Breast Reduction

What is a breast reduction?

A breast reduction (reduction mammoplasty) is a procedure that decreases the size of your breasts. People with disproportionately large breasts can experience pain in their back, neck or shoulders and other physical symptoms. Breast size can also have an impact on your self-esteem and sense of well-being. In breast reduction surgery, your surgeon removes breast fat, tissue and skin to achieve a breast size that’s more comfortable for you.

You may be a candidate for breast reduction whether you were assigned female at birth (AFAB) or assigned male at birth (AMAB). People who were AMAB with conditions like gynecomastia (a condition where male breasts are abnormally enlarged) may seek breast reduction.

What happens during a breast reduction consultation?

Before getting breast reduction surgery, you’ll go in for a preoperative consultation. During this time your surgeon will take a detailed medical history, including asking you what medications you are taking, what allergies you may have, your smoking history and any prior surgeries. Your surgeon will also need specific information regarding pregnancy and lactation, mammograms, personal or family history of any breast problems, and any history of breast lumps or biopsies. You should be in good physical and mental shape to undergo this surgery.

It's important that you are completely honest during this consultation. That includes being completely open about your medical history. It also means being very open about why you're seeking a breast reduction. You should expect to discuss the emotional issues you've dealt with. That is, how you have felt dealing with your breast size. How has it made you feel physically? What types of physical conditions have you experienced?

Your surgeon will measure your breasts. They may take photos. During this time, they’ll discuss how much breast tissue should be removed to achieve the desired results. You’ll also learn about how to prepare for the surgery and how to plan for your recovery. Your surgeon also may prepare you for this procedure by performing a mammogram and breast exam.

How do I prepare for a breast reduction?

It’s important to follow your surgeon's instructions on vitamins you can take before and after the surgery. Likewise, it's very important to eat well-balanced meals. Nicotine (smoking and other tobacco products) interferes with healing — you’ll need to stop using tobacco products for some time before and after surgery to ensure proper healing. Likewise, you also may have to stop taking certain medications, such as aspirin or certain anti-inflammatories like Motrin® or Aleve®. Your surgeon will instruct you on this.

Establishing a home recovery area

Before you go in for surgery, make sure you set up a recovery area at home that will suit all your needs. This should include:

• Pain-relieving medication like acetaminophen (Tylenol®).
• Gauze and clean washcloths and towels.
• Loose, comfortable tee shirts and blouses.
• Surgical bras.
• Antibiotic ointments (only if recommended by your doctor).
• Telephone within reaching distance of your primary rest area.
• Magazines, movies, etc.

Recovery and follow-up care

You’ll need to take at least one week off from work or school. Some people require two weeks, but each situation varies. Your surgeon will instruct you on follow up appointments to remove bandages and sutures. You may not be able to resume your exercise and other strenuous physical activity for at least one month after surgery. Surgery can be both physically and emotionally stressful. Make sure you communicate with your doctor about all your concerns.

How is a breast reduction done?

Depending on your situation, breast reduction surgery can be performed in an outpatient facility, or you may have to stay at least one night in the hospital. In either case, you’ll be given general anesthesia, which means you’ll be put to sleep for the procedure. It's important to have someone with you who can drive you home and stay with you at least the first night if you're not staying in the hospital.

The surgery itself will take about three to five hours. Your surgeon will make an incision around your nipple, then downward on your breast, in a keyhole shape. The excess skin, tissue and fat are removed, and your nipple is relocated and the incisions are closed. Your surgeon may use drainage tubes. Your surgeon then sutures the incision and applies a dressing. If your surgeon feels it’s required, they’ll ask you to wear a surgical bra.

What are the complications and side effects of breast reduction surgery?

You should expect to feel tired and you’ll have some breast pain. It's important to note that after a breast reduction, you’ll have scars along the incisions. These scars are permanent, but they’ll fade with time. Also, depending on the extent of your procedure, you may not be able to breastfeed.

You should avoid lifting heavy objects during the first few weeks to reduce tension on the incision and decrease your risk of bleeding problems. You may also notice loss of feeling or changes in sensation in your nipple as a result of breast reduction. In some cases, the change is permanent. Though they are rare, some people may experience certain complications, such as inadequate healing, which may require a skin graft.

Contact your doctor immediately if you experience

• Fever.
• Unusual discharge from the incision site, including pus. (This could be a sign of an infection).
• Release or detachment of any sutures before they’re supposed to be removed.
• Enlargement on one or both breasts associated with pain and pressure.

Does insurance cover breast reduction?

The good news is yes, in many cases. Because breast reduction can be considered medically necessary, your chances of getting insurance coverage are good. But you must be sure to follow the procedures set forth by your carrier. Your surgeon will need to take photos of your breasts, measure your height and weight, and detail your physical symptoms caused by enlarged breasts in a letter. Finally, your insurance carrier will consider the estimated amount of breast to be removed. Begin communicating early with your carrier and make sure you understand exactly what expenses they’ll cover, such as lab costs, anesthesiologist, etc. This will save you a headache in the long run, when you have more important things to do, like focus on your recovery.

A note from Cleveland Clinic

Breast reduction surgery can feel like having a weight lifted off your chest. It can relieve years of back, shoulder and neck pain, and improve your self-esteem and body image. While the outpatient procedure only takes a few hours, it may be several weeks before you can resume activities that require physical exertion. Be sure to discuss the risks and benefits of breast reduction surgery with your healthcare provider.