Breast reduction

Page last reviewed: 13/07/2011

Female breast reduction, also known as reduction mammoplasty, is a surgical operation to reduce the weight and volume of the breasts. During the procedure, fat, glandular tissue and skin are removed from the breasts, which are then reshaped and the nipples repositioned.

Breast size is determined by genes, hormones, body frame and weight. For most women, breast size is proportionate to the body, but for some, the breasts are particularly large.

Large breasts can cause physical symptoms such as:

  • discomfort
  • backache
  • neck pain
  • skin irritations

Large breasts can also cause psychological distress. Common complaints from women with large breasts include not being able to wear fashionable clothes and finding it difficult to take part in active sports.

Breasts are particularly sensitive to the hormone oestrogen. They can grow particularly large during adolescence or later in life following the menopause or because of the use of hormone replacement therapy (HRT). Some women also develop a noticeable asymmetry (difference in size or shape) between their breasts.

Breast reduction surgery can help women who are unhappy with the shape, weight or droop of their breasts by making them smaller and more lifted. However, breast size alters with body weight, so even after surgery, your breasts may increase in size if you put on weight or become pregnant.

Glossary

Genes

Genes contain information that you inherit from your parents, such as eye or hair colour. They are carried by chromosomes.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Hormone replacement therapy

Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts to replace those that the body no longer produces.

Psychiatrist

Psychiatrists are doctors who treat mental and emotional health conditions, using talking and listening methods.

Obesity

Obesity is when a person has an abnormally high amount of body fat.

Steroids

Steroids are types of chemicals found naturally in the body. They are also produced artificially to treat diseases.

Page last reviewed: 13/07/2011

You may consider having a breast reduction operation if you have physical discomfort or psychological distress due to having large breasts.

Physical problems may be:

  • backache
  • neck pain
  • shoulder ache
  • skin irritation
  • poor posture
  • excessive sweating, rashes and skin infections under the breasts
  • grooves on the shoulders from bra straps
  • an inability to exercise or take part in sports

Psychological distress can be:

  • unwanted attention
  • self-consciousness
  • difficulty finding clothes that fit
  • depression

For both women and men, breasts can become large due to fatty deposits within them. Losing weight by eating a healthy diet and doing regular exercise may help reduce the size of your breasts without the need for surgery.

Glossary

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Ache
An ache is a constant dull pain in a part of the body.
Depression
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.

Page last reviewed: 13/07/2011

Breast reduction should only be considered by women who have taken medical advice from a qualified surgeon.

Many patients gain a better quality of life following a breast reduction as symptoms, such as back pain, are often dramatically reduced. However, any kind of surgery, including breast reduction, should not be undertaken lightly. You may feel it will improve your appearance and quality of life but it can be expensive and time consuming and, as with any form of surgery, there are a number of risks.

The decision to have a breast reduction should only be taken after a lot of careful thought and questioning.

Do your research

If you feel that you will benefit from a breast reduction, it is important that you are as well informed as possible.

Talk to your GP to get information and general advice on the procedure, and look into the surgeons, hospitals and clinics that perform breast reductions.

Your GP should refer you to an appropriate surgeon who can discuss your problems, examine you and advise you about the options available, along with their advantages and disadvantages.

Do not be nervous about asking for information from your GP or a surgeon. The Department of Health has a checklist of questions about cosmetic surgery that can help you get all the details you need to make an informed decision on whether surgery is right for you, available at: http://www.dohc.ie/press/releases/2010/20101118.html

Choosing a surgeon

Surgeons who are trained in general surgery should have FRCSI (Fellow of the Royal College of Surgeons) after their name. .

Doctors who are also considered to be suitably trained are listed on the specialist register kept by the General Medical Council (GMC). You can find out if a doctor is on the specialist register by going online at http://www.medicalcouncil.ie/Registration/Search-for-a-doctor/

Before choosing a surgeon, find out about their experience of doing breast reductions and make sure you meet them before committing to surgery.

When you find a surgeon, be honest and clear about your expectations of the procedure and find out if a breast reduction can really give you the results you want. A surgeon should provide full details of the procedure before you decide to go ahead with it. Expect the consultation to take half an hour or longer.

Expected results

It is important to discuss the results you expect from surgery with your surgeon. Sometimes, a very radical reduction will alter the shape and look of the breasts. There will be scarring and sometimes also a loss of nipple function and sensitivity.

For women with very large breasts, the benefits of a reduction may outweigh any potential imperfections. For women with only moderately large breasts, the benefits may not be worth the potential risks and side effects.

Your breasts can still change in size and shape after surgery. They should not regrow, unless the operation is done at an age when your breasts are still growing, but they can increase in size if you put on weight or become pregnant. They can also decrease in size if you lose weight. Normal breasts also have a tendency to droop over time.

You will be asked to sign an agreement form before having your breast reduction procedure. Make sure you understand and are happy with the agreement before you sign.

The agreement should include details of cost. Make sure you understand what this covers, especially in terms of aftercare and any revision surgery (surgery to treat any complications or problems) that may be needed. There may also be financial penalties if you decide to cancel the agreement.

Your records

The provider of your procedure, a private clinic or hospital, will keep a record of your treatment that may contain before and after photographs of you. Think about whether you would mind the provider showing these to other potential patients. The provider should ask for your consent before showing any part of your records to other patients.

Surgery abroad

Cosmetic surgery, such as breast reduction, may be cheaper abroad than it is in Ireland. However, this needs to be weighed up against the cost of travel and accommodation and any follow-up or revision surgery that may be needed.

Glossary

Blood test
During a blood test, a sample of blood is taken from a vein using a needle so it can be examined in a laboratory.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Psychiatrist
Psychiatrists are doctors who treat mental and emotional health conditions, using talking and listening methods.

The cosmetic surgery checklist

1. Think about the CHANGE you want to see. Find out about the treatment you want and be precise as to the change you hope to see and why.

2. CHECK OUT potential surgeons. Make sure you find a surgeon with the right qualifications who is on the specialist register with the GMC and has experience of doing the procedure you want. Make sure you meet them before committing to surgery.

3. Have a thorough CONSULTATION. Your surgeon should discuss your treatment options with you and then plan your treatment. Make sure you know the risks involved with the procedure and the likely results.

4. COOL OFF before you commit. You need to be confident in your decision to have cosmetic surgery. After an initial consultation with a surgeon, take some time to think about whether the procedure is right for you and if you are happy with the surgeon who will be treating you.

5. CARE about your aftercare. Aftercare can be just as important as your actual surgery, so make sure you know how you will be looked after, especially if there are any complications following surgery.

Page last reviewed: 13/07/2011

Before the operation

You will be asked to undergo some general health tests before your operation to check that you are fit to have surgery.

If you smoke, you may be asked to quit in the weeks before your operation. This is because smoking increases your risk of chest and wound infections and can slow the healing of your wounds, leaving you with worse scarring. Being overweight can also slow the healing process, so if you are overweight you will be encouraged to lose weight before your operation.

If you take the oral contraceptive pill or hormone replacement therapy (HRT), your surgeon may advise you to stop taking it a few weeks before your operation because they can increase your risk of developing deep vein thrombosis (a blood clot in a leg vein). Also avoid aspirin and anti-inflammatory drugs.

Before your operation, you will be asked to sign a consent form. This is to confirm that you understand the risks, benefits and possible alternatives to the operation.

The operation

Breast reduction surgery is usually done under general anaesthetic (when you are asleep). You will be asked to follow fasting instructions before your operation. Typically, you cannot eat or drink for six hours before having the anaesthetic.

Surgery takes between one-and-a-half and three hours. You are usually required to stay in hospital for one or two nights. The aim of surgery is to create a natural shape and retain as much function and sensation in the nipples as possible.

The surgeon will use a pen to mark areas of the skin where the incisions (surgical cuts) will be made. With your permission, the surgeon may also photograph your breasts for confidential before and after images for your records.

Most breast reduction surgery begins with the nipple, which is moved to its new position, usually while still attached to the blood supply. If you have extremely large breasts, the nipples may be removed and repositioned as a skin graft. They will develop their own blood supply.

Excess skin and breast tissue are then removed. The remaining breast tissue is reshaped to create smaller and more elevated breasts.

Breast reduction techniques

There are various different ways to do a breast reduction. Your surgeon will decide which is most appropriate for you depending on the size of your breasts and the desired outcome. Techniques include:

  • Anchor type or inverted T reduction: the most common type of breast reduction, this results in an anchor-shaped scar starting around the nipple, travelling vertically down and then horizontally across the breast crease.
  • Vertical pattern breast reduction: this results in a circular scar around the areola, the brownish or pink ring of tissue surrounding the nipple, and a vertical scar passing downwards. This technique has the advantage of leaving no scarring under the breast but is not appropriate when dealing with large breasts and may take longer to heal.
  • Circumareolar reduction: this only results in a circular scar around the areola. This technique is only suitable when removing a small amount of tissue.

Glossary

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Incision
An incision is a cut made in the body with a surgical instrument during an operation.
Vein
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
HRT
Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts, to replace those that the body no longer produces.

Page last reviewed: 13/07/2011

After surgery

When you wake up after having breast reduction surgery, your breasts will be bandaged and plastic tubes may be attached to your breasts to drain blood away. Some patients bleed a lot and, in rare cases, a blood transfusion may be required to replace lost blood.

After one to two days, any tubes will be removed and you should be able to go home. You may experience some pain for a few days, which can be relieved with painkillers.

Getting back to normal

Once you have returned home, depending on your age and general fitness, you will need to rest for two to six weeks. The length of time you need to keep the dressings on will depend on how quickly your wounds heal. After one to two weeks, your stitches will either dissolve or be removed at an outpatient clinic.

At your follow-up appointment, your surgeon will advise you when you can resume your normal activities and return to work. You may need to take two to four weeks off, depending on what your work involves.

Avoid stretching, strenuous exercise and heavy lifting for up to six weeks after your operation. You also need to keep your breasts supported by wearing a well-fitting, wireless sports bra.

Results

It is likely that your breasts will be swollen and feel tender and lumpy after surgery. The final appearance of your breasts may not be obvious for several weeks.

Scars are usually quite red for the first six weeks after surgery. They then change to a purple colour over the next three months before fading to white. Most scars heal well but occasionally patients are left with red and lumpy scars that do not improve in appearance.

Glossary

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Blood transfusion
A blood transfusion involves transferring blood into a person using a tube that goes directly into a vein in the arm.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Painkillers
Analgesics are medicines that relieve pain. Examples include paracetamol, aspirin and ibuprofen.

Page last reviewed: 13/07/2011

The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot. Complications specific to breast reduction surgery are described below.

Scarring

The main disadvantage of having breast reduction surgery is that you will be left with permanent scarring. The operation, when done using the anchor technique, leaves three scars:

  • one around the nipple (areola)
  • one from the nipple to the crease below the breast (this is the worst scar as it takes the most tension)
  • one from the breast bone to the armpit along the crease below the breast

The severity of scarring largely depends on the individual. Some women are left with red and raised scars but most scars fade over time and should be invisible under normal clothing and most bras or bikini tops.

Uneven shape

Your breasts will change shape after reduction surgery. There is a chance that they may end up slightly lopsided, lumpy or with uneven nipples.

Wound healing problems

Wound healing problems after breast reduction surgery are common, particularly after the anchor scar procedure where the vertical and horizontal scars meet.

Most wound problems are minor and can be simply managed and treated. More severe wound complications, such as infection, skin loss, wound separation and delayed healing, can be harder to manage.

Occasionally, some fat in the breasts dies off, leaving them red and lumpy. This can take some time to settle and lead to a lot of discomfort. There can also be some excess skin left around the scars and, if this does not drop off after a few months, it will need to be surgically removed.

If you smoke or have diabetes, you may have poor circulation which will affect how quickly your wounds heal.

Loss of nipple sensation 

Some women lose sensation in their nipples after a breast reduction, including their ability to become erect. This is because the nerve supply to the nipple can be damaged during surgery.

Very rarely, a disrupted blood supply may cause your nipple to die and fall off. This is more likely if you are a heavy smoker or you have poor circulation.

Depending on the type of breast reduction you have, if your nipples have been separated from the milk ducts during the operation, you may be unable to breastfeed after the operation.

Infection

Any kind of surgical procedure carries a potential risk of infection. In the case of breast reduction surgery, there is a chance of infection from germs in the ducts of the breasts. This can be treated with antibiotics and sometimes further surgery. If you do get an infection after your surgery, this will delay the healing process.

Haematoma

If the tubes attached to your breasts do not remove all of the blood after the operation, blood may begin to collect under your breasts, causing them to become very painful. This is called a haematoma. If this happens, you may need to have another operation to drain the blood and stop the bleeding.

Glossary

Discharge
Discharge is when a liquid such as pus oozes from a part of your body.
Haematoma
Haematoma is a collection of blood in the tissues from a leaking blood vessel, which causes bruising.
Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local) or to put a patient to sleep (general) during surgery.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
HRT
Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts to replace those that the body no longer produces.

Page last reviewed: 13/07/2011

Causes of male breast enlargement

Enlargement of male breasts is known as gynecomastia. Large breasts in men are often believed to be a result of obesity, but this is not the only cause. Men, like women, can have an abnormal growth of glandular breast tissue, usually due to a hormone imbalance.

Other causes of enlarged male breasts include:

  • excessive alcohol intake
  • use of certain drugs, particularly anabolic steroids
  • certain diseases, such as liver failure and cancer
  • congenital abnormality (a problem from birth)
  • dramatic weight loss, which can cause the skin to sag

For men who feel self-conscious about their appearance, breast reduction surgery may be considered to flatten the breast area.

Before surgery

When breast enlargement is due to obesity, poor health or excessive alcohol intake, breast size may be reduced through healthy eating and regular exercise. Consult your doctor and consider all your options before choosing to have breast reduction surgery.

Procedure

Male breast reduction surgery usually takes an average of one hour. The surgeon will make an incision around the areola and liposuction may be used to suck out excess fatty tissue. If there is a lot of tissue to remove, cuts may extend down the chest from the areola and the nipples may need to be repositioned.

You will be required to stay in hospital overnight, take a few days off work to rest and avoid lifting or strenuous physical exercise for one month after the operation. An elastic garment also needs to be worn for one to four weeks after the operation to encourage smooth results.

Results

Male breast reductions are usually required to reduce the size of the breast area and give a flattened shape.

Results are permanent but weight gain, hormonal imbalances and the use of certain drugs can cause the breast area to enlarge again.

Risks

Surgery can leave red and lumpy scars. These may last for several months but should eventually fade to your natural skin colour. Other risks include uneven results and loss of sensation in the nipples.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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