We had an extensive discussion about breast reduction surgery, medically known as reduction mammoplasty. This procedure addresses overly large breasts that can cause physical discomfort, pain, and aesthetic concerns. Breast reduction removes excess breast tissue, fat, and skin to create smaller, lighter, and more proportionate breasts that are lifted to a more youthful position.
Medical and Quality of Life Benefits
Large, heavy breasts can create a wide range of day-to-day problems. We reviewed the most common ones:
- Chronic neck, shoulder, and back pain
- Shoulder grooving from bra straps bearing excessive weight
- Skin irritation or rashes beneath the breasts
- Difficulty finding properly fitting clothing
- Limitations in physical activity and exercise
- Postural problems
- Self-consciousness about appearance
Breast reduction surgery often provides dramatic relief. Many patients describe it as one of the most life-changing procedures they undergo.
The Breast Reduction Procedure
Breast reduction involves removing excess breast tissue, fat, and skin, then reshaping the remaining tissue and repositioning the nipple-areola complex to a higher, more aesthetic position on the breast mound. The result is a smaller breast that is lighter, lifted, and more proportional to your body.
Incision Patterns
Several incision patterns may be used depending on the amount of tissue to be removed, breast shape, skin quality, and your anatomy. I outlined your planned incision pattern on the anatomical diagram. The most common patterns include:
- Anchor (Inverted-T) Pattern: A circular incision around the areola, a vertical incision from the areola down to the breast crease, and a horizontal incision along the inframammary fold. This allows maximum tissue removal and the strongest lift and reshaping. It is often used for moderate to large reductions.
- Vertical (Lollipop) Pattern: A circular incision around the areola and a vertical incision down to the breast crease, without the horizontal component. This can work well for moderate reductions with good skin quality.
- Periareolar (Donut) Pattern: A circular incision around the areola only. This is used for very modest reductions and is less common.
The best technique depends on how much tissue needs to be removed, the degree of sagging, skin quality, and the desired final size and shape.
Tissue Removal and Reshaping
During the procedure, several key steps occur:
- Tissue removal: Excess breast tissue, fat, and skin are removed while preserving blood supply to the nipple-areola complex and maintaining a natural breast shape.
- Nipple-areola repositioning: The nipple and areola are moved to a higher, more youthful position. In most cases, they remain attached to underlying tissue on a pedicle, which helps preserve blood supply, nerve connections, and potential breastfeeding ability.
- Free nipple graft in very large reductions: In rare cases where removal is extremely large, the nipple-areola may need to be removed and transplanted as a free graft. This affects nipple sensation and eliminates breastfeeding potential.
- Breast reshaping: The remaining tissue is sculpted to create a smaller, lifted, and aesthetically pleasing contour.
- Symmetry: We work toward the most symmetric result possible, though perfect symmetry is not realistic because most women have natural baseline differences.
Liposuction as an Adjunct
In some cases, I may use liposuction to remove excess fat from the sides of the breasts or the axillary (armpit) area to improve overall contour and reduce lateral bulk. This is performed using the same power-assisted liposuction approach discussed in other body contouring procedures.
Liposuction is used to refine shape, not replace surgical reduction of breast tissue when a meaningful reduction is required.
Nipple Sensation and Breastfeeding
Nipple Sensation
Changes in nipple sensation are common after breast reduction. Some patients experience increased sensitivity, while others experience decreased sensation or numbness. When the nipple-areola is preserved on a pedicle, sensation usually improves gradually over months to years, though it may not fully return to pre-surgical levels. If a free nipple graft is required, permanent loss of sensation is expected.
Breastfeeding
The ability to breastfeed may be affected:
- If the nipple-areola remains attached on a pedicle, some breastfeeding capability may be preserved, but milk production is often reduced.
- If a free nipple graft is required, breastfeeding will not be possible.
If future breastfeeding is important to you, we should factor that into your timing and surgical planning.
Breast Augmentation for Superior Fullness After Reduction
Some patients are very happy with their smaller, lifted breasts but later want more fullness in the upper portion of the breast. Because reduction removes tissue throughout the breast, including the upper area, this is not uncommon.
If you want more upper breast fullness in the future, breast augmentation with implants can be done as a separate procedure. This is typically delayed 6–12 months after reduction to allow full healing and settling.
Why Staging Matters
- The breasts need time to heal and settle into their final shape.
- Swelling must resolve so final volume can be accurately assessed.
- Tissue blood supply and strength must recover before another procedure.
- Staging reduces surgical stress and increases safety.
This decision does not need to be made now and can be reassessed once you have lived with your reduced breasts for several months.
Scars and Their Appearance
Breast reduction results in permanent scars. The scar pattern depends on the technique used:
- Anchor pattern: scars around the areola, vertically down the breast, and along the breast crease
- Vertical pattern: scars around the areola and vertically down the breast
- Periareolar pattern: scar only around the areola
Scars usually fade over 12–24 months, evolving from red or pink to lighter, flatter lines. Scar quality varies by genetics and skin type. I use meticulous closure techniques to optimize healing, but scars will always exist. Most patients feel the physical relief and improved shape far outweigh scar concerns.
Recovery From Breast Reduction
Surgical drains may be placed in select cases, though I typically do not use them. You will wear a surgical support bra continuously for about six weeks to reduce swelling and support healing tissues.
- Most patients take 2–3 weeks off work.
- Sedentary jobs may allow an earlier return.
- Physically demanding jobs may require additional time.
- Avoid heavy lifting, strenuous exercise, and overhead reaching for at least six weeks.
- Bruising and swelling are expected and usually resolve within 2–3 weeks, though mild swelling can last for months.
Final breast shape and position typically become clear between 6 and 12 months as swelling fully resolves and scars mature.
Setting Realistic Expectations
Breast reduction provides a meaningful improvement in size, shape, posture, and symptoms. It is important to understand:
- Scars are permanent and substantial, though they fade and soften with time.
- Perfect symmetry is not achievable, and some natural imbalance may remain.
- Nipple sensation may change temporarily or permanently.
- Breastfeeding may be reduced or not possible depending on technique.
- Breasts will continue to age and change with gravity, hormones, pregnancy, and weight shifts.
- Weight stability matters. Gain can increase size again, loss can cause deflation.
- Some patients need minor revision to refine shape or scars.
Potential Complications and Risks
Risks include:
- Unfavorable scarring, including thick, wide, or raised scars
- Changes in nipple or breast sensation
- Asymmetry in breast size, shape, or nipple position
- Partial or complete nipple-areola loss from blood supply compromise (rare)
- Difficulty or inability to breastfeed
- Fat necrosis causing firm lumps
- Wound healing problems such as separation or delayed healing
- Infection
- Hematoma or seroma requiring drainage
- Blood clots such as deep vein thrombosis or pulmonary embolism
- Contour irregularities or dissatisfaction with appearance
- Need for revision surgery
I take multiple precautions to minimize these risks, including preserving blood supply to the nipple-areola complex, careful bleeding control, and close post-operative monitoring. Following all instructions before and after surgery significantly reduces complication rates.
Insurance Coverage
Breast reduction may be covered by insurance when considered medically necessary, based on symptoms and tissue removal requirements. However, I do not participate with insurance. If I believe your reduction might qualify for coverage, I can help refer you to a surgeon who does accept insurance.
Making the Decision
Breast reduction is a significant decision. We discussed your specific symptoms, anatomy, and goals. Please take time to consider everything we reviewed. If you decide to move forward, my goal is to achieve a result that is safe, proportional, lifted, and strongly improves your comfort and confidence.
Photos were obtained, a quote was given, and the patient will return in a week for follow-up discussion if needed.
