Breast Reduction Surgery

My patient, Jennifer, (not her real name) just returned for her annual exam and had a big announcement. “I finally did it!” she exclaimed. “I had my breast reduction surgery.” She went on to say the same thing, I’ve heard from thousands of women. “I wish I had done this a long time ago.” 

There’s a lot to consider when thinking about breast reduction surgery. They’ve been endlessly photographed and used to market everything from tires to tomato sauce. Breasts are revered, worshiped, pushed up, enhanced, and no matter what your size receive amazing amounts of attention – unwanted and wanted. 

Let’s face it, our culture has weighed down women’s humble mammary glands with a whole lot of baggage But, they actually do weigh a lot just on their own. A pair of D-cup breasts can weigh between 15 and 23 pounds, that’s the equivalent of carrying around a seven-month-old baby. What if you’re a DD or H, I, J? 

What is Involved

Known as reduction mammaplasty, this is surgery performed to remove excess breast fat, glandular tissue and skin to achieve a more comfortable and balanced breast size. Very large breasts (called macromastia), or those that are out of proportion to the rest of the body, can cause psychological stress and embarrassment as well as physical problems. 

Here are problems large breasts can cause:

• Pain –The weight of large breasts can cause pain in the neck, shoulders, and back. In addition, the breasts themselves may be painful simply because of the excess weight and pull on the skin.
• Rashes – Large breasts trap heat and moisture underneath them, causing chronic rashes or skin infections.
• Shoulder Grooves – Bras may not fully support the breasts and lead to deep groves in the shoulder under the straps. A high-quality bra with wide straps can help but may not eliminate the marks.  Most women I know over 40 with C or D cups have permanent grooves, myself included!
• Numbness – Some women report numbness in their breasts from the excess weight. Also, numbness in the fingers, hands, and arms, which happen when the weight of the breasts and poor posture cause nerve compression.
• Inability to Exercise – Large breasts make it hard for women to exercise comfortably, participate in sports, or perform certain activities. Lack of exercise has long term health consequences. 
• Shortness of Breath – The excess weight on the chest can lead to shortness of breath.
• Headaches – Large breasts have also been linked to migraine and tension headaches due to the muscle strain on the collarbones and shoulders.

How the Surgery is Done

The amount of breast tissue removed will be discussed in consultation with your plastic surgeon, and depends on current size, breast composition, and what you would like as an end result. Commonly, breast reduction patients decide to go down one to two cup sizes. The surgery is about three hours long and is done on an outpatient basis, although some women will stay overnight and go home the next day. Here are the surgical techniques used:

Liposuction – Through a small cut in the skin the surgeon will insert a thin tube connected to a vacuum that suctions the fat and fluids from your breast. This option is best for small reductions and for people with younger more flexible skin. 

Vertical or “lollipop” – An incision is made around the nipple and then straight down the breast from 6 o’clock. After the excess tissue is removed, the extra skin is removed and the nipples realigned. 

Inverted-T or “anchor” – This is the lollipop shape incision with another cut along the crease underneath the breast and is used for large reductions and lifting. 

Drainage tubes maybe inserted and your breasts will be wrapped in a surgical gauze. You may also need to wear a post-surgical bra. There will be some swelling and discomfort for about a week, icepacks are recommended, and any vigorous exercise should wait 4-6 weeks. The scars from the incision wounds will fade within the first year but will always be visible. 

The Risks and Positive Outcomes

All surgeries carry the risk of infection, but as medical procedures go this one seems to have very few problems and negative side effects. Plastic surgeon Steven Bernard, MD of the Cleveland Clinic says, “It has one of the highest satisfaction rates of all the procedures we do,” In one study, 95% of patients said they felt satisfied with the results. That said, loss of some nipple sensation and breastfeeding problems are reported in some cases.  

Gynecomastia in Men

Gynecomastia refers to enlarged breast tissue in men. It usually occurs in newborns, during puberty, and after age 50. Often the breast tissue will shrink after puberty, but sometimes the enlargement stays. The cause is hormonal surges, or an imbalance of testosterone and estrogen. Later in life weight gain, the use of anabolic steroids in bodybuilders, and a number of prescription medications also cause male breast enlargement. Male breast reduction surgeries have increased by 30% over the past ten years, more than any other plastic surgery procedure for men.

Consult with at least 2 surgeons

If you’re thinking about having breast reduction surgery, most surgeons will provide a free consultation and show you before and after photos of women who have agreed to share their photos. Do ask around and read the testimonials and reviews. Factor in time off to recover and remember that this is one surgery that 95% of women are happy they had. 

You can use this link from the American Society of Plastic Surgeons to find a breast reconstruction surgeon in your area.