Breast reduction surgery: everything you need to know

Breast reduction is a popular surgery chosen by many women who feel that reducing the size of their breasts will ultimately improve their quality of life. Esteemed consultant plastic surgeon Mr Adam Sierakowski explains everything you need to know about the procedure.

What is breast reduction surgery, and how is it done?

Breast reduction surgery is an operation performed primarily to reduce the size and weight of the breasts. At the same time, the breasts are lifted and the areolae are made smaller.

Women usually choose to undergo this surgery if they feel that their breasts are too large. They often face problems such as neck pain, back ache and their bra straps digging into the shoulders, as well as having difficulties finding clothes that fit, a rash in the lower breast fold and feeling self-conscious. Most women undergo breast reduction surgery with the hope of reducing their breasts to a size which suits their frame, and to achieve a lifted, more pert breast.

The surgery usually involves removing excess breast tissue from around the nipple/areola which is then maintained on a stalk, called a pedicle. The nipple is lifted into a new position and the skin is stitched around it in order to produce an anchor-shaped scar.

For patients with exceptionally large breasts, the nipples may be transferred as skin grafts (free nipple graft) because use of a pedicle may cause risks to their blood supply. The surgery is performed under general anaesthesia and takes about 3 hours.    

Who is a good candidate for breast reduction, and how do I know if I need it?

If you suffer from any of the problems mentioned above and feel that you would like to have smaller breasts, breast reduction surgery may be a good option for you. It is important that you do not smoke as smoking can seriously affect the blood supply to the nipple and cause wound healing problems.

What are the risks and potential complications of breast reduction surgery?

Like all operations, breast reduction surgery carries risks. First and foremost, it will result in scars; a scar all the way around the areola, a scar vertically down from the bottom of the areola to the lower breast crease, and a scar along the lower breast crease i.e., an anchor-shape scar on each breast.

These scars usually fade between 6 months to a year following the surgery, but sometimes can become stretched or excessively lumpy. It is normal to have some pain, bruising and swelling after the surgery. Usually only simple pain killers are required, and the symptoms soon ease.

Additionally, as with any surgery, breast reduction carries a risk of bleeding and infection. There is a risk of wound healing problems (especially at scar T junctions), which may require the prolonged use of dressings. In rare situations, the blood supply to the nipple may be compromised, leading to partial or complete loss of the nipple.

Nipple sensation may also change following surgery, in the form of numbness, itching, reduced sensitivity or increased sensitivity. Rarely, an area of fat or breast tissue may lose its blood supply after the surgery and die, referred to as fat necrosis. The dead fat can form a firm lump, or liquify and discharge through a wound.

As time goes by, the effects of ageing, gravity, pregnancy, weight change and menopause can all affect the overall appearance of your breasts, usually by causing them to sag. Some patients may wish to undergo more surgery in the future to fix this.

How long is the recovery time after breast reduction, and when can I resume normal activities?

This surgery takes place under general anaesthetic and takes about 3 hours. Patients usually stay in hospital overnight.

You will need to wear a compression bra continuously for 6 weeks after your surgery and you should any gym exercises, strenuous activity and heavy lifting for at least 6 weeks following surgery.

Time off work depends on how physical your job is. Normally it is around one to two weeks for an office job and around four weeks for a more physical job. Most people go back to driving after two weeks.

Will breast reduction surgery affect my ability to breastfeed or perform mammograms in the future?

It’s difficult to predict how breast reduction surgery will affect your ability to breast feed. The result can vary from not being able to breast feed at all, only being able to produce small amounts of milk, or being able to breast feed normally. The one situation where you should definitely not expect to be able to breast feed afterwards is if you have had a free nipple graft.

Breast reduction surgery does not affect your ability to have mammograms in the future. For patients over the age of 40, I recommend a pre-operative mammogram is performed to check for any underlying breast disease and also to provide a baseline for future mammograms performed as part of the national breast screening program.  

If you are considering breast reduction surgery and would like to book a consultation with Mr Sierakowski, do not hesitate to visit his Top Doctors profile today.