As gratifying as breast augmentation is to some, breast reduction can be just as satisfying at the opposite end of the spectrum. Several years years ago, we completed an evaluation of 100 patients undergoing breast reduction at our Center. This study confirmed our impression that breast reduction is very successful in meeting the goals of our patients both from the standpoint of improving appearance and also relieving symptoms.*

Large breasts can cause problems in many aspects of a woman’s life. When they are larger than the usual standards of attractiveness in our society, the breasts are considered aesthetically displeasing. A fullbreasted woman may appear heavier than she really is and she may have difficulty obtaining stylish clothing. In some cases, it may even be difficult to find a properly fitting bra. Often, women with large breasts feel very self-conscious. Teenagers may not develop proper poise and posture as they try to hide the fullness of their breasts, a subject they are unlikely to discuss freely with their parents.

The actual weight and bulk of the breasts often causes physical problems and symptoms that compound the feeling of unattractiveness. There can be a feeling of uncomfortable fullness, neck or back pain, and shoulder grooving. These symptoms may contribute to limited performance in certain occupations and in sports. Finally, large breasts can also be difficult to assess for lumps or masses, thus making cancer detection much more difficult for the patient or for her physician. This may well be a source of further anxiety in a patient who is already embarrassed about her condition. Because of these medical problems, in some cases, medical insurance will cover the cost of breast reduction.

The goal of breast reduction, also called reduction mammaplasty, is to reduce, recontour, elevate and reshape the breasts. The breasts are made smaller. The nipple areola complex is repositioned upward, and if indicated, reduced in size. Excess skin and breast tissue is removed from the lower and lateral portion of the breast. A preoperative plan is made which allows both the surgeon and the patient to share in the decision as to the proposed general size of the breast after surgery. The surgeon will attempt to make the breasts as identical as possible, but often some asymmetry remains. Furthermore, it is not possible to predict exactly how large the breast will finally be after surgery. Healing results in some progressive change in breast size, at first making the breast seem fuller and larger due to swelling, and ultimately making them appear somewhat smaller.

SURGICAL PROCEDURE

Incisions are made in the lower breast resulting in three scars: one around the nipple, which usually heals very nicely; a vertical incision from the nipple to the crease beneath the breast, which remains visible; and finally, an incision in the fold under the breast. Breast tissue is sculpted using a combination of sharp dissection and liposuction. The nipple remains attached to the deeper breast tissue and is not removed.

The remaining breast is folded around the nipple and its pedicle after which the incisions are closed. Care is taken to close these incisions as carefully as possible. Nevertheless, patients must realize that resultant scarring is as much a factor of tissue response as it is surgical skill, and there is a tendency for wide scars to form on the lower portion of the breast. Fortunately, with time, these scars do tend to blend into the normal skin, becoming less noticeable.

In the past, breast reduction was considered a major undertaking, requiring several days’ hospitalization, long hours in the operating room, and frequently the use of blood transfusions. Fortunately, this has changed. Experience with highly developed and refined techniques of surgery, coupled with improvements in the delivery of outpatient care, now make this operation well-suited to the ambulatory surgical setting. Bleeding is minimal in nearly all cases and drains or bulky dressings are not required. The procedure generally takes two to three hours and is routinely done in the Cosmetic Surgical Center.

The initial recovery period is quite brief, although it takes some time for final healing and shaping of the breasts to occur. There is some soreness after the operation, but patients usually are fully ambulatory the day after surgery. Generally the patient may return to work three to six days after surgery, although complete healing should not be expected for three to six weeks.

REDUCTION WITH AUGMENTATION

Often, patients chose to have some of the saggy breast tissue that has been removed replaced with breast implants. This operation helps to provide better fullness in the upper breast. The procedure has largely replaced breast lifting with augmentation since it gives much better support than is possible when only tightening the skin. While it seems strange that a patient who is having surgery to remove breast volume would choose to consider and implant, the combination can work very well in patients whose primary concern is sag related to excess volume. When considering this operation, patients should carefully read the chapter on breast augmentation as well as this chapter.

COMPLICATIONS

There are possible complications that must be clearly understood and weighed prior to surgery. Wide scars and slow healing are problems sometimes seen postoperatively. Other possible complications are asymmetry of the breasts, hematoma, infection, loss of nipple sensation and scarring or necrosis of the nipple. This latter complication is the most serious, although fortunately extremely rare. Although pain is usually moderate, prolonged pain, soreness or numbness is possible. These risks will be discussed in detail during your consultation. It is important that the patient understand that minor revisions may be necessary after surgery in a small number of cases.

Breast reduction is an operation that is enjoying a rapid increase in popularity. For the proper patient, it is a very gratifying procedure. Not only can it help patients to improve self-esteem; it can be of significant benefit in the treatment of neck, back and shoulder pain related to large heavy breasts. The combination of reduction with augmentation is very common in our practice.

* The study evaluating the results of breast reduction at The Facial Plastic & Cosmetic Surgical Center appeared in the American Journal of Cosmetic Surgery. Reprints are available from the Center upon Request.