Overly large breasts can be both health and emotional problems to some women. In addition to self-image issues, some of them may also experience health-related problems such as breast pain, skin problems, chronic neck pain, shoulder pain or backache as well as psychological issues. The weight of excess breast tissue can impair your ability to lead an active life due to difficulty in finding clothes that fit or playing sports.

Breast reduction surgery (reduction mammoplasty) is a surgical procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size that is proportionate to the woman’s body and to alleviate the discomfort associated with overly large breasts. The essential reconstructive consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts.

The objectives of breast reduction surgery are for restoration of the breasts that are proportionate to the woman’s body, of the women’s self-image and quality of life. The techniques breast reduction surgery is determined by the patient’s condition, breast composition, amount of reduction desired and the surgeon’s personal preference. Breast reduction surgery is usually performed through incisions on the breasts with surgical removal of the excess fat, glandular tissue and skin.

The incision options available for breast reduction surgery are:

  • Periareolar incision: around the areola incision
  • Lollipop incision: around the areola and vertically down from the areola to the breast crease
  • Anchor incision: around the areola, vertically down from the breast crease and horizontally along the breast crease

After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary. Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft). In selected cases, excess fat may be removed through liposuction in conjunction with breast reduction surgery. If breast size is mostly due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.

Ideal candidates for breast reduction surgery

  • Concerned about overly large breasts
  • Limitation of daily activities due to large breasts
  • Chronic neck, shoulder and back pain caused by the weight of the breasts
  • Skin irritation or indentation at the shoulder from bra straps that support large heavy breasts
  • Chronic skin problems beneath the breast creases and shoulders
  • Long and pendulous breasts with stretched skin
  • Nipples lie below the breast crease when breasts are unsupported
  • Enlarged areolas due to stretched skin
  • Unequal position of the breasts
  • Healthy individuals who do not have medical conditions that can impair healing or increase the risk of surgery
  • Individuals with a positive outlook and realistic expectations
  • Non-smokers

Preoperative evaluation for breast reduction surgery

Communication is vital to achieving the patient’s goals. During the initial consultation, patients will have the opportunity to discuss their goals and desired results with the plastic surgeon. The plastic surgeon will work closely with the patients to reach an agreement about the expectations from the surgical procedures involved and their long term benefits. Every patient is different. Therefore a specific treatment regimen is planned to suits an individual’s need. The preoperative evaluation for breast reduction surgery includes:

  • Discussion about patients’ expectations and desired outcome
  • Medical conditions, drug allergies and previous medical or surgical treatment
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Discussion on anaesthesia and its risks
  • Physical examination
  • Breast examination including detailed measurements of their size and shape, skin quality, placement of nipples and areolas
  • Photography for preoperative and postoperative evaluation

Preparation for breast reduction surgery

  • Get laboratory testing or a medical evaluation
  • Get a baseline mammogram before surgery and after surgery to help detect any future changes in the breast tissue
  • Adjust medications if for specific medical conditions
  • Stop smoking and alcohol well in advance before the scheduled date for surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements before surgery
  • Special instructions will be given on the day before and after surgery

The risks and safety information on breast reduction surgery

It is essential for patients to understand that every surgical procedure has its complications and downtime. However, if a patient is appropriately assessed before the surgery and postoperative care is given adequately, these risks can be eliminated or reduced.

Some of the common risks of breast reduction surgery:

  • Infection
  • Bleeding
  • Poor wound healing
  • Wound breakdown
  • Skin discolouration
  • Swelling due to a blood clot or fluid accumulation
  • Fluid accumulation
  • Unfavourable scarring (hypertrophy or keloidal scar)
  • Temporary numbness or changes in the skin sensation around the nipple or breast
  • Breast contour and shape irregularities
  • Excessive firmness of the breast
  • Potential inability to breastfeed
  • Possible loss of skin/tissue of breast where incisions meet each other
  • Possible partial or total loss of nipple and areola
  • Injury to deeper structures such as nerves, blood vessels or muscles
  • Asymmetry
  • Possibility of revision surgery
  • Anaesthesia risks

Postoperative expectations

After the surgery, temporary dressings or bandages are applied to the incision sites. Small tubes may be temporarily placed under the skin for 24-48 hours to remove any excess blood or fluid that may be collected after the surgery. During the first 2-3 days, there may be discomfort, swelling, bruises and tightness around the breasts. Once the tubes and temporary dressings are removed, the patient is advised to wear a sports bra (for 4-6 weeks) to minimise the swelling and support the breasts during the healing phase. It is advisable to avoid strenuous activities such as heavy weight lifting or vigorous exercise for the first 4-6 weeks after the surgery. However, that, light physical and social activities can be resumed from the 7-10 days after the surgery. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively. Stitches will be removed on 7-14 days after the surgery. The symptoms of discomfort, swelling, bruises and tightness around the breasts may disappear completely about 3-4 weeks after the surgery, but the breasts may gradually take several months or a year to soften and feel more natural.

Postoperative care

  • Regular application of antibiotic ointment and cleaning the operated areas for the first one week after the surgery
  • Bed rest with arms elevated to reduce swelling
  • Avoid excessive arm movement or weight lifting for the first 4-6 weeks after surgery
  • Arm movement should be limited for up to 2-3 weeks following the surgery
  • Wear sports bra (no underwire bra) for 4-6 weeks after the surgery
  • Regular use of scar gel and massage after the surgery to improve the scar and breast shape

How much will a breast reduction surgery cost?

Cost is always a consideration in elective surgery. The cost of breast reduction surgery can vary widely.

The cost of breast reduction surgery may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Medical tests and x-rays
  • Prescriptions for medication

Most health insurance does not cover cosmetic surgery or its complications. However, when breast reduction surgery is performed for reconstructive and treatment purpose of relieving symptoms of back pain, neck pain, breast pain and other medical problems associated with large breasts, it may be covered by insurance. This requires a detailed examination to verify the cause before authorisation from your insurer. Carefully review your policy or find out more from your medical insurance agent. Patients are advised to contact their insurance company for further verification well in advance of surgery.