Breast Reduction

Procedure time

1.5 to 3 hours

Overnight stay

1 to 2 nights

Anaesthetic

General or local with sedation

Final results

6 – 12 months

A breast reduction, which is also known as a reduction mammoplasty, is a surgical procedure that aims to reduce the size of a woman’s breasts. It is often referred to as a “boob reduction”. It is important to have a good understanding of the surgery before you go in for your operation. This breast reduction overview will provide you with a short introduction.

What can a breast reduction achieve?

You may consider having a breast reduction if your breasts are causing you physical discomfort, or you are unhappy with the size and shape of your breasts. A breast reduction can help:

  • Balance a difference in breast size
  • Achieve a more desirable look
  • Relieve a feeling of unwanted attention.

Many women may choose to have this procedure done if their breasts are causing them unpleasant physical symptoms such as:

  • Neck, back and/or shoulder pain
  • Skin irritation under the breast fold
  • Problems with clothing
  • Skin indentation from bra straps
  • Difficulties and discomfort during exercise.

Your surgeon may also choose to combine your breast reduction with a breast uplift and/or a nipple and areola reduction. This is so that they can achieve an overall more aesthetically pleasing result.

Why have a breast reduction?

Women who are unhappy with the size of their breasts may benefit from having a breast reduction. Although some patients choose to have this procedure done for cosmetic reasons, many also want it done to reduce unpleasant physical symptoms. The ideal breast reduction candidates can therefore include women who experience the following:

  • Physical symptoms such as neck, back or shoulder pain
  • Problems with clothing
  • Indented skin from tight bra straps
  • Discomfort while exercising
  • Skin irritation under the fold of the breast

Women choosing to have a breast reduction for cosmetic purposes may want to do this because of:

  • Breasts that are unequal in size
  • Unwanted attention
  • A desire to change the look of the breasts

Ideal candidates should be physically and emotionally healthy. They should also not be pregnant or nursing. If you have recently had a baby, you should wait 3 to 6 months after you have given birth and stopped nursing before you have your surgery.
Optimising your general health can increase your suitability for a breast reduction. You can achieve this by: doing regular exercise, reducing your alcohol intake, eating a healthy diet and stopping smoking.

What can a breast reduction achieve?

A breast reduction procedure aims to:

  • Reduce the size of the breasts
  • Remove any excess skin
  • Reduce the size of the nipple and/or areola, if necessary
  • Adjust the position of the nipple and areola

In most cases, the breast reduction will also include a breast uplift (mastopexy). Combining these two can create a better aesthetic result. Whether or not your surgeon includes an uplift can depend on the size of the reduction, as it may not be necessary for a small reduction.
Your surgeon will be able to tell you the details of what a breast reduction can achieve during your consultation.

How is a breast reduction performed?

A breast reduction procedure requires your surgeon to make a skin incision before they can remove the excess breast tissue. The choice of which type of skin incision your surgeon will make is separate to the choice of which tissue removal technique they will use. This therefore means that there is a large variety of combinations of these two steps that surgeons can use for the procedure.

How does a breast reduction affect breastfeeding?

As your breast tissue contains ducts and glands that produce milk, removing parts of this tissue will have an impact on your ability to breastfeed. This means that the amount of tissue your surgeon removes and the methods they use to remove it will determine the extent to which you are able to breastfeed after surgery.
The skin incision technique will not greatly affect your ability to breastfeed, but it will represent the final appearance of your scar.

The procedure

When choosing which techniques to use for your breast reduction procedure, your surgeon will consider your:

  • Breast size
  • Breast shape
  • Areola size and position
  • Degree of breast sagging
  • Skin quality and quantity.

Your breast reduction procedure will involve the following steps:

1. Consent form

Before you have your breast reduction, you will need to sign a consent form for the surgery. You will meet your surgeon and anaesthetist to sign the form after they discuss the procedure with you. Normally, you either sign this form on the day of surgery or during your pre-operative assessment.

2. Anaesthesia

Your anaesthetist will give you your anaesthetic. Depending on what you and your surgeon have agreed upon, you will either have a general anaesthetic or a local anaesthetic with IV (intravenous) sedation.

3. Skin incision

Your surgeon will begin by making an incision on the skin. The choice of which incision they will use depends on how much excess skin you have. The types of incisions that your surgeon can make include:

Donut (Circumareolar) 

This incision is made around the full circumference of the areola. It can only remove a small amount of tissue and is therefore most appropriate for very small breasts.

Lollipop (Vertical) 

Surgeons use this incision for small to medium sized breasts.

Anchor (Inverted-T) 

The most common incision used for breast reductions is the inverted-T incision as it is most appropriate for larger breasts.

4. Breast tissue removal

After your surgeon has made the skin incision, he will remove the breast tissue to decrease the size of your breasts. The different breast tissue removal techniques include:

Technique 1: Pedicles

The most common technique that surgeons use are the “pedicle techniques”. These involve leaving a section of breast tissue called a pedicle attached to the nipple and areola. The pedicle contains a blood supply, nerve supply and milk ducts. This therefore allows for better preservation of nipple sensation and a higher chance of being able to breastfeed after the procedure. It is important to keep in mind however, that each technique will affect your ability to breastfeed differently. The two most popular ones are the inferior pedicle and the superior pedicle.

Inferior pedicle

The pedicle is positioned below the areola where there is a large nerve supply. In combination with an anchor skin incision, this method is the most popular surgeons. They often use it for larger reductions.

Superior pedicle 

The pedicle is positioned above the areola. This technique is most often combined with a lollipop skin incision.

Technique 2: Free nipple graft

Another type of tissue removal technique is a “free nipple graft”. This involves the surgeon removing the nipple, removing the underlying breast tissue and then stitching the nipple back on. Surgeons do not commonly use this method as there is poor preservation of nipple sensation and the ability to breastfeed will greatly reduce.

5. Closing of incisions

After your surgeon removes the excess breast tissue, they will close the incision with stitches.

6. Return to the ward

You will go back to the ward to recover after your breast reduction. As this procedure is quite invasive, most patients will need to stay in hospital for one to two nights.
Your breast reduction procedure may also include a breast uplift. Surgeons often combine these two procedures to help achieve a better result.

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