This procedure is used to treat a condition known as mammary hypertrophy which describes disproportionately large and heavy breasts.
The breast is a complex combination of breast gland (milk-producing) tissue, fat and skin. Breast size is affected by puberty, pregnancy, weight changes and menopause.
What does breast reduction surgery accomplish?
It reduces the overall size of the breasts and the size of enlarged areolas (pink/brown area around the nipple).
It reduces the fullness along the sides of the chest if due to breast tissue and lifts the breasts to a more youthful position.
It permits easier breast examinations.
It reduces the discomfort and activity restrictions due to the excessive size and weight of the breasts.
Who are good candidates for a breast reduction?
Women who experience any of the following conditions may be good candidates.
Back pain, shoulder and neck pain due to the excess weight of the breasts
Difficulty maintaining good posture due to breast size
Painful shoulder grooving due to heaviness of the breasts on the bra straps
Limited exercise tolerance due to breast weight.
Skin irritation under the breasts due to sagging and weight of the breasts
Difficulty performing adequate self breast examinations for cancer detection due to large breast size.
How is a breast reduction performed?
Techniques vary tremendously but follow basic rules.
The most common procedure uses a "pedicle technique” whereby the nipple and areola remain attached to the breast tissue at all times during the surgery. Many different types of incisions are used. The most common is a keyhole-shaped incision that encircles the areola and extends downward along the midline of the breast, and then follows the natural crease of the fold underneath the breast.
The extra fat, skin and breast tissue are removed.
The nipple and areola are then moved upward to their more youthful and higher position.
In cases where the breasts are extremely large and sagging, some surgeons may recommend a technique called "free nipple graft” where the nipple and areola are temporarily removed during the surgery until the reduction is complete and then placed in their desired position at the end of the surgery. This procedure is rarely necessary. The majority of even extremely large reductions may be safely performed with the pedicle approach described above.
Where are the scars following a breast reduction?
The scars are around the areola, down the middle of the breast, and along the crease underneath the breast. The length of the scars along the crease depends on the type of technique used and the size of the reduction necessary. In general, larger reductions require longer crease scars.
Every attempt is made to decrease the extent of the scars. Some surgeons perform small and moderate breast reductions without a horizontal scar or with only a minimal horizontal scar along the breast crease.
The final shape of the breasts may not be completely evident until one year after surgery. Initially, the breasts may appear boxy. This is more likely to be true in larger reductions, but usually the breasts round out nicely and take on a more natural shape over the 6 to 12 months following surgery.
What type of anesthesia is recommended during a breast reduction?
Typically, most breast reductions are performed under general anesthesia.
How long will the effects of a breast reduction last?
Although breast tissue has been permanently removed, subsequent breast sagging will occur as the result of aging, loss of skin elasticity, and the effect of gravity on the remaining breast tissue.
The future size of the breasts is also influenced by weight gain or loss, pregnancy and menopause.
Re-development of enlarged breasts due to an increase in breast tissue (not simply weight gain) following breast reduction surgery has been reported but is uncommon.
When is the right time for a breast reduction?
Women present for breast reductions at many different points in life.
They may present during or just after completing puberty if they experienced a significant growth in their breasts. Usually, these young women are very self-conscious of the size of their breasts and are often unable to wear youthful clothing or participate in a variety of sports. They generally complain of difficulty maintaining good posture and limited exercise tolerance even though they may not have yet developed the back pain, shoulder and neck pain due to the excess weight of the breasts. In these young patients it is important to be certain that their breasts have completed growth prior to undergoing a breast reduction.
Women may present much later in life when they have developed physical changes due to the weight of the breasts and can no longer tolerate the excess breast weight. Usually, they present with neck and back pain, limited exercise tolerance, skin irritation under the breasts due to sagging, painful shoulder grooving due to heaviness of the breasts on the bra straps, and difficulty performing adequate self breast examinations for cancer detection due to breast size.
Ideally, women would undergo a breast reduction when they begin to experience the side effects of the enlarged breasts and prior to developing advanced stages of these side effects.