Dear Alice,

I have a breast reduction coming up soon and I wanted to know if you could explain to me how and what is done so that I could understand it better?

Dear Reader,

Breast reduction surgery (also known as reduction mammoplasty) is usually performed when the size of a breast causes physical discomfort, (e.g., back pain, neck pain, skin problems, breathing difficulties) or affects self-image or confidence. Breast reduction surgery removes some of the fat, glandular tissue, and skin in order to reduce the size of the breasts and relieve these symptoms. Depending on the size of the areola (the pigmented area around the nipple), it may be surgically reduced in size in order to make the breast and areola appear proportionate to each other. Breast reduction surgeries are most commonly performed on those who identify as women, although they’re also occasionally performed on those who identify as men.  

Before surgery, a health care provider will likely take photos of the breasts to help plan for your operation. In many cases, photos are drawn or recreated to show you what you'll look like after surgery. This initial appointment may be a time for you to ask the surgeon any questions you have about the procedure and what kind of preparation you'll need before and after surgery. For example, you may want to ask what the surgery will entail, where and how many stitches will be used, how long you'll be in the hospital, who may be expected to bring you home, and what kind of post-surgical care will be needed.

On the day of the surgery, you'll receive general anesthesia so that you’re unconscious throughout the procedure. An incision is usually made around the nipple and areola, and then down underneath the breast, so that the scars are somewhat hidden by the breast's natural crease. The surgeon usually tries to leave the areola and nipple attached throughout the surgery, if possible. When large amounts of breast tissue are removed, the nipple and areola may be detached and repositioned in a higher location on the remaining breast tissue.

Some of the side effects of this surgery may include decreased or lost sensation in the breast skin, nipple, and areola. If the surgery required significant removal of glandular tissue, breastfeeding in the future may not be possible. It’s also good to note that following the surgery, flexible drainage tubes are usually left in the breasts for a day or two to drain fluid that may accumulate. Patients may stay at the hospital for a day or two, and then they’re sent home with some prescription painkillers and antibiotics. While the procedure and hospital stay may be brief, complete recovery could take about a year. It’s best to talk with your surgeon about specific post-surgical guidelines, but here are a few to keep in mind that may be helpful:  

  • It’s wise to check in about how long you may need to wait before taking a full shower or bath.
  • Talk with your health care provider about the types of over-the-counter pain-relieving strategies that would be safe or recommended for use, including heat versus ice or acetaminophen versus ibuprofen.
  • Avoid physical activity for a few weeks after surgery, including lifting more than five pounds.
  • It's wise to consider scheduling and whether it conflicts with work or school; your surgeon may be able to offer recommendations for how long to take off.
  • Avoid wearing underwire bras for some time after surgery; in fact, the surgeon may suggest wearing a more protective garment, such as an elastic compression or surgical bra.

Another procedure for reducing breast size, though not as common, is liposuction-only breast reduction, for those who only need minimal breast reduction. This technique results in minimal scar tissue, complications, and recovery time. Those who undergo this procedure typically retain the ability to breastfeed and have feeling in their nipples. If you’d like to consider this option, it’s best to talk with your health care provider and insurance company about whether this procedure may meet your needs.

Your surgeon is your best resource for information about the procedure, addressing your concerns, and helping you feel prepared. If you have further concerns about breast reduction surgery, you can talk to your health care provider, who can provide you with referrals for specialists. You can also reach out to your insurance company to ask any questions about your coverage and benefits. Knowledge is power, especially before an operation. 

Good luck!

Alice!

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