Breast Reduction

A BREAST REDUCTION procedure is performed to reduce the size of a woman’s breasts and to enhance their shape so that they are more in proportion with her body. Breast size and shape can affect a woman’s well-being, self-image, psyche and lifestyle. The operation is one of the most commonly performed, the results are predictable and the women who have this operation amongst the happiest in any plastic surgeon’s practice.

If you are considering a breast reduction operation, this information will give you a basic understanding of the procedure - when it can help, how it is performed and the results you can expect. It cannot answer all of your questions, since a lot depends on the individual patient. Please ask about anything you do not understand.

Who is a suitable candidate for breast reduction?

Ideally you should be of normal weight for height, not overweight, when the operation is done. Any woman with large breasts may be a candidate for the operation. If your breasts are so large that they are causing symptoms, then a breast reduction operation may help you. Possible symptoms include:

  • Neck, back and/or shoulder ache
  • A feeling of heaviness in the breasts
  • Bra strap grooves in the shoulders
  • Rashes underneath the breasts
  • Pins and needles in the hands
  • Striae (stretch marks) or dilated veins on the breast
  • Enlarged areolae


Heavy breasts can lead to physical discomfort, a variety of medical problems, shoulder indentations due to tight bra straps, and extreme self-consciousness.

A breast reduction operation can improve your self-image, self-confidence and self-esteem. It can liberate you and allow you to perform exercise, and wear clothing such as bathing costumes and T-shirts that you previously could not.

Usually the operation is not performed until a woman’s breasts are fully developed, in other words, from late teens onwards. The best candidates are those who are mature enough to fully understand the procedure and those who have realistic expectations about the results. Occasionally, marked breast growth can occur in early puberty warranting the performance of the operation in the teens.

What are the risks?

When performed by a qualified plastic surgeon, breast reduction is normally safe and the results predictable. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anaesthesia. Some patients develop small sores along the lines of the incisions after surgery; these generally heal of their own accord or may require the removal of a suture.

The procedure does leave permanent scars, although your bra or bathing suit will cover these. The usual scar circles the nipple-areola complex, extends vertically down to a scar underneath the breast, similar in shape to an anchor. For smaller reductions Ms Grob uses a vertical scar technique where the scar goes around the nipple-areola complex, and vertically downwards only. This resembles the shape of a lollipop, and has the benefit of less overall scarring when compared with the anchor scar. Poor healing and wider scars are more common in smokers. The procedure can also leave you with slightly mismatched breasts, unevenly positioned nipples or some breast asymmetry. Future breast-feeding may be difficult, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience numbness in their nipples or breasts. In most patients this resolves within a few months of surgery although sometimes it may last for up to two years and can, rarely, be permanent. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, using skin grafts from elsewhere on the body.)

Up to 50 % of women will have one or other minor complication. In the long term however 95% of women are delighted with the results.

What can be expected at the initial consultation?

At the initial consultation you will be assessed as to whether you are a good candidate for the operation. Your fitness for the procedure will be evaluated and potential problems sought. Your breasts will be examined and measured.

It is important to bring to your surgeon’s attention any previous breast problems that you may have had. Such problems would include breast lumps, nipple discharge, breast pain, breast cancer and any surgery you might have had on the breasts. You should also inform your surgeon as to whether you have any family history of breast cancer, particularly in your mother or sisters. Please tell your surgeon if you take any medication, if you have any allergies, if you have a tendency to bleed or bruise easily, if you have had any previous surgery, if you have had any previous problems with local or general anaesthesia and if you have any chronic medical ailments. You should also discuss what your goals and expectations are. Clearly, these should be realistic.

How should one prepare for the operation?

Ideally the operation is done when you are at your normal weight. No specific diet or exercise program is required prior to surgery. In general you should be healthy and fit to have the procedure. If you gain weight after the operation, your breasts may enlarge slightly, but not to their former, pre-operative size. Exercise will be easier after the operation.

It is advisable to stop smoking at least two weeks prior to surgery and not to smoke till all wounds have healed. It is well known that there is a higher frequency of complications in women who continue to smoke. Best of all stop smoking altogether. Arnica (a homeopathic remedy) started a day or two prior to surgery, and continued for about 10 days afterwards, may help to diminish swelling and bruising.

On the day of surgery, you should be feeling fine and not have flu, a cold or any other illness. If you think you might be anxious the night before surgery, a sedative can be prescribed. It is wise to shower or bath and wash well the morning of surgery.
Prior to the operation, Ms Grob will take photographs for your medical records, and put pen marks on your breasts. These help obtain a symmetrical shape and size during surgery. The new nipple and areolar position will be determined and the amount of breast tissue to be removed decided. It is not possible to guarantee a particular cup size, especially as cup sizes vary amongst different bra manufacturers.

The anaesthetist will also consult with you, prescribe a sedative if necessary and discuss the anaesthetic options. Breast reduction operations are done under general anaesthesia.

What is done during the operation?

The operation takes between two and three hours. Once asleep, you will be cleaned and draped. A mixture of local anaesthetic (which will help with post-operative pain relief) and vasoconstrictor (which diminishes the amount of bleeding during surgery) will then be injected into the breasts. Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Excess breast tissue is excised and the nipples moved to their new position. A drain is often left in each breast and allows the removal of excess blood or fluid and will be removed a day or two after the operation. The wounds are then stitched with dissolving stitches and drains are placed which have to stay for one or two days. Dressings will be applied.

What can be expected after the operation?

As you wake up, you should experience minimal pain. The prescribed analgesics will ease any discomfort. You will be allowed to eat once you are awake. On the first day after surgery, you will be encouraged to get out of bed into a chair and to walk around. A shower on the first day, and daily thereafter also makes for a quick recovery.

You will be discharged from hospital on the first, or second day after surgery. Although you may be up and about in a day or two, your breasts may still ache for a couple of weeks. Sedentary or office workers are usually given two weeks off from work, although this is adjusted for individual needs. If your work is more active you may need up to one month off work. Driving can be resumed two weeks after surgery and athletics and sport 6-8 weeks after the operation. It is advised that you are able to fly short haul 2 weeks after the operation and that you can fly long haul 4-6 weeks post-operatively. You will probably find that you have much less stamina for several weeks after the operation and you should limit your exercises to stretching, bending and walking until your energy level returns. You should avoid lifting or pushing anything heavy for six to eight weeks.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, do not hesitate to call me.

What can go wrong?

In general, breast reduction is associated with a high degree of patient satisfaction and the vast majority of women are very pleased with the result. Nevertheless, as with all surgery, there can be complications. Serious complications are very rare and can include anaesthetic problems, drug reactions, deep venous thrombosis (clots in the leg) which can migrate to the lung and cause a pulmonary embolism. Most complications, however, are minor. More commonly, breast-related problems may occur, e.g.:

  • Bruising, Bleeding, Haematoma, Seroma 
  • Infection and Wound Breakdown
  • Sensory Problems in the Breast
  • Scarring and Dog-ears
  • Size, Shape and Symmetry Problems
  • Skin Nipple or Areolar Loss
  • Fat Necrosis
  • Breast Feeding Problems
  1. Bruising, Bleeding, Haematoma and Seroma, Bruising of the breast is the norm and can be expected to last for 2-3 weeks after operation.  Occasionally, after the operation, a vessel may start to bleed in the operated breast. This can result in a collection of blood (haematoma). The commonest time for this to occur is early after the operation and if the amount of blood is excessive, a small operation will be required to control the bleeding. Seroma refers to the accumulation of serous fluid (a pale straw coloured fluid) that leaks out from damaged capillaries and lymph vessels. Sometimes a seroma requires repeated drainage with a needle and syringe. This is usually relatively painless and is done in the outpatient rooms.
  2. Infection and Wound Breakdown Infection is not uncommon with breast reduction and can result in swelling, redness and tenderness at any time up to three weeks after surgery. This usually responds well to a course of antibiotics. Occasionally however, it can result in some opening of the wounds, esp. at the bottom of the breast (at the T-junction of the anchor scar). This wound breakdown is usually managed by regular wound dressings and heals in about four to six weeks.
  3. Sensory Problems, Almost all patients experience early sensory problems, usually diminished sensation and sometimes heightened sensation. By 6 months after the operation, 80% of patients have regained most sensation and usually one can expect an improvement for 2 years after the operation. Some patients have a permanent, either complete or partial, sensory loss. There is no treatment available for sensory loss, but fortunately it is a rare occurrence. Most women are happy to exchange some sensation for smaller, more comfortable breasts.
  4. Scarring and Dog-ears, All patients will have scars and these must be expected after the operation. In the majority of patients by one year after surgery the scars settle down to thin lines, which are soft and not very noticeable. If you have other scars on your body from previous surgery or trauma, these may give an indication as to the quality of scar you can expect. To minimise scarring, you will be expected to support the scars with tape for about 6 months after the operation. You will be advised as to how to do this. Massage and sun avoidance also help. Occasionally scars may become abnormally large or even form a keloid, which may require further treatment. Dog-ears are small folds of skin that occur at either end of the scar, caused by a natural folding of the skin when the wound is closed. Great care is taken during the operation to avoid producing dog-ears, but sometimes they cannot be avoided. Small dog-ears seen in the early postoperative period will eventually settle on their own in the first 6-9 months after surgery. If they do not settle after this time, they can be simply excised in a small operation under local anaesthetic) to correct them.
  5. Size, Shape and Symmetry Problems, Every attempt will be made to make the breasts symmetrical. Tissue removed from breast is weighed separately and the weights are compared. It must be understood, however, that no patient is exactly symmetrical to start with. By making the breasts smaller, asymmetries can become more obvious. Additionally, the two breasts may heal differently and this can cause asymmetry. It is also not always possible to achieve proper alignment of the nipples. If this happens you will be advised to wait for about nine to twelve months for all scarring and swelling to settle completely before reassessing the final outcome. Minor asymmetries of breast volume can be then corrected by a small liposuction procedure or minor asymmetries of nipple position can be rectified by relocating the nipple under local anaesthesia.
  6. Skin, Nipple or Areolar Loss, During a breast reduction the nipple-areolar complex is moved with a block of breast tissue that preserves a blood vessel and nerve. If this blood vessel becomes kinked or damaged, the blood supply to the nipple-areolar complex will fail and part or all of it will die. If this happens, then that tissue will become darker and eventually blister and disappear. Fortunately, this is a very rare occurrence (less than 1 %). Should nipple-areolar loss occur, reconstructive procedures can be done. Skin loss, especially underneath the breast may be associated with infection. Small skin losses often heal very well with dressings, although this can take some time. Occasionally a small operation or even a skin graft is required to treat the problem.
  7. Fat Necrosis, If the blood supply to part of the breast tissue within the breast is compromised during the operation, a piece of that tissue may die. This usually becomes apparent about two to four weeks after the operation. Although this does not cause major problems, it can show up as a firm lump in the breast. This lump of dead fat is called fat necrosis and does not usually require any treatment. It often settles on its own over the following few months. Sometimes it may discharge old liquid fat and fluid through a small hole in the scar on the breast and need regular dressing until this heals on its own.
  8. Breast Feeding Problems, Although most women have the ability to breast-feed subsequent children, often the amount of milk produced is reduced and the child requires supplementary bottle-feeding.
  9. General surgical complications General surgical complications such as deep vein thrombosis. This is a rare but serious complication of surgery and anaesthesia, where a blot clot forms in the veins, usually the legs and may migrate to the lungs interfering with their normal function resulting in possible life threatening consequences.
  10. Anaesthetic Complications, Problems with anaesthesia, drugs, etc.: These should be rare and the risks will be explained to you by your anaesthetist.

How satisfied can one expect to be with the procedure?

Because this is a common plastic surgery procedure, the results are predictable. After the operation, you should feel better, you should be able to wear attractive clothes, exercise, and have greater self-esteem and self-confidence.

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy. Although every effort will be made to ensure that your scars are as inconspicuous as possible, it is important to remember that breast reduction scars are extensive and permanent. They may remain red and slightly prominent for months, before fading to thin pale lines.
Breast reduction results in a marked change in your body and your body image. You will look better proportioned, and clothes will fit you better. Often self-esteem and self-confidence improve and patients find that they can now exercise. As a consequence, patients frequently lose weight after the procedure. Studies show that over 97% of women are very happy with the procedure and that if they were in the same situation again, they would opt for the operation. Most complications are minor and resolve without the need for further surgery. Breast reduction patients are amongst the happiest in any Plastic Surgeon's practice.

Checklist

  • Make sure I know all the medications you are taking before surgery.
  • Do not take any Aspirin or blood thinning drugs (which include some homeopathic supplements) for at least 2 weeks prior to surgery. Paracetamol is safe.
  • Oral contraceptives can increase the risk of Deep Vein Thrombosis or Pulmonary Embolism. The contraceptive “pill” should ideally be stopped a month prior to surgery but please use some alternative form of contraception.
  • It is advisable not to smoke six weeks prior to surgery and until complete healing has taken place. Nicotine reduces oxygen levels required for wound healing.
  • Please buy a sports bra and bring this into hospital with you. You will need to wear it day and night for about 6-8 weeks after surgery. You must not wear an underwired bra for at least six weeks after your operation.
  • Please have a shower in the morning of surgery and do not apply deodorant or any other products (e.g. body lotion, perfume etc.)
  • Please do not have anything to eat (including chewing gum) 6 hours prior to surgery. You are able to drink still clear water up to 2 hours prior to your admission.

If you are worried post-operatively

  • Telephone the ward of the hospital from which you have been discharged.
  • Telephone Ms Marion Grob under +44 7881808974
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