Breast reduction for women

Breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size that is in better proportion with your body. It is often performed to relieve the discomfort associated with very large breasts. The procedure is also known as reduction mammoplasty.

Why some women consider breast reduction#

Overly large breasts can cause both physical and emotional problems. Physical symptoms may include back, neck and shoulder pain, and skin irritation beneath the breast crease. The weight of excess breast tissue can also limit a woman’s ability to lead an active life.

Some women feel very self-conscious about having large breasts. If you are worried about the way you look, or are thinking about cosmetic treatment to boost your confidence, there are alternatives. Talking to a counsellor or psychologist may help you work through concerns about your appearance.

Things to consider before surgery#

Some important issues to think about include:

• The procedure is best done when the breasts are fully developed
• Breast and nipple piercings can lead to infection
• Breast reduction surgery can interfere with some diagnostic procedures, such as breast imaging
• Your ability to breastfeed in future may be reduced, so talk to your practitioner if you are planning to breastfeed a baby later
• Pregnancy, or significant weight loss or gain, can alter the outcome of previous breast reduction surgery

Think about the financial cost#

Breast reduction is commonly regarded as a reconstructive procedure, even though it has a cosmetic component. As a result, the surgery may be covered by health insurance when it is performed to relieve medical symptoms. Ask your practitioner about any out-of-pocket costs you can expect and whether you may be eligible for a rebate, and check the terms of your own health cover.

Smokers are at increased risk of complications#

To reduce the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery.

Finding a qualified practitioner#

It is important to have as much information as possible before deciding to have breast reduction surgery. Consider asking another practitioner for a second opinion.

At your first consultation, ask about the practitioner’s training and experience. This surgery should be carried out by a practitioner who is specially trained in breast reduction and who has significant experience with this type of operation. Ask to see the certificates that show they are qualified to perform it, and check that they are registered with the relevant medical regulator in your area.

Your medical status#

If you are considering breast reduction, discuss your current medical status with your practitioner. This includes:

• Your physical health and past medical history, such as illnesses, surgeries and immunizations
• Your current health status, including diet and exercise
• Your mental health, including any mental illness and its treatment
• Medications you take, including vitamins and supplements
• Any allergies and past reactions to medications

From this discussion, your practitioner can assess the risks and possible complications for you, and explain what you should do to help your recovery go as smoothly as possible.

All surgery should be performed in a licensed and accredited facility. A registered anaesthetist should be present to manage any adverse reaction to the anaesthetic. You can ask to see a facility’s certificate of registration, which is usually displayed where consumers can see it.

What happens during surgery#

Breast reduction is usually performed under general anaesthetic. When the reduction is only small, the practitioner may use local anaesthetic with sedation instead. In general, the surgery involves:

• An incision is made around the nipple, continuing in a vertical line down to the breast crease, and sometimes along the crease itself
• In most cases the nipple stays attached to its blood and nerve supply throughout; occasionally a very heavy breast needs a “free nipple graft”, where the nipple is removed and reattached higher on the breast
• Excess skin, fat and glandular tissue is removed, sometimes with the help of liposuction (in some cases liposuction alone can reduce breast size)
• Stitches are placed deep inside the breast tissue to add support, and the skin incisions are then brought together and closed

After surgery#

The results of breast reduction are usually visible straight away. Immediately afterwards you may have:

• A drainage tube in the wound to help prevent fluid building up
• Bruising and swelling
• Possible numbness, pain and discomfort
• Dressings or bandages

Possible complications#

All surgery carries some degree of risk. Possible complications of breast reduction include:

• Breathing difficulties related to the general anaesthetic or breathing tube
• Surgical risks such as bleeding or infection
• Damage to deeper structures such as nerves, blood vessels, muscles or the lungs, which may be temporary or permanent
• Fluid building up around the operation site
• Allergic reaction to suture materials, tape adhesive or other medical materials and lotions
• Skin discolouration, permanent pigmentation changes, swelling and bruising
• Death of fatty tissue deep in the skin (fat necrosis)
• Changes in breast and nipple sensation, including temporary or permanent numbness
• Raised, lumpy or irregular (keloid) scar tissue that may be inflamed and itchy
• Asymmetry (unevenness) of the breasts
• Breastfeeding difficulties, including reduced milk supply
• Partial or total loss of the nipple and areola
• The need for further surgery to treat complications
• Risks of anaesthesia, including allergic reaction or, rarely, serious cardiovascular complications such as heart attack, or a blood clot in the deep veins of the legs (deep vein thrombosis) that can travel to the lungs (pulmonary embolus) or brain and be life threatening

This is not a complete list. Your medical history or lifestyle may put you at increased risk of certain complications, so speak to your practitioner for more information.

Recovery and self-care#

Your practitioner will give you post-operative instructions, such as:

• How to care for your surgical site after surgery
• Medications to apply or take to aid healing and reduce the risk of infection
• Specific signs to watch for at the surgical site or in your general health
• When to follow up

Over time the swelling will settle. It may take around 18 months for the scarring to fade into faint lines. Satisfaction with your new shape should continue to grow as you recover. Your new breast size should help relieve the pain and physical limitations you had before, and a better-proportioned figure may boost your self-confidence.

Long-term outlook#

The results should be permanent. However, your breasts can still change over time due to ageing, weight changes, hormonal factors and gravity.

Alternatives to breast reduction#

Alternatives can include:

• Talking to a counsellor or psychologist to help with concerns about your appearance
• Significant weight loss, if you are overweight
• Professionally fitted bras
• Liposuction

Key points#

• Very large breasts can cause both physical and emotional problems
• Important issues to consider include that the procedure is best done when the breasts are fully developed
• Breast and nipple piercings can cause infection
• Smokers are at increased risk of complications
• It is important to have as much information as possible before deciding to have breast reduction surgery

Where to get help#