Breast Reduction FAQ
If you're considering breast reduction...
Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.
Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.
If you're considering breast reduction, this will give you a basic understanding of the procedure- when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
View more before and after breast reduction photos
The best candidates for breast reduction
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.
In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.
All surgery carries some uncertainty and risk
Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.
The procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)
Planning your surgery
In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient-and every physician, as well-has a different view of
what is a desirable size and shape for breasts.
Heavy breasts can lead to physical
discomfort, a variety of medical
problems, shoulder indentations due
to tight bra straps, and extreme
self-consciousness.
The surgeon will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He or she will discuss the variables that may affect the procedure-such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.
Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have your surgeon write a "predetermination letter" if required.)
Preparing for your surgery
Your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation.
Breast reduction doesn't usually require a blood transfusion. However, if a large amount of breast tissue will be removed, your physician may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used.
While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where your surgery will be performed
Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes two to four hours, but may take longer in some cases.
Types of anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.
The surgery
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.
Incisions outline the area of skin,
breast tissue, and fat to be removed
and the new position for the nipple.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)
Skin formerly located above the nipple
is brought down and together to reshape
the breast. Sutures close the incisions,
giving the breast its new contour.
Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.
Scars around the areola, below it, and
in the crease under the breast are
permanent, but can be easily concealed
by clothing.
After your surgery
After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.
You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain.
The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.
If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.
Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Getting back to normal
Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.
Your surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. But you'll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You'll also need a good athletic bra for support.
You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.
A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don't hesitate to call your doctor.
Your new look
Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.
Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.
Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.
However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be pleased with the results.
For a breast reduction in Los Angeles contact Southern California Board Certified Plastic Surgeon Steven Teitelbaum today.
With smaller, better proportioned
breasts, you'll feel more comfortable
and your clothes will fit better.
© Copyright 1994,
American Society of Plastic Surgeons
Breast Reduction FAQ
Q: Who is a candidate for a breast reduction?
A: Anyone who feels their breasts are too large or heavy for their body is a candidate for a breast reduction. Of course they have to also be healthy enough to undergo the surgery and mature enough to decide that this is right for them.
Q: What are the most important factors to consider when deciding whether or not to get a breast reduction?
A: The simple most important factor is recognizing that you would rather be smaller and perkier with scars than how you are now without scars.
Q: What are some of the benefits of getting a breast reduction?
A: A breast reduction can reduce neck, back, shoulder, and breast pain. It can reduce rashes that can occur under pendulous breasts; it can alleviate grooving from bra straps; it can make a woman feel more proportionate and wear a greater variety of clothing and lingerie. But the most significant differences are issues such as improved self-esteem, not feeling that people are staring at their breasts, an increased ability to exercise and play sports, and overall feeling lighter and more spry.
Q: Will a breast reduction lift my breasts?
A: A breast reduction includes a breast lift. Skin is removed and tightened - that takes care of the lift. Tissue is removed on the inside, and that takes care of the reduction.
Q: Will my nipple be removed?
A: NO. NEVER. Everyone thinks that this will happen, and it does not. Skin around the nipple is removed and tightened, but the nipple always remains attached to the breast. Purely out of historical interest, there was an operation years ago for extremely massive breasts that involved removal of the nipple, but that is not done today.
Q: What is the difference between a regular breast reduction and a 'scarless' breast reduction?
A: A standard breast reduction involves significant scarring on the breast. It can remove skin and lift the breast, as well as removing any amount of breast volume on the inside. A 'scarless' breast reduction is nothing more than liposuction of the breast. One or two very small incisions are made underneath the breast and fat is removed. But there is no removal of skin or lift.
Q: How will you decide which breast reduction is best for me?
A: The standard reduction is best for most patients because it allows for correction of droopiness and the greatest volume of tissue removal. But if the skin is relatively good, if the breast is not very droopy, and if the breast has a significant fatty component, then a scarless reduction can be a good choice. With the removal of weight in the breast, the breast may rebound upwards a bit, but it does not actually lift the breast per se. With a regular reduction, Dr. Teitelbaum can remove as much skin and tissue as a patient wants. But with the scarless he does not remove any skin, and the amount of volume removed is limited by the amount of the breast volume that is fat (because the glandular, milk-making part of the breast is too firm and dense to be removed by liposuction.)
Q: How much smaller will my breasts be after a breast reduction?
A: You and your surgeon will discuss how much smaller you want to be. But understand that the actual footprint of the breast on the chest - where the breast starts towards the center and where it ends to the side - can be changed little in most situations. Given that, there is an ideal breast volume that will create the most aesthetic breast. In an attempt to go too small, the breast can look wide and flat; if it is left too big for the width, the breast will of course still look too big. This is the subject for an extensive conversation at the time of your consultation. With a scarless breast reduction, only fat tissue can be removed, and so this limits the amount that can be removed. Patients are usually satisfied with the volume removed, but at other times they wish that more could be removed. Even so, most of these patients are still satisfied that for whatever lack of reduction they had, they still didn't have to have any scars. They can still have a regular reduction to remove more, but it is rare for a scarless reduction patient to ask for this to be done.
Q: Will my breasts have a natural and pretty shape after a breast reduction?
A: Reduction patients never look fake like an augmentation patient might. In other words, an excessively perky and round breast isn't possible, even if that were to be your goal. The shape is almost always significantly better than before the reduction. Other than the scars, the breasts will look and feel totally natural - because they are.
Q: Are the results of a breast reduction permanent?
A: The tissue that is removed is gone. Remaining breast tissue can fluctuate with hormones, fat in the breast can fluctuate with weight, and droopiness can start to increase just due to gravity. But by and large most of the result of a breast reduction is permanent, though like all breasts, they will of course change over time.
Q: If I gain weight after a breast reduction will my breasts get big again?
A: They can increase in size, but they are unlikely to get as large as they were unless you gain a significant amount of weight.
Q: What will the scars be like if I have a standard breast reduction?
A: You will have what is called an "anchor" scar, which is a scar that goes around the nipple, straight down to the bottom, and across the underneath part of the breast. This affords the greatest shaping in all three dimensions. The so-called "vertical" lift only has a scar around the nipple and straight down to the bottom of the breast. Many surgeons do not consider the shape of these breasts to be as attractive, which makes sense because there is one less direction of control the surgeon has. And though there is less total length of scar, inch by inch the quality of the scar is less because this technique requires 'bunching' of skin, which often makes a wider scar. The vertical frequently requires some scar revision, often including the placement of a horizontal scar at the bottom at a later date, so in most cases it does not make sense. Patients always ask about the "donut" lift, also known as the "circumareolar" or "Benelli" scar. This is very limited in how much tissue can be removed and in how much the breast is reshaped. The breasts often end up looking underprojected, and therefore this procedure has not really caught on in the USA.
Q: What will the scars be like if I have a 'scarless' breast reduction?
A: There are usually two scars, each about ¼" long located in the crease under your breast. For all intents and purposes, these scars are invisible.
Q: Will I lose sensitivity in my breasts after a reduction?
A: Loss of sensation is a risk of breast reduction. Many women with large breasts have lost sensation from the stretching of their nerves, and for them this is not an issue. But many others have a lot of sensation, and the risk of losing that sensation is important to them. It is very hard to measure and quantify changes in breast sensation. While most patients do not experience a reduction in feeling, the bottom line is that you have to decide for yourself that you would rather be smaller even if it meant you lost sensation.
Q: Can I get regular mammograms after a breast reduction?
A: Mammograms can be done after breast reduction and they are just as effective as if the reduction had not been done. In fact, if the breasts were very large and pendulous the mammogram can be even better.
Q: Will I be able to breastfeed after I have a breast reduction?
A: Today's techniques for breast reduction do not cut the milk ducts. Studies show that 2/3 of women getting a breast reduction are able to breast feed afterwards. Of course, not all of the 1/3 who couldn't would have been able to breast feed without the reduction, as a many women with breasts large enough to need reductions have stretched out ducts and flattened nipples that babies may not be able to latch on to.
Q: What form of anesthesia will be used for my procedure?
A: Most surgeons use a light general anesthesia so that the patient doesn't feel any pain or anxiety. Scarless reduction can be done under local anesthesia, though most patients choose to go to sleep.
Q: Does insurance cover breast reductions?
A: If a patient has symptoms of neck, back, shoulder, and breast pain, or has a history of rashes under the breasts, most insurers will pay for a reduction. As time goes on, they are getting more and more strict. They also usually require removal of 500g (a bit more than a pound) in order to pay for it, which doesn't make any sense because that could be a lot on a short woman and a small amount on a taller woman. But even if the insurance company agrees to pay, you will still have significant financial responsibility unless you choose an "in network" plastic surgeon.
Q: What should I bring with me the day of surgery?
A: We will give you detailed instructions after you have scheduled your surgery. We will provide you with the bra you will need to wear after surgery. Just wear a comfortable sweatshirt top you can zip on and off.
Q: Do I need to go to an aftercare facility after my surgery?
A: You are well enough to go home; you do not need to go to an aftercare facility. But some patients go if they do not have a friend to watch them the night of surgery, or if there is just too much commotion going on at home for them to be able to relax.
Q: How painful is the recovery?
A: Most patients use the word sore more than painful. They feel achy, they feel a pressure, but the pain is never sharp or severe. The pain builds gradually, so if you feel yourself getting uncomfortable, take a pain pill and you will feel better.
Q: Will I get a phone call from the doctor the night of my surgery?
A: Dr. Teitelbaum will call you the night of surgery. He will also give you my personal cell phone and email address so that you can reach me directly.
Q: How soon can I go to work?
A: When you will feel ready to do your job is highly individualized. So long as your work doesn't involve straining and heavy lifting, you can expect to be back to work after five or six days. Some people go back even sooner, and many work from home the next day.
Q: When can I drive?
A: You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. That is ultimately a decision that I cannot make for you.
Q: When can I travel by airplane?
A: There is nothing about airline travel that you must avoid for a specific period of time. The issues involved have to do with the difficulty of getting through airports these days, and whether you are going somewhere there is a plastic surgeon to look after you should you have questions or problems or just need to be looked at by an experienced doctor. These issues are usually very individualized, and you should discuss them with me. But in general, breast reduction patients will get on an airplane after about five or six days.
Q: When can I resume exercise?
A: We suggest you wait 3 weeks to to be sure that everything is healed. There is always a chance of causing bleeding if you start much before that time. When you start, listen to your body. You will be a little out of condition and a bit sore. But you will get back to where you were before surgery very quickly.
Q: What is considered to be exercise?
A: Elevating your heart rate or blood pressure, bleeding hard, or straining or sweating. But light walking is beneficial starting the day of surgery.
Q: Does not being able to exercise then exclude sex?
A: Sex can be resumed as you feel comfortable. Most often patients hit their level of comfort in 3-7 days. Again, respect the fact that you have undergone surgery and try to avoid the manipulation of the incisions.
Q: When can I lift my child?
A: You can lift a cooperative child that is up to 35 pounds right away. But don't try to pick up your child if he or she is upset.
Q: When can I drink alcohol?
A: A small amount of alcohol will not interfere with your recovery.
Q: When can I smoke cigarettes?
A: Cigarettes pose a particular hazard to patients undergoing this operation. They shrink critical small blood vessels that are important for healing in a breast reduction. You should wait a minimum of three weeks after surgery to have them. This is a very real and very important issue with this operation.
Q: When can I sunbathe?
A: We'd like to say never, since nothing ages us as much as the sun, and the damage it does to the skin. This is particularly true in the decolletage area, where sun damage makes women look very aged. But it is okay to go out in the sun within days after surgery, provided that the incision is protected by something that will totally block the sun, and it is a good idea to keep the incision totally blocked form sun for a year or so.
Q: When can I shower/take a bath?
A: You can take a shower the day after surgery. You should wait about two weeks before taking a bath so that your incisions are somewhat healed.
Q: What will my post-operative appointment schedule be like?
A: There are no drains or stitches to be removed after a breast reduction, so there are really no compulsory visits or times at which something in particular must be done. Dr. Teitelbaum wants to see everyone the day after surgery to be sure that everything is okay. We offer patients frequent visits thereafter, usually at one week, one month, six months, one year, and yearly therafter. But some patients will come more frequently, some less frequently. We do not charge for these visits. Some people have little questions they want answered, and other people feel fine on their own. But he is always available for a patient who wants to come in. It is not uncommon for breast reduction patients to have a "spitting stitch" or a small area here or there of delayed healing that he will need to see. So the visits are more on an "on or if-needed" basis than anything specific.
Q: Is there swelling and if so, how long does it last?
A: Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you'll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.
Q: Is there bruising and if so, how long does it last?
A: Usually there is a little bit of bruising on and around the breast, but it is typically very mild and is all gone by ten days to two weeks.
Q: Will I have a special bra or garment to wear after surgery? How long will I have to wear it?
A: We will give you a bra that is easy to take on and off after surgery, and it will provide a gentle amount of compression. But there is nothing really special about it. All reduction patients feel more comfortable with a bra, and you can use a soft bra of your own if you prefer. It is normal for the skin to ooze a bit for about four or five days after surgery. We will give you sterile gauze pads to tuck into your bra to absorb this.
Q: What do I have to do to care for the incision?
A: It is okay to shower, get it wet, and blot it the day after surgery. Let the steri strips start to peel on their own, and then tease them off in the shower. That usually occurs at a week to ten days. Then wash your breasts gently with a soapy washcloth to remove any small crusting. The breast skin can get dry after a reduction, so put a rich moisturizer all over your breasts after the steri-strips come off.
Q: When do the stitches need to be removed?
A: For a standard reduction the stitches all dissolve. For a scarless reduction, there is one tiny stitch at each incision that is removed about five or six days after surgery.
Q: What should I do to prevent scarring?
A: The bottom line is that the fate of your scar is mostly determined by your own genetics and by the surgery itself. It is not clear the extent to which putting things on scars will influence their final appearance. However, most patients want to do something. There has never been a direct comparison between the various products. Patient feedback has been the most positive from three sorts of things: Scar Guard, which is a liquid containing steroid, Vitamin E, and silicone that you brush on like nail polish; Silicone gel strips (such as Neosporin scar strips); and silicone ointment (such as Scar Fade.) You can get these from the office or the pharmacy, and you can start putting them on once the glue or the steri strip is off, following the instructions on the packaging.
Q: What do I need to watch out for?
A: It is normal when operating on two sides of the body for them to swell differently, but by and large they serve as a control for the other. So if one is much larger or more painful, let us know right away. If the incisions get red, tender, inflamed, let us know. Sometimes there can be a little separation along the incision or a "spitting" suture, and you should come in so we can help you treat this.
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