Breast reduction surgery: The complete guide

Breast reduction surgery, also known as reduction mammaplasty, is a common surgical procedure designed to alleviate the discomfort associated with overly large breasts.

Mr Andreas Shiatis, renowned consultant plastic surgeon, provides answers to common questions about breast reduction surgery, including the consultation process, the procedure itself, and the expected results.

Who is a candidate for breast reduction surgery?

A candidate for breast reduction surgery often experiences physical discomfort or emotional distress caused by overly large breasts. Specific criteria include:

• Chronic persistent pain in the back, neck, and shoulders.
• Skin rashes or irritation under the breast crease.
• Physical activity limitation due to breast size.
• Self-consciousness or psychological distress about breast size.
• Poor posture resulting from the weight of the breasts.
• Shoulder indentations from bra straps.
• Difficulty with finding appropriate bra and clothing selection.

Candidates should be in good overall health, not smoke, and have realistic expectations about the surgery’s outcomes.

What can I expect during the initial consultation?

The initial consultation is a crucial step in the breast reduction journey. During this appointment, the plastic surgeon will discuss your medical history, including any previous surgeries, medical conditions, and current medications. There will be a discussion about your symptoms related to this condition, your family history of breast cancer, in addition to expectations regarding breastfeeding and having children in the near future. A physical examination will be performed to assess your breasts' size, shape, and skin quality.

In addition to these assessments, the surgeon will talk with you about your goals and expectations for the surgery. They will explain the details of the breast reduction procedure, including the techniques used and what to expect during recovery. Potential risks and complications of the surgery will also be discussed.

This consultation provides an opportunity for you to ask any questions or express any concerns you may have. It helps the surgeon determine the best surgical approach for your individual needs and ensures you are fully informed about the procedure.

How is breast reduction performed?

Breast reduction surgery involves the removal of excess breast fat, glandular tissue, and skin to achieve a breast size more proportionate to your body and alleviate discomfort.

The procedure typically begins with the administration of anaesthesia to ensure your comfort during the surgery. The procedure is mainly performed under general anaesthetic.

Pre-operatively, the surgeon will mark various aspects of the normal anatomy on your breasts, including your ideal nipple position, infra-mammary fold, and your breast meridian. Certain measurements will be made to allow them to decide the amount of tissue required to be removed in order to reshape your breast into a youthful, reduced and well-balanced size and shape.

During breast reduction surgery, several incisions are made on the breasts. The pattern of these incisions will vary depending on the technique used and the desired amount of reduction. This step is crucial for providing the surgeon with access to the necessary areas while minimising visible scarring.

Following the incisions, excess breast tissue, fat, and skin are removed to reduce the overall size of the breasts. Often, the tissue removed is routinely sent for histological examination. The nipple and areola are repositioned higher on the chest to achieve a more natural placement. After repositioning, the remaining breast tissue is shaped to achieve a natural contour. This step is essential for ensuring that the breasts look symmetrical and proportionate to the patient’s body.

The incisions are closed with sutures, skin adhesives, or surgical tape, depending on the surgeon’s preference and the specifics of the procedure. Finally, bandages and dressings are applied to support the breasts as they heal, helping to minimise swelling and protect the surgical area from infection.

What techniques are used in breast reduction surgery?

Several techniques are used in breast reduction surgery, each with its own advantages and suitability depending on the individual case. Common techniques include:

• Anchor (inverted T) incision: Involves three incisions: around the areola, vertically down from the areola to the breast crease, and another horizontally along the breast crease.
• Vertical (lollipop) incision: Involves two incisions: one around the areola and another vertically down to the breast crease.
• Circumareolar (doughnut) incision: Involves an incision around the edge of the areola.

The choice of technique depends on factors such as breast size, the amount of tissue to be removed, skin elasticity, and patient preference.

What are the potential risks and complications?

Breast reduction surgery is a safe procedure, but as with every surgery there are small risks that you need to be aware of.

The commonest risks are minor, and these include: infection (which is reduced via the use of prophylactic antibiotics), noticeable scars (which can be avoided by careful pre-operative planning and post-operative care), wound breakdown (which is often managed with regular dressing changes). A transient loss of sensation at the nipple is also common, but this usually improves with time.

A small degree of size and shape discrepancy is to be expected as most breasts are asymmetric to start with, but in certain cases there might be a more obvious discrepancy between the two sides. Very rarely, as the nipple is moved to a new position, there might be a disturbance to its blood supply leading to nipple necrosis. In the hands of an experienced, well-trained surgeon, the risk of this happening is minimal.

As with every general anaesthetic surgery, there are potential risks from the anaesthetic, which includes chest infections and blood clots. 

Surgeons take several steps to minimise these risks. We begin with a thorough pre-surgical evaluation to assess your health and suitability for the procedure. During the surgery, we use sterile techniques to prevent infection and employ precise surgical methods to minimise tissue damage. After the surgery, detailed post-operative care instructions are provided to promote healing.

What is the recovery process?

Most bilateral breast reductions can be managed as day-case procedures, but for certain patients an overnight stay might be a better option.

Following surgery, you will have to wear a post-surgical bra for a period of 6 weeks. This bra has no underwire and clips at the front for comfort. 

We advise that patients take approximately 1 week off work. During this week, you will likely require some painkillers to keep you comfortable and might require some assistance at home. Total recovery from surgery is approximately 6 weeks. We recommend no heavy exercise or lifting during this time.

When will I see the final results of my breast reduction?

The final results of breast reduction surgery will not be immediately apparent due to post-surgical swelling and bruising.

Initially, you will notice a difference in breast size and shape immediately after surgery, but swelling and bruising will obscure the final outcome. Over the span of 12 months, the breasts will settle into their ultimate position and shape as scars progressively fade and soften.

It's important to follow your surgeon’s post-operative care instructions and attend all follow-up appointments to ensure optimal healing and results and to address any complications promptly.

To schedule an appointment with Mr Andreas Shiatis, head on over to his Top Doctors profile today.