Breast Reduction

Breast reduction, also called reduction mammaplasty decreases the size of the breasts in women with large and/or dropping breasts. In breast reduction surgery, excess fat, breast tissue, and skin are removed and the nipple areolar complex is repositioned in order to achieve a breast size proportional to a woman's body.  This surgery lifts and reshapes the breasts and increases projection of the breast at the correct level on the chest wall. Breast reduction surgery has the potential to improve an individual's appearance, relieve social discomfort, and correct the functional symptoms of physical discomfort and pain that are associated with large breasts. It is the fifth most common reconstructive surgical procedure performed by Board-certified plastic surgeons. This article explains what it takes to achieve aesthetic results, describes the techniques available, lists the possible complications, and suggests the steps someone considering this surgery should take.

Breast Reduction Before and After - Source: Mary H. McGrath MD. BREAST REDUCTION: Plastic surgery to reduce the size of overly large breasts and per Knol, American Society of Plastic Surgeons

Who is a good candidate for breast reduction?

Breast size that is out of proportion to a woman's body build influences the supporting musculature of the shoulders, neck and back.  Studies in the plastic surgery literature have shown that about one half of the women with bra cup sizes D or larger who seek surgery are experiencing pain all or most of the time in the upper back, shoulders, neck and lower back.

In addition to back pain, other symptoms that are reported commonly include headaches, pain in the breast tissue itself, abrasions, and deep grooves over the shoulders from bra straps, stretch marks, shortness of breath when lying on the back, and trouble sleeping due to difficulty finding a comfortable position due to the weight and bulk of the breasts. 

 A nearly universal problem is irritation of the skin under the overhanging breasts where moisture, redness, itching, and rashes can develop. Less commonly, degenerative arthritis of the neck and upper back and numbness in the hands due to nerve stretching in the shoulder area are problems.

Due to the physical constraints, women with abnormally large breasts find it difficult to exercise or play sports and may struggle to maintain a normal weight.  The more sedentary life-style, weight gain, and difficulty finding attractive clothing can have a material effect on well-being and social interaction, and by extension on personal and professional opportunities. For such individuals, it is helpful to know that studies of women after breast reduction show significantly higher scores in all the health domains of quality-of -life assessment, including mental as well as physical components. 

About the Surgery

There is no single best, or ideal size for a human breast. There is wide variation in height, weight, body shape, and physical activity among women and these factors influence what would be an optimal size for any given individual.  A woman's personal preferences are very important and there are surgical limitations to changing the size and shape of a breast based on a person's original anatomy.

After the Surgery

Ideally, there are three consequences of breast reduction that one would like to avoid if the "ideal" surgical technique could be developed.  These include:

• Visible scars - these vary depending on myriad factors including how different persons form scars when wounds are healing
• Possible loss of the ability to breast feed children after the surgery (see comments above)
• A change in the sensibility of the nipple and areola in about 20 - 25% of cases and this can be either an increase or decrease in sensation

Plastic surgeons encourage patients to consider these three important consequences carefully before making a decision about going forward with this surgery.

Patient Satisfaction

Over the years, many studies have looked at outcomes after reduction mammaplasty for breast hypertrophy.  The majority of patients gain relief from their symptoms of pain and discomfort, engage more actively in physical activities, and are happy with the results.

• In one study of 133 women, 93% reported a decrease in symptoms.
•  In another survey of 185 women, 97% reported improvement in back, shoulder and neck pain, 95% said they were happy or very happy with the results of surgery, and 98% said they would recommend it to others.
• In this study, only 4% of the patients considered their scars unsatisfactory, but when studies focus specifically on questions about scarring, larger numbers of patients will voice complaints about the prominence of their scars.