Women with very large, pendulous breasts may experience a variety of medical problems caused by excessive weight–from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman–or teenage girl–feel extremely self-conscious. Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

The Best Candidates For Breast Reduction

Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. In most cases, breast reduction isn’t performed until a woman’s breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.

All Surgery Carries Some Uncertainty and Risk

Breast Reduction is not a simple operation, but it’s normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician’s advice both before and after surgery.

The procedure does leave noticeable, permanent scars, although they’ll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.

Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)

Planning Your Surgery

In your initial consultation, it’s important to discuss your expectations frankly with Dr. Paula Legere, and to listen to her opinion. Every patient — and every physician, as well — has a different view of what is a desirable size and shape of breasts.

Dr. Legere will examine and measure your breasts, and will photograph them for reference during surgery and afterwards. (The photographs may also be used in processing of your insurance coverage.) She will discuss the variables that may affect the procedure — such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they’ll be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.

She will describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The anesthesia used, the facility where the surgery will be performed, and the costs will also be discussed. (Some insurance companies will pay for breast reduction if it’s medically necessary; however they may require that a certain amount of breast tissue be removed. Check your policy, and if your insurance company lists breast reduction as a covered procedure, Dr. Legere’s staff will write a “pre-determination letter” to determine eligibility and benefits).

Preparing For Your Surgery

You may be required to have a mammogram (breast x-ray) before surgery. You will also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

The Surgery

Breast reduction is typically done as an outpatient procedure. The surgery itself usually takes two to four hours, but may take longer in some cases.

Step 1 – Anesthesia

Medications are administered for your comfort during breast reduction surgery using general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Techniques for breast reduction vary, but the most common procedure involves and anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast.

Incision options include:

A circular pattern around the areola

The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.

An keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease

An inverted T or anchor-shaped incision pattern

Step 3 – Removing tissue and repositioning

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) – this will result in a loss of sensation in the nipple and areolar tissue.

Step 4 – Closing the incisions

The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Stiches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast.

Incision lines are permanent, but in most cases will fade and significantly improve over time. Liposuction may be used to remove excess fat from the armpit area.

Step 5 – See the results

The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.

After Your Surgery

After surgery, you’ll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.

You may feel some pain for the first couple of days — especially when you move around or cough — and some discomfort for a week or more. Dr. Legere will prescribe medication to lessen the pain.

The bandages will be removed a day or two after surgery, though you’ll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.

Your first menstruation following surgery may cause your breasts to swell and hurt. you may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, cause 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 may be permanent.

Getting Back To Normal

Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three to four weeks.

Dr. Legere will give you detailed instructions for resuming your normal activities. Most women can return to work (if it’s not too strenuous) and social activities in about two weeks. But you’ll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You’ll also need a good athletic bra for support.

You may be instructed to avoid sex for a week or more, since sexual arousal and cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.

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, don’t hesitate to call your doctor.

Your New Look

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.

Dr. Legere will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You’ll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.

However, as much as you may have desired these changes, you’ll need time to adjust to your new image — as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you’ll be pleased with the results.