.

Recovery

While the actual operation time for a breast reduction is short, the recovery process requires a bit more time and patience. So you can focus on healing, it's important to have a partner, another loved one, or a friend take over household chores for you for a couple of weeks after surgery.

Your surgeon will not want you to lie in bed all day. Walks that slowly increase in duration and frequency will be encouraged starting the day after surgery.

Healing

As you recover, expect to have pain around the incision sites. To ease your discomfort, take your pain medication exactly as prescribed. You will likely be given an opioid to start, followed by Tylenol (acetaminophen) alone, and eventually, an NSAID like Motrin or Advil (ibuprofen).

Bruising and swelling are also common after surgery. To reduce swelling, your surgeon will ask that you continuously wear the support bra placed at the end of surgery for the first four to six weeks post-op.

While you may be eager to shower after surgery, your surgeon will ask that you avoid showering for several days. Until then, you can take sponge baths or use body wipes, but avoid washing your incision sites and your hair (so you don't re-open your incision sites when you lift your arms).

When you finally can shower, remove your support bra and the gauze pad/dressing covering your incision sites. Your surgeon will advise you to wash your incision sites gently with warm water and pat the skin dry with a clean towel. After you shower, you must put your support bra back on (the gauze pads/dressings can be discarded).

Other common post-operative instructions will likely include:

• Avoid driving for at least 24 hours after surgery until you are off all prescription pain medications.
• Avoid bathing until your incision sites are healed (around six to eight weeks after surgery).
• If you work, you can return to work around one to three weeks after surgery (assuming your job does not require strenuous activity).
• Avoid using your upper body muscles repetitively or strenuously for six weeks after surgery.
• Avoid jogging or high-intensity exercise for six weeks.

Expect to see your surgeon one week after surgery. At this appointment, your surgeon will check your incision sites, remove any non-absorbable stitches and drain(s), and monitor for complications. If you have any abnormal breast tissue results, these will also be discussed during your first post-operative visit (if not sooner).

Long-Term Care

It takes up to six months after surgery for your breasts to take their new position and shape. As your breasts fully heal, your surgeon will need to continue seeing you for follow-up appointments.

During these appointments, your surgeon will monitor your progress and provide guidance on minimizing your scars (which, while permanent, will naturally diminish in visibility over time).

For scar reduction, your surgeon may recommend massaging various topical agents, like vitamin E oil or a silicone ointment/tape, over the scar. Do not use any scar treatments until your wounds have fully healed, which is around two to three weeks after surgery.

Possible Future Surgeries/Therapies

Rarely, a second breast reduction surgery may be needed for undesirable surgical outcomes, like breast asymmetry or contour irregularity. Surgical complications like seromas, hematomas, hypertrophic or keloid scars, or nipple necrosis may also warrant revision surgery.

If breast cancer is incidentally diagnosed from the surgery, you will be referred to an oncologist. You can expect to undergo breast surgery, radiation, chemotherapy, hormone therapy, or some combination, depending on the type and stage of breast cancer found.

Lifestyle Adjustments

Most people are pleased with the outcome of their breast reduction surgery. The results are generally permanent, although breast shape may change a bit with weight changes, pregnancy, or hormone fluctuations.

That said, surgery will not magically transform your life or self-image if that was an aim. If you experience symptoms of depression or anxiety before or after surgery, be sure to talk with your healthcare provider.

Also, breast reduction surgery does not change anything when it comes to keeping up with your routine breast cancer preventive care. Be sure to continue to undergo screening tests (e.g., mammogram or breast MRI) based on your level of breast cancer risk.

Summary

Breast reduction is an elective surgical procedure that removes unwanted tissue, skin, and fat from the chest area. Large breasts can cause chronic pain or other debilitating symptoms. Some people also have the surgery to reduce breast sagging, move and exercise more easily, feel more comfortable in their body, or fit better in clothing,

Breast reduction surgery is performed in a hospital or surgical center by a plastic surgeon. After you have been given medicine to put you to sleep during the procedure, the surgeon will remove any unwanted tissue, fat, and skin from the chest area. They will reshape the breast and reposition the nipple and areola.

Your healthcare team may place surgical drains in your chest to keep fluid from building up under the skin. These drains are removed within a couple of weeks of surgery.

Most people go home on the day of surgery. It takes several weeks to recover, and it is important to have someone at home to help care for you.

It can take up to six months for your breasts to settle into their new position and shape. Most people are pleased with their outcomes once this occurs. Remember that you will still need to keep up with breast cancer screenings such as mammograms.