Breast reduction surgery, also called reduction mammoplasty or breast reduction and lift, is a plastic surgical procedure that can reduce the size of the breasts and change their shape. Michele Manahan, M.D., professor of plastic and reconstructive surgery, talks about the procedure and what to consider if you are contemplating a breast reduction.

What is a breast reduction?

Breast reduction is a plastic surgery procedure to make breasts smaller. The plastic surgeon removes breast fat, glandular tissue, and skin to reduce its size and change its shape and position on the chest.

“In addition to addressing the patient’s appearance, the procedure can relieve discomfort or painful symptoms associated with large breasts such as muscle strain, soreness and skin breakdown,” Manahan says.

Is breast reduction right for me?

You may be considering reduction mammoplasty if you wish to change your appearance or if you have large breasts that are causing or contributing to:

• Neck strain
• Headaches
• Shoulder pain
• Low back pain
• Chronic skin infections under the breast fold

Whether you wish to relieve discomfort or have your breasts reshaped for an appearance more pleasing to you, breast reduction can help.

How long does breast reduction surgery take?

In general, the surgery takes about three to four hours. Removing excess breast volume (fat and glandular tissue), creating an aesthetic contour and closing the wound to minimize scarring can take additional time in some patients.

Patients with extremely large breasts may require more complex surgery. The surgeon may remove the areola (the darker area around the nipple) and nipple before making the breast smaller, and reattach them after the breast is reduced.

Types of Breast Reduction Surgery

Incision Patterns for Breast Reduction

There are two different incision patterns commonly used in reduction mammaplasty. Manahan explains, “For many breast reduction and lift procedures, we use a vertical reduction pattern, which results in what is often called a ‛lollipop scar.’ The incisions form a circle around the areola and a vertical, straight line underneath.” Patients who have a small or moderate amount of tissue to be removed may be good candidates for this incision approach.

“For other patients with larger breasts or for those who may require more tissue removal, we may use a Wise incision. On each breast, the Wise pattern scar resembles an upside down ‛T’ or anchor, with a vertical line extending down from the areola scar, meeting a horizontal line under each breast.”

Once the incision is made, the surgeon removes tissue from under the skin, navigating the patient’s blood vessels and nerves, which, Manahan says, differ from person to person.

Liposuction for Breast Reduction

If the surgeon can create the results you want by removing only body fat in the breast area, he or she may be able to use liposuction, which results in a smaller incision and scar than open surgery.

Gynecomastia Surgery: Breast Reduction

Breast reduction can also address gynecomastia, which is excess breast tissue or fatty tissue in one or both breasts of a person designated male at birth. Your cosmetic surgeon can offer recommendations as to what type of procedure will work best for you.

One option for this surgery that can minimize scarring involves removing tissue without lifting and revising the skin of the breast. In these cases, breast reduction for men may take 2 to 3 hours. In other patients, excess skin and nipple and areola relocation are necessary. This may lead to additional scarring and additional operating time.

Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless.

Breast Reduction for Gender Affirmation

Bilateral mastectomy can be part of surgery for gender affirmation. In this instance, the procedure involves the removal of the breasts, shaping of a contoured, male chest and refinement of the nipple and areola.

Breast Reduction and Breast Cancer

Breast reduction surgery can also be part of managing breast cancer. Some people with large breasts who have a cancerous tumor may be able to have the tumor removed using an oncoplastic breast reduction, a method of lumpectomy that incorporates a breast reduction. Then, the other breast can be made smaller with plastic surgery to restore a more symmetrical appearance for the patient.

Breast Reduction Scars

Because breast reduction involves cutting and removing excess skin, you can expect some permanent scars.

“The scars will likely look pink for several months before fading,” Manahan explains. “They will not ever disappear entirely, but they’re located on the bottom halves of the breasts. For women, these areas are usually hidden with clothes, including swimsuits and low necklines.”

On the other hand, she says that men who undergo gynecomastia surgery will have scars that will be visible when the patient is shirtless.

If you are worried about scarring, be sure to talk with your surgeon about techniques that can minimize the appearance of scarring, such as laser treatments.

Does breast reduction surgery affect sensation in the breast?

“Sensation loss is a real concern,” Manahan admits. “It’s hard to guarantee breast and nipple sensation will be the same after breast reduction. As surgeons, we do everything we can.

“There is not one major nerve that we can see and preserve when we operate. The nerves that supply sensation are more like seedlings or sprouts in a pot, and sometimes removing excess tissue from the interior of the breast results in areas of numbness. If loss of sensation is a serious concern for the prospective patient, that’s an important factor to consider.”

Breast Reduction Cost: Does health insurance cover breast reduction?

In some cases, health insurance may cover this procedure, but it may take time to work out. Manahan suggests that patients talk to their medical insurance provider and find out what their requirements are, since insurance companies decide if breast reduction surgery is covered.

Breast Reduction Surgery: What to Expect

Consulting with a skilled plastic and reconstructive surgeon who specializes in the breast is an essential first step. You and your surgeon will discuss your unique situation and what you envision for your outcome. Your surgeon’s expertise will help shape realistic expectations so you can be happy with your results.

Preparation for Surgery

• It is important to follow your surgeon’s directions on restricting eating, drinking and taking medications before your procedure.
• Most breast reductions are outpatient procedures, and you will go home the same day.
• You will need to arrange for someone to drive you home.
• Talk to your surgeon about any special support garments you might need, such as bras for women or compression vests for men, and be sure to purchase them in time to have them when your surgery is scheduled. 

Breast Reduction Surgery: Recovery

Pain medication may be prescribed for immediately after the surgery.

Patients should plan on taking weeks off work. Manahan recommends, “During the recovery period, you want to be careful and protect the chest and avoid strenuous activity.”

Swelling and minor bruising are normal, and these signs will generally calm down over a few weeks. Your surgeon may recommend that you wear an elastic pressure garment for additional support and protection during your recovery.

“Patients, in general, are very happy afterward,” says Manahan.

Am I too young or too old for a breast reduction procedure?

Manahan assures prospective patients that age is not often a factor in deciding on surgery for too-large breasts.

“As a patient, when you feel it is time to consider breast reduction, consult with a plastic surgeon. I see patients who are teenagers and those who are senior who have lived with discomfort for many years, and they are pleased with their results.”