Breast reduction is a surgical procedure used to alleviate pain and discomfort for patients with very large breasts. The surgery goal is to reduce the breast tissue and excess skin to create smaller breasts that are proportional to each patient’s body. The most common reasons for surgical intervention are overtly large breasts causing neck, shoulder and back pain, discomfort during daily activities, irritation or even infection under the breasts.
Anchor scar or inverted T technique is the traditional breast reduction technique and it is most commonly performed in the US. With this technique, the scar is around the nipple, vertically from the nipple to the breast fold and along the breast fold. Excess fat, skin, and breast tissue from the breast are removed, mostly from the outer part and inferior part of the breasts. The nipple-areola complexes are often reduced and repositioned to fit the new lifted breast mound. This type of procedure entails more scarring and is ideal for women who have extremely large breasts and droopy nipple. Wound complication is the most common problem encountered after surgery but most often the wound heals with local wound care and additional surgery is not necessary.
Vertical breast reduction, also known as short-scar reduction, is a recently popularized technique involving less scarring on the breasts. The incision extends around the areola then runs down to the breast crease to form a “lollipop” shape. There’s less scarring involved and this technique is great for women who have moderately to very large breasts with normal distance between the nipple and the fold as this technique can lengthen the nipple to fold distance.
In very rare situations where the breasts are extremely large and low hanging, partial mastectomy (amputation of the hanging part of the breasts) with free nipple grafts (excision of the nipple areola complexes and transferring them on to their new positions) may be indicated.
In all above techniques, there is always a possibility of partial to total nipple loss. Fortunately, total necrosis is extremely rare and lack of blood flow to the nipple is often noted during the surgery and either mitigate through releasing tension or conversion to free nipple graft.
Who are Candidates for Breast Reduction?
The best candidates are healthy people with realistic expectations of surgery. Weight stabilization for 6 months or more and BMI below 30 are strongly recommended prior to surgery. Patients should be close or at their ideal weight to minimize any need for revision surgery and reduce peri-operative complications.
How is Breast Reduction performed?
The breast reduction can be performed through vertical (lollipop) incisions or wise pattern (anchor) incisions depending on the amount of excess skin and the location of the nipples. In rare occasion, nipple grafts may be necessary if there are concerns with blood flow to the nipple areola complex.
What is Recovery Like?
Downtime from surgery is between 1-2 weeks. Moderate swelling and minor bruising are expected in the first week. Majority of the swelling will resolve by one month after surgery. Post-operative supportive bra is often recommended for 1 month post-op. Discomfort from swelling and pain along the scar are the major complaints after surgery. There also may be change in nipple sensitivity after the surgery.
Breast reductions patients are often in the child-bearing age and breast feeding after surgery is one of the main concerns. The surgery reduces breast tissue, therefore may have an effect on milk production. However, with the anchor technique (inverted T) and the vertical (lollipop) technique, the major milk ducts and their connections are preserved. Therefore, it is still possible to breast-feed after breast reduction surgery.