Reduction Mammaplasty

A breast reduction removes excess breast tissue and skin to achieve a breast size in proportion with your body and alleviate discomfort.

Introduction

What is breast reduction surgery?

Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). Disproportionately large breasts can cause both physical and emotional distress for patients. Patients with macromastia may experience physical discomfort resulting from the weight of their breasts. The resulting pain can make it challenging for some patients to perform common physical activities. Along with the physical ailments of macromastia, some patients may suffer from emotional distress or more significant mental health problems as a result of their large breasts. Although breast reduction is often performed to address medical issues, patients who do not have the symptoms of macromastia but are unhappy with the size of their breasts can still pursue breast reduction as an aesthetic procedure. Patients choosing to undergo breast reduction surgery for cosmetic reasons may cite any number of factors, including social stigmas and wardrobe concerns.
Candidates

Who is a good candidate for breast reduction surgery?

Overly large breasts can cause health and emotional problems. In addition to self-image issues, you may also experience physical pain and discomfort. The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts can be as important an issue as the physical discomfort and pain. You may be a candidate for breast reduction surgery if:
  • You are physically healthy
  • You have realistic expectations
  • You don’t smoke
  • You are bothered by feeling that your breasts are too large
  • You have breasts that limit your physical activity
  • You experience back, neck and shoulder pain caused by the weight of your breasts
  • You have shoulder indentations from bra straps
  • You have skin irritation beneath the breast crease
Cost

How much does breast reduction cost?

The average cost of breast reduction (aesthetic patients only) is $5,475, according to 2019 statistics from the American Society of Plastic Surgeons. This average cost is only part of the total price – it does not include anesthesia, operating room facilities or other related expenses. Please consult with your plastic surgeon’s office to determine your final fee. A surgeon’s fee for breast reduction will be based on his or her experience, the type of procedure used and the geographic office location. Your surgeon may offer patient financing plans, so be sure to ask.

Breast reduction costs may include:

  • Anesthesia fees
  • Hospital or surgical facility costs
  • Medical tests
  • Post-surgery garments
  • Prescriptions for medication
  • Surgeon’s fee
When choosing a board-certified plastic surgeon for breast reduction, remember that the surgeon’s experience and your comfort with him or her are just as important as the final breast reduction costs.

Is breast reduction surgery covered by health insurance?

Many health insurance plans cover breast reduction surgery. Your plastic surgeon may need to obtain authorization from your insurer for the surgery. This may require a letter and the submission of photographs. Once authorization is obtained, you will be able to schedule your surgery. You will be responsible for any copays or deductibles required by your insurer. If your health plan does not cover breast reduction, you may decide to pay for the surgery yourself.
Consultation

What should I expect during a consultation for breast reduction surgery?

The success and safety of your breast reduction procedure highly depends on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle. During your breast reduction consultation be prepared to discuss:
  • Why you want the surgery, your expectations and desired outcome
  • Medical conditions, drug allergies and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries
  • Family history of breast cancer and results of any mammograms or previous biopsies
Your plastic surgeon will also:
  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine your breasts, and may take detailed measurements of their size and shape, skin quality, placement of your nipples and areolas
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes of your breast reduction procedure and any risks or potential complications
  • Discuss the use of anesthesia during your procedure for breast reduction
The consultation is the time to ask your plastic surgeon questions. To help, we have prepared a checklist of questions to ask your breast reduction surgeon that you can take with you to your consultation.
Questions to Ask

What questions should I ask my plastic surgeon about breast reduction surgery?

Use this checklist as a guide during your breast reduction consultation:
  • Are you certified by the American Board of Plastic Surgery?
  • Are you a member of the American Society of Plastic Surgeons?
  • Were you trained specifically in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • Where and how will you perform my breast reduction procedure?
  • Do you have hospital privileges to perform this procedure? If so, at which hospitals?
  • Is the office-based surgical facility accredited by a nationally or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • Am I a good candidate for breast reduction?
  • What will be expected of me to get the best results from breast reduction surgery?
  • What surgical technique is recommended for me?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What are the risks and complications associated with my breast reduction procedure?
  • How are breast reduction complications handled?
  • How will breast reduction affect my ability to breastfeed?
  • How can I expect my breasts to look over time? After pregnancy? After breastfeeding?
  • What are my options if I am dissatisfied with the outcome?
  • Do you have breast reduction before-and-after photos I can look at for this procedure? Which results are reasonable for me to expect?
Risks and Safety

What are the risks of breast reduction surgery?

The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable. Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications. Possible breast reduction surgery risks include:
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
  • Anesthesia risks
  • Bleeding (hematoma)
  • Blood clots
  • Breast asymmetry
  • Breast contour and shape irregularities
  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Damage to deeper structures – such as nerves, blood vessels, muscles and lungs – can occur and may be temporary or permanent
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Excessive firmness of the breast
  • Fatty tissue deep in the skin could die (fat necrosis)
  • Fluid accumulation
  • Infection
  • Pain, which may persist
  • Poor wound healing
  • Possibility of revisional surgery
  • Potential inability to breastfeed
  • Potential loss of skin/tissue of breast where incisions meet each other
  • Potential, partial or total loss of nipple and areola
  • Skin discoloration, permanent pigmentation changes, swelling and bruising
  • Unfavorable scarring
You should know that:
  • Breast reduction surgery can interfere with certain diagnostic procedures
  • Breast and nipple piercing can cause an infection
  • Your ability to breastfeed following reduction mammaplasty may be limited; talk to your doctor if you are planning to nurse a baby
  • The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
  • Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single breast reduction procedure and another surgery may be necessary.

Where will my surgery be performed?

Breast reduction procedures may be performed in your plastic surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or a hospital. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

When you go home

If you experience shortness of breath, chest pains or unusual heartbeats, seek medical attention immediately. Should any of these breast reduction complications occur, you may require hospitalization and additional treatment. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Be careful

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself and minimize breast reduction surgery risks. Be sure to ask questions: It’s very important to address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with your plastic surgeon.
Preparation

How should I prepare for breast reduction surgery?

After researching the basics about breast reduction, many patients want to know what to expect before breast reduction surgery. Prior to breast reduction surgery, you may be asked to:
  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
  • Stop smoking well in advance of breast reduction surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Special instructions you receive will cover:
  • What to do on the day of surgery
  • Post-operative care and follow-up
Your plastic surgeon will also discuss where your procedure will be performed. Breast reduction surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory surgical center or a hospital.

You’ll need help

If your breast reduction procedure is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and stay with you the following night.
Procedure Steps

What are the steps of a breast reduction procedure?

Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.

In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.

The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice.

Step 1 – Anesthesia

Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Incision options include:

  • A circular pattern around the areola

The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.

  • A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease

  • An inverted T or anchor-shaped incision pattern

Step 3 – Removing tissue and repositioning

After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.

Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

Step 4 – Closing the incisions

The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.

Step 5 – See the results

The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.

Recovery

What should I expect during my breast reduction recovery?

Many patients have questions about recovery from breast reduction surgery. When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect. You will be given specific instructions for breast reduction recovery that may include:
  • How to care for your breasts following breast reduction surgery
  • Medications to apply or take orally to aid healing and reduce the risk of infection
  • Specific concerns to look for at the surgical site or in your general health
  • When to follow up with your plastic surgeon
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery? When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?
Results

What results should I expect after breast reduction surgery?

The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction. Breast Reduction Before & After Photos Your better-proportioned figure will likely enhance your self-image and boost your self-confidence. However, over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.
Glossary of Terms

What words should I know about breast reduction surgery?

Areola

Pigmented skin surrounding the nipple

Breast reduction

Also known as reduction mammaplasty, the surgical removal of breast tissue to reduce the size of breasts

General anesthesia

Drugs and/or gases used during an operation to relieve pain and alter consciousness

Hematoma

Blood pooling beneath the skin

Intravenous sedation

Sedatives administered by injection into a vein to help you relax

Liposuction

Also called lipoplasty or suction lipectomy, a procedure that vacuums out fat from beneath the skin’s surface to reduce fullness

Local anesthesia

A drug injected directly to the site of an incision during an operation to relieve pain

Mammogram

An x-ray image of the breast

MRI (Magnetic Resonance Imaging)

A painless test to view tissue, similar to an x-ray

Reduction mammaplasty

The surgical removal of breast tissue to reduce the size of breasts; also known as breast reduction surgery

Sutures

Stitches used by surgeons to hold skin and tissue together
Choosing a Surgeon

How do I choose a plastic surgeon for breast reduction surgery?

Breast reduction surgery involves many choices. The first and most important is selecting a board-certified plastic surgeon you can trust who is a member of the American Society of Plastic Surgeons (ASPS). ASPS member surgeons meet rigorous standards:
  • Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada®
  • Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
  • Pass comprehensive oral and written exams
  • Graduate from an accredited medical school
  • Complete continuing medical education, including patient safety, each year
  • Perform surgery in accredited, state-licensed or Medicare-certified surgical facilities
Do not be confused by other official-sounding boards and certifications. The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name. By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board certified by the ABPS or the Royal College of Physicians and Surgeons of Canada.
Before and After Photos
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