Breast reduction surgery: Decrease breast size, ease discomfort

Breast reduction surgery may be the solution to the discomfort caused by excessively large breasts. Find out what the procedure involves and what you can expect from the surgery.

Constant back and neck pain, gouges in your shoulders from bra straps, deteriorating posture and an inability to participate in certain activities rank among the common complaints of women with large breasts. Breast reduction surgery (reduction mammaplasty) may help relieve these symptoms. As technology advances and surgical techniques improve, more women are seeking consultations from plastic surgeons to discuss options for adjusting their breast sizes to a healthier and more comfortable level. According to the American Society of Plastic Surgeons, more than 104,000 breast reduction surgeries were performed in 2006.

If you're considering breast reduction surgery, find out more about who the surgery can benefit and what you can expect from the procedure.

What are the indications for breast reduction surgery?

Breast reduction surgery is for women who have large breasts and want to resolve one or more of the following associated problems:

Chronic back, neck and shoulder pain
Poor posture
Skin rash under the breasts
Deep grooves in the shoulders from bra strap pressure
Restricted levels of activity
Low self-esteem
Difficulty wearing or fitting into certain bras and clothing

You can have breast reduction surgery at any age, but it's generally advisable to wait until you're at least age 20, by which time your breasts are likely to be fully developed. However, sometimes surgery is performed in teens who suffer significant emotional and psychological effects of having too-large breasts.

If you want children, consider postponing breast reduction surgery until you've had them. Changes to breast tissue during pregnancy could alter your surgical results. Also, after the surgery, breast-feeding may be difficult.

What can you expect during the initial consultation with your plastic surgeon?

During your first visit, your plastic surgeon should:

Provide a detailed description of the procedure and its results, including likely scarring
Discuss your expectations for breast size and appearance after the surgery
Examine and measure your breasts
Take photographs of your breasts for insurance preapproval and for reference during and after the surgery
Discuss factors that may affect the surgery, such as your age, the size and shape of your breasts, and your skin condition
Discuss the positioning of the nipple and areola — the circular, pigmented area around your nipple
Explain the type of anesthesia used
Determine where the surgery will be performed — in a hospital or outpatient surgery center
Discuss costs and insurance considerations

The extent of surgery — specifically, how much breast tissue will be removed — depends on many factors, including the breast size you hope to achieve and the guidelines followed by your insurance provider.

Is breast reduction surgery covered by insurance?

It might be. Insurance providers stipulate that the procedure be medically necessary, not cosmetic. To meet the standard of medical necessity, you might be required to have your breasts reduced to a predetermined size shown to provide significant symptom relief. To be sure you're covered, check with your insurance company beforehand.

The cost of breast reduction surgery varies, depending on what your procedure involves and where you have it done, and it can range from $5,000 to $10,000. If your insurance company won't cover these costs, be prepared to pay all expenses out-of-pocket.

How do you prepare for breast reduction surgery?

Your first consultation with a plastic surgeon is a good time to ask questions and find out exactly what breast reduction surgery entails. Make sure you fully understand what you're about to go through, and review the possible complications.

If you've never had a mammogram, you may be required to get one before surgery, depending on your age and family history of breast cancer. If you smoke or use other nicotine products, you'll be asked to stop for a period of time before and after the surgery. Nicotine use impairs blood flow to the tiny vessels that supply the nipple area.

Follow your surgeon's directions in preparing for surgery. This might include restrictions on eating, drinking or taking medications.

How is breast reduction surgery done?

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Breast reduction surgery

Surgeons use different techniques, but the most common one involves an anchor-shaped incision that goes around the areola, down the breast toward the crease between the breast and abdomen, and then horizontally in the crease under the breast. The surgeon removes excess breast tissue, fat and skin to reduce the size of your breast. If amount of tissue to be removed is relatively small, your surgeon may not need to make the horizontal incision.

In most cases, the nipple and areola remain attached to the breast. If the breasts are very large and droopy, however, the surgeon may have to remove the nipple and areola and reattach them at a higher position as a skin graft. In this case, detaching the nipple and areola from their blood vessels and nerves causes them to permanently lose sensation and can result in the inability to breast-feed.

What can you expect during the surgery?

Before surgery, your doctor measures and puts marks on your breasts. Breast reduction surgery usually is performed under general anesthesia that you inhale as a gas or receive through an intravenous (IV) line. It affects your entire body, inducing a temporary state of unconsciousness.

Breast reduction surgery generally lasts two to three hours. After the surgery, you wake up in a recovery room, where your health care team monitors you for any complications.

What can you expect after the surgery?

After surgery, your breasts are covered with a gauze dressing or elastic bandages. A drainage tube may be placed under each arm for one day to several weeks. Medication for pain and nausea as well as antibiotics to decrease your chance of infection will be available for you. You may stay in the hospital overnight, but outpatient surgeries also are common. Make plans for someone to drive you home from the hospital.

During the initial recovery period, your breasts likely will feel very tender and sensitive. They may also be swollen and bruised. Scarring is permanent, but it won't be visible when you're clothed.

You may be able to return to work in two to three weeks if your job doesn't require strenuous activity. It may take up to a month for the pain and sensitivity to disappear. And it may take even longer — six months or more — for your final breast shape to become apparent.

What are the benefits of breast reduction surgery?

Benefits of the surgery include relief of pain in your upper back, neck and shoulders; reduced shoulder pressure from bra straps; increased ability to exercise and participate in physical activities; and a more positive self-image. The surgery may also help you breathe and sleep easier. Most women who have breast reduction surgery are highly satisfied with the results.

What are the risks of breast reduction surgery?

Breast reduction surgery has the same risks as any other type of major surgery — bleeding, infection and an adverse reaction to the anesthesia. Other possible risks specific to breast reduction surgery include:

Loss of sensation in the nipples and areolae
Impaired blood supply to the nipples, leading to loss of the nipples and scarring
Inability to breast-feed
Asymmetry in size, shape, position and contour of the nipples or breasts, which may lead to further surgery to improve appearance
Altered body image and a period of adjustment to get used to the change in your appearance

Understanding what's involved in breast reduction surgery and weighing the benefits and risks of surgery can help you decide if it's right for you.